Prospective development of a cost-efficient program for radical retropubic prostatectomy.
OBJECTIVE
We designed and implemented a broad-based program to decrease costs while maintaining quality of care in patients undergoing radical retropubic prostatectomy.


METHODS
This program initially involved identification of factors that contribute to patient costs after radical prostatectomy and elimination or control of items that were deemed unnecessary. Patient care was standardized with a collaborative care pathway coordinated by a clinical nurse specialist and that served as a goal for each case.


RESULTS
Length of total hospital stay was reduced from a mean of 5.7 days to 3.6 days after full implementation of the program (p < 0.0001). A reduction in operating room time, material utilization, antibiotic use, routine laboratory studies, and refinements in postoperative pain management contributed significantly to cost savings. Overall, the average adjusted total hospital charges were reduced from $13,783 to $7741 (p < 0.0001) by the implementation of this program, with no discernible adverse effect on morbidity rates.


CONCLUSIONS
Careful analysis of the critical components of medical care and implementation of a standardized pathway with emphasis on a collaborative approach can substantially increase the cost efficiency of medical care.
Koch
M O
MO
Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
Smith
J A
JA
Hodge
E M
EM
Brandell
R A
RA
D000368:Aged; D003363:Cost Control / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D016730:Program Development; D011446:Prospective Studies; D011468:Prostatectomy / Q000191:economics*; D011787:Quality of Health Care; D013714:Tennessee