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BACKGROUND AND PURPOSE: A large community hospital implemented an acute stroke program to respond to stroke patients in a consistent, systematic, and efficient manner. The primary objectives were to monitor the care delivered, improve the quality of care, and move the patients through their initial hospital stay in a timely manner. METHODS: Acute stroke standing orders were developed, with a critical path developed on the basis of these orders and an expected length of stay. A multidisciplinary team began the rehabilitation process early in the hospital stay, monitored patient progress and length of stay, and provided appropriate discharge placement. Retrospective chart reviews were performed over a 4-year period, and the data were collated on a yearly basis. RESULTS: Over a 4-year period, 414 Medicare patients demonstrated a steady decline of initial hospital length of stay from 7. 0 to 4. 6 days. During this same period of time, there was a decline in total hospital charges from 14, 076 to 10, 740 per patient. This represented a total dollar savings in charges of 1, 621, 296 (approximately 453, 000 per year). The mortality rate for 1994 was 4. 6%, with 46. 5% of survivors discharged to home, 16. 9% to acute rehabilitation, and 32. 6% to nursing homes. CONCLUSIONS: The implementation of a multidisciplinary acute stroke program decreased length of stay and hospitalization costs of Medicare patients.
Wentworth et al. (Sat,) studied this question.