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Containing costs in the treatment of congenital heart disease
Insights
Implementing practice changes in pediatric cardiology reduced costs and hospital stays without affecting patient outcomes. This approach achieved significant financial savings and improved efficiency in congenital heart care.
Area of Science:
- Pediatric Cardiology
- Healthcare Management
- Cost Containment
Background:
- Congenital heart disease programs face challenges in managing costs while maintaining quality of care.
- Previous practices in pediatric cardiac care involved extended hospital stays and extensive diagnostic testing.
Purpose of the Study:
- To evaluate the impact of medical practice alterations on cost, quality, and access in a pediatric congenital heart program.
- To assess the feasibility of reducing hospital stay duration and diagnostic test utilization without compromising patient outcomes.
Main Methods:
- Analysis of elective pediatric cardiac catheterization outcomes for 483 patients, focusing on same-day discharge.
- Review of 151 elective congenital heart disease surgical cases (1978-1982) to assess changes in perioperative hospital stay.
- Reassessment and elimination of non-essential pre-catheterization laboratory tests.
- Comparison of outcomes for patients diagnosed via echocardiography versus those undergoing cardiac catheterization.
Main Results:
- Same-day discharge for pediatric cardiac catheterization reduced hospital bills by 29% ($493 per patient) with minimal readmission.
- Shortened postoperative intensive care unit stay for surgical correction decreased from 6.8 to 4.4 days, saving $991 per procedure.
- Eliminating unnecessary tests and reducing cardiac catheterizations by 80 cases in one year yielded savings of $188,800.
- No increase in morbidity or mortality was observed with shortened hospital stays or reliance on echocardiography for diagnosis.
Conclusions:
- Cost containment in congenital heart programs is achievable without compromising patient quality or access.
- Optimizing hospital stay duration and diagnostic protocols can lead to significant financial savings.
- Evidence-based practice changes can enhance efficiency and reduce healthcare costs in pediatric cardiac care.
Abstract:
In the Congenital Heart Program at San Diego Children's Hospital, alterations in medical practice have reduced costs without impairing quality or access. Pediatric cardiac catheterization was done in 483 consecutive elective patients without overnight hospital stay. Hospital readmission was required in one patient for psoas tendinitis. Avoiding overnight hospital stay minimized attendant risks of hospital care, lessened psychosocial trauma and reduced the average hospital bill by $493 (29%). Hospital stay was also reduced for elective surgical correction of congenital heart disease on a case-by-case basis. Review of 151 consecutive cases (1978 through 1982) showed a decrease in both preoperative days in hospital and postoperative days in an intensive care unit. The duration of the postoperative stay was shortened from 6.8 days in 1978-1979 to 4.4 days in 1982 (P <.05). No increase in morbidity and no mortality resulted from the shortened perioperative hospital stay. Financial savings from this process averaged $991 per procedure.Diagnostic tests were reassessed and many precatheterization laboratory tests were eliminated. Without change in new patients seen or surgical volume, the use of cardiac catheterization decreased from 241 procedures in 1981 to 161 in 1982 and the number of operations without catheterization increased (11 to 22, 1981 to 1982). No increase in surgical morbidity or mortality was found comparing those diagnosed only by echocardiography with those who had preoperative cardiac catheterization. The decrease of 80 catheterizations in one year resulted in a savings of $188,800.True cost containment (reducing cost without reducing quality) can be accomplished in congenital heart programs. Similar cost containments in other disciplines may also be achieved.