Implementation of an acute stroke program decreases hospitalization costs and length of stay.
OBJECTIVE
A large community hospital implemented an acute stroke program to respond to stroke patients in a consistent, systematic, and efficient manner. The primary objectives were to monitor the care delivered, improve the quality of care, and move the patients through their initial hospital stay in a timely manner.


METHODS
Acute stroke standing orders were developed, with a critical path developed on the basis of these orders and an expected length of stay. A multidisciplinary team began the rehabilitation process early in the hospital stay, monitored patient progress and length of stay, and provided appropriate discharge placement. Retrospective chart reviews were performed over a 4-year period, and the data were collated on a yearly basis.


RESULTS
Over a 4-year period, 414 Medicare patients demonstrated a steady decline of initial hospital length of stay from 7.0 to 4.6 days. During this same period of time, there was a decline in total hospital charges from $14,076 to $10,740 per patient. This represented a total dollar savings in charges of $1,621,296 (approximately $453,000 per year). The mortality rate for 1994 was 4.6%, with 46.5% of survivors discharged to home, 16.9% to acute rehabilitation, and 32.6% to nursing homes.


CONCLUSIONS
The implementation of a multidisciplinary acute stroke program decreased length of stay and hospitalization costs of Medicare patients.
Wentworth
D A
DA
Mercy General Hospital, Sacramento, Calif 95819, USA.
Atkinson
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RP
D002561:Cerebrovascular Disorders / Q000191:economics / Q000534:rehabilitation / Q000628:therapy*; D002985:Clinical Protocols; D017046:Cost Savings; D003365:Costs and Cost Analysis; D019091:Critical Pathways / Q000191:economics; D017722:Hospital Charges; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006764:Hospitals, Community / Q000191:economics; D006801:Humans; D007902:Length of Stay; D006278:Medicare; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010351:Patient Discharge; D011787:Quality of Health Care; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States