Innovative co-management between Neuro-ICU and Neurorehabilitation Unit in patients with severe acquired brain injury: enhancing clinical care pathways.

Abstract

Severe acquired brain injury (sABI) is a major challenge in post-acute care, affecting disability, quality of life, and healthcare resources. Traditional sequential care from acute units to rehabilitation often fails to meet the needs of complex patients. Interdisciplinary co-management between Neuro-ICU and Intensive Neurorehabilitation Unit (INRU) has been proposed to enhance continuity of care and optimize resource utilization. we analyzed 173 patients admitted to the INRU over three semesters: T1 (pre-implementation, n = 64), T2 (transition, n = 50), and T3 (co management, n = 59). The model involved joint management by a neurointensivist and an internal medicine specialist with expertise in neurorehabilitation, including a multidisciplinary assessment of clinical stability and the appropriateness of the rehabilitation pathway. Median age was 68.3 years [IQR 19.8], 60% male, with no differences across semesters. Co-management reduced length of stay (LoS) (68 vs 53 days) and urgent Emergency Department (ED) transfers (29.7 vs 18.6%), while stabilizing MDRO colonization despite higher admission prevalence. Transfers to rehabilitation units increased (23.8 vs 59.3%), long-term care admissions decreased (28.6 vs 13.6%), and mortality dropped from 7.9% to 3.4%. Negative outcomes (urgent ED transfers, long-term care admission and death) decreased from 56% to 25% (p = 0.003). Co-management enhances continuity of care, integrates acute and rehabilitative goals, and improves outcomes in complex patients. Structured interdisciplinary collaboration, coordinated by the internist-rehabilitation specialist, facilitates optimization of care pathways. Limitations include the retrospective, single center design and potential temporal bias. Further prospective and multicenter studies are needed to confirm its clinical and organizational benefits.