Abstract TP300: Implementation of Stroke Pathways to Reduce Length of Stay, Cost, Readmissions, and Mortality

Abstract

Introduction: Acute stroke is a major contributor to healthcare costs. In 2012, estimated direct costs associated with stroke was $71B, which is projected to double to $184B by 2030. As healthcare evolves and reimbursements decrease, cost control in disease specific populations is critical. In November 2017, length of stay (LOS) peaked at 5.78 days, as did variable and total cost/case (Table). In fiscal year 2017 the 30-d readmission rate was 9% and the mortality rate was 12%. Compliance with stroke admission order sets was at 55%. Methods: A multidisciplinary committee was formed in February 2017 to develop standardized, evidence-based clinical pathways for three populations: Ischemic stroke (IS) treated with IV tPA, TIA/IS without IV tPA, and intracerebral hemorrhage. The team met biweekly to standardize clinical pathways, decrease time to follow-up imaging, focus on physician order set utilization, and control costs. A comprehensive education program for all clinical staff was completed; official implementation of the pathways was in November 2017. A stroke financials team meets monthly to continue to look at opportunities and transitions of care. We reviewed a retrospective financial report of all in-hospital cases coded as MS-DRG 61-69 from 12/2017 through 7/31/2019 and compared it the 11/2017 report. Results: A total of 83 cases were available for 12/2017 and 2192 for 1/2018 through 7/2019. There was a reduced LOS by 26% (4.34 days), reduced variable cost/case by 24% ($5,958), reduced total cost/case by 23% ($13,790), reduced the 30-d readmission rate to 6%, and reduced the mortality rate to 4%. Case mix index was 12% higher at 1.3272 (vs. 1.2055 previously). Order set compliance improved to 94% (Table). A total cost saving dollar realization of $4.5 million. Discussion: Standardization of stroke clinical pathways led to improved order set compliance, almost 1/4 reduction in variable and total costs per case, shortened LOS, and reduced mortality and readmission rates.