Implementation and Outcomes of an Advanced Practice Provider-Led Care Pathway for Toxic Encephalopathy in Neurosurgery

Introduction: This study aims to evaluate the impact of an Advanced Practice Provider-led care pathway on clinical outcomes in patients with toxic encephalopathy, a condition with limited targeted interventions in current neurosurgical research. Existing literature on toxic encephalopathy primarily focuses on its pathophysiology and critical care management, with minimal emphasis on standardized care pathways that incorporate APPs. By demonstrating the effectiveness of an APP-driven approach, this study seeks to fill a gap in neurosurgical practice and provide a replicable model that enhances patient outcomes in complex neurotoxicity cases.

Methods: This retrospective cohort study analyzed 75 adult patients diagnosed with toxic encephalopathy and treated within a large academic neurosurgical unit over two years. Inclusion criteria involved patients presenting with neurotoxic symptoms necessitating neurocritical care, while exclusion criteria included patients with concurrent neurodegenerative disorders. The APP-led care pathway emphasized standardized diagnostic protocols, symptom management strategies, and structured follow-up.

Results: Implementation of the APP-led care pathway for toxic encephalopathy patients yielded significant improvements in clinical and operational outcomes. Analysis revealed a reduction in ICU length of stay, with an average decrease of 1.5 days (pre-intervention mean = 6.2 days; post-intervention mean = 4.7 days; p < 0.01, paired t-test). Hospital readmission rates within 30 days decreased from 22% to 13% post-implementation, a statistically significant improvement (p = 0.04, chi-square test).

Conclusion : The significant reduction in ICU stays, readmission rates, and improved patient-reported outcomes indicate that APP-driven models not only improve patient care but also optimize healthcare resource use—a critical factor in high-acuity settings. This study serves as a foundation for further research on APP-led pathways for other neurocritical conditions and encourages exploration of APP roles in developing care models that address specialized patient needs. Future research could focus on multi-center trials to validate these findings, investigate long-term patient outcomes, and refine pathways for broader application in neurosurgery.