title: Cost containment in cardiac surgery: results with a critical pathway for coronary bypass surgery at the New York hospital-Cornell Medical Center.
abstract: OBJECTIVE
  A multidisciplinary project was undertaken at The New York Hospital-Cornell Medical Center to develop critical pathways for open-heart surgery to help reduce cost, shorten hospital length of stay (LOS), and streamline patient care.
  
  
  METHODS
  A critical pathway for elective coronary artery bypass grafting instituted on March 1, 1995, was developed through a cooperative effort involving surgeons, anesthesiologists, nurses, social workers, physical therapists, nutritionists, and patient case managers. Prospective data collected on consecutive patients forming a critical pathway group (n = 114) over a 6-month period were compared with retrospective data on consecutive patients forming a cohort group (n = 382) who underwent elective coronary artery bypass grafting in 1994.
  
  
  RESULTS
  The critical pathway group of patients experienced a significantly shorter total hospital LOS (7.7 +/- 2.3 days vs 11.1 +/- 6 days, p < 0.0001) and shorter intensive care unit LOS (1.5 +/- 0.9 days vs 2.0 +/- 2.8 days, p < 0.0001). Direct costs were computed by use of hospital charges multiplied by the Medicare cost-to-charge ratio. Mean hospital direct cost (ancillary resources) was $1181 lower in the critical pathway group when compared with the control group (p < 0.0001). The postoperative mortality and readmission rates were similar for the two groups of patients.
  
  
  CONCLUSIONS
  The ongoing analysis of cost, LOSs, and outcomes has made possible a process of continuous quality improvement on the cardiothoracic service in which further areas for improvement are identified and studied. The use of a critical pathway for elective coronary artery bypass grafting at our institution significantly reduced hospital LOS and direct costs while maintaining the overall quality of patient care.
authors.affiliation: Department of Cardiothoracic Surgery, New York Hospital-Cornell University Medical College, New York City 10021, USA.
authors.forename: F T
authors.initials: FT
authors.lastname: Velasco
authors.forename: W
authors.initials: W
authors.lastname: Ko
authors.forename: T
authors.initials: T
authors.lastname: Rosengart
authors.forename: N
authors.initials: N
authors.lastname: Altorki
authors.forename: S
authors.initials: S
authors.lastname: Lang
authors.forename: J P
authors.initials: JP
authors.lastname: Gold
authors.forename: K H
authors.initials: KH
authors.lastname: Krieger
authors.forename: O W
authors.initials: OW
authors.lastname: Isom
mesh_terms: D001026:Coronary Artery Bypass / Q000191:economics* / Q000451:nursing; D017046:Cost Savings / Q000379:methods; D019091:Critical Pathways / Q000458:organization & administration*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008332:Management Quality Circles; D009519:New York City; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D016730:Program Development; D011446:Prospective Studies; D012189:Retrospective Studies