Belnap, Star

D\u27Amour, Daniel

De Armas, Peter

De Los Rios La Rosa, Felipe

Fernandez, Albert

Hartnett, Daniel

Patel, Kunal

Starosciak, Amy

Strauss, Jayme

Waisbrot, Andrew

English

Scholarly Commons@Baptist Health South Florida

Baptist Health South Florida Scholarly Commons @ Baptist Health South Florida All Publications 2-2020 Implementation of Stroke Pathways to Reduce Length of Stay, Cost, Readmissions, and Mortality Jayme Strauss Miami Neuroscience Institute Daniel Hartnett Miami Neuroscience Institute, DanielH1@baptisthealth.net Peter De Armas Miami Neuroscience Institute, peterde@baptisthealth.net Albert Fernandez Miami Neuroscience Institute, albertf@baptisthealth.net Felipe De Los Rios La Rosa Baptist Hopsital of Miami; Miami Neuroscience Institute, felipedl@baptisthealth.net See next page for additional authors Follow this and additional works at: https://scholarlycommons.baptisthealth.net/se-all-publications Citation Strauss, Jayme; Hartnett, Daniel; De Armas, Peter; Fernandez, Albert; De Los Rios La Rosa, Felipe; Patel, Kunal; Starosciak, Amy; Waisbrot, Andrew; Belnap, Star; and D'Amour, Daniel, "Implementation of Stroke Pathways to Reduce Length of Stay, Cost, Readmissions, and Mortality" (2020). All Publications. 3453. https://scholarlycommons.baptisthealth.net/se-all-publications/3453 This Conference Poster -- Open Access is brought to you for free and open access by Scholarly Commons @ Baptist Health South Florida. It has been accepted for inclusion in All Publications by an authorized administrator of Scholarly Commons @ Baptist Health South Florida. For more information, please contact Carrief@baptisthealth.net. Authors Jayme Strauss, Daniel Hartnett, Peter De Armas, Albert Fernandez, Felipe De Los Rios La Rosa, Kunal Patel, Amy Starosciak, Andrew Waisbrot, Star Belnap, and Daniel D'Amour This conference poster -- open access is available at Scholarly Commons @ Baptist Health South Florida: https://scholarlycommons.baptisthealth.net/se-all-publications/3453 Elevating care through discoveryImplementation of Stroke Pathways to Reduce Length of Stay, Cost, Readmissions, and MortalityJayme Strauss, RN, MSN, MBA, SCRN, Daniel Hartnett, RN, MSN, SCRN, Peter De Armas, RN, MSN, SCRN, Albert Fernandez, RN, BSN, SCRN, Felipe De Los Rios La Rosa, MD, Kunal Patel, MS, Amy Starosciak, Ph.D., Andrew Waisbrot, RN, MSN, SCRN, Starlie C. Belnap, Ph.D., Daniel D’Amour, RN, BSN, CEN, SCRN OBJECTIVETo reduce length of stay (LOS) and variable cost percase for stroke cases on a Neuroscience unit in acommunity Comprehensive Stroke Center usingstandardized, evidence-based clinical pathways.BACKGROUNDAcute stroke is a major contributor to healthcare costs. In2012, estimated direct costs associated with stroke were$71B, which is projected to double to $184B by 2030. Ashealthcare evolves and reimbursements decrease, costcontrol in disease specific populations is critical. InNovember 2017, length of stay (LOS) peaked at 5.78days, as did variable and total cost/case (Table 1). Infiscal year 2017 the 30-d readmission rate was 9% andthe mortality rate was 12%. Compliance with strokeadmission order sets was at 55%.METHODSA multidisciplinary committee was formed in 02/2017 todevelop standardized, evidence-based clinical pathwaysfor three populations:• Ischemic stroke (IS) treated with IV t-PA• TIA/IS without IV t-PA• Intracerebral hemorrhageThe team met biweekly to standardize clinical pathways,decrease time to follow-up imaging, focus on physicianorder set utilization, and control costs. The strokepathways were implemented in 11/2017. Pathways arediscussed daily in stroke and rapid discharge rounds toensure compliance and identify opportunities forimprovement.RESULTSWe reviewed a retrospective financial report of all in-hospital cases coded as MS-DRG 61-69 from 12/2017through 9/30/2019 and compared it the 11/2017 reportfor LOS (LOS) (Fig. 1), case mix index (CMI) (Fig. 2),variable and total costs per case (Fig.3),readmissions (Fig.4), and mortality (Fig. 5).Figure 3. Total (A) and Variable (B) cost/case per month and by Nov 2017*RESULTS• There was a 26% reduction in LOS (4.34 days)• A  24% ($5,958) reduction in variable cost per case• 6% reduction the 30-d readmission rate, and a 4%reduction in mortality rate.• Case mix index was 12% higher at 1.3272 (vs. 1.2055previously)• Order set compliance improved to 94%• All of these improvements resulted in a realized totalcost savings of $4.5 million.CONCLUSIONSStandardization of stroke clinical pathways led toimproved order set compliance, almost ¼ reduction invariable and total costs per case, shortened LOS, andreduced mortality and readmission rates compared to thefirst month after implementation of stroke pathways.Figure 1. Monthly and Nov 2017 ALOS* Figure 2. Monthly and Nov 2017 CMI*Figure 4. Quarterly and by Nov 2017readmission rate* Figure 5. Quarterly and by Nov 2017 mortality rate* 0123456789May-17Jul-17Sep-17Nov-17Jan-18Mar-18May-18Jul-18Sep-18Nov-18Jan-19Mar-19May-19Jul-19Sep-19ALOS (d) Implementation11-17 AVG 5.8700.511.52May-17Jul-17Sep-17Nov-17Jan-18Mar-18May-18Jul-18Sep-18Nov-18Jan-19Mar-19May-19Jul-19Sep-19Case Mix IndexImplementation11-17 AVG 1.210%5%10%15%20%ReadmissionsImplementation11-17 AVG 9%0%5%10%15%20%MortalityImplementation11-17 AVG 4%$7$9$11$13$15$17$19$21$23May-17Jul-17Sep-17Nov-17Jan-18Mar-18May-18Jul-18Sep-18Nov-18Jan-19Mar-19May-19Jul-19Sep-19Total Cost ($K)11-17 AVG $17,995Implementation $2$3$4$5$6$7$8$9$10$11May-17Jul-17Sep-17Nov-17Jan-18Mar-18May-18Jul-18Sep-18Nov-18Jan-19Mar-19May-19Jul-19Sep-19Variable Cost/Case ($K)11-17 AVG $7,850Implementation*Limitation: All variables were compared to a single 1-month time point as opposed to amore prolonged period.

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

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

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