title: Cost savings associated with a multidisciplinary protocol that expedites definitive fracture care.
abstract: Changes in health care reimbursement will reward systems that can improve patient outcomes and reduce costs. We implemented an integrated-care pathway protocol that coordinates the efforts of all the teams involved in the care of multiple-trauma patients by providing standard resuscitation parameters to recommend timing of definitive fracture fixation. The Early Appropriate Care (EAC) protocol was projected to reduce complications and length of stay (LOS) in the hospital. We propose to calculate the projected cost savings associated with reductions in complications and shorter LOS from implementing the protocol. To determine complication rates, LOS, and costs of care, we reviewed the cases of 1114 patients treated surgically for femur, pelvis, or acetabulum fractures between 2000 and 2006. Complications increased LOS by 12.2 days in femur patients and 13.8 days in pelvis and acetabulum patients. Mean additional cost per day was $4368 for femur patients and $4304 for pelvis/acetabulum patients. Mean cost per complication was $58,968 for femur patients and $98,465 for acetabulum patients. Projecting a 10% reduction in complications with EAC forecasts a $2,746,638 or $2,145,847 reduction in costs based on reduced per-complication costs or reduced LOS, respectively. Initial EAC implementation has resulted in fewer complications with an estimated annual cost reduction of $2,227,151, consistent with the projections. Literature review yielded cost estimates of $2480 per hospital day and $37,772 per complication. These literature estimates forecast total cost savings of $888,940 per reduction in LOS and $1,531,646 per reduction in complications. In spite of the wide range of estimates for the total cost reduction, it is clear that the reduction in costs associated with a 10% reduction in complications from implementing the EAC protocol will be substantial. Initial clinical data have shown up to 17% fewer complications with EAC adherence, which is projected to reduce our hospital costs by $2 million per year. These cost reductions justify further investment in refining the EAC protocol and securing hospital resources needed to support further implementation.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Childs
authors.affiliation: Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH. hvallier@metrohealth.org.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Vallier
mesh_terms: D000077:Acetabulum / Q000293:injuries; D000328:Adult; D002985:Clinical Protocols; D017046:Cost Savings; D005269:Femur / Q000293:injuries; D050723:Fractures, Bone / Q000191:economics* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010348:Patient Care Team / Q000191:economics; D010384:Pelvic Bones / Q000293:injuries; D011183:Postoperative Complications / Q000191:economics* / Q000517:prevention & control; D012189:Retrospective Studies; D055815:Young Adult