IMPACTING COST AND APPROPRIATENESS OF STRESS-ULCER PROPHYLAXIS AT A UNIVERSITY MEDICAL-CENTER

Objective: To determine the appropriateness and medication cost of str ess ulcer prophylaxis before and after a targeted educational interven tion. Design: In the preintervention cohort (phase 1), 264 patients we re evaluated over 2 months, using stress ulcer prophylaxis guidelines developed by a comprehensive literature search. Targeted educational p rograms were subsequently used to inform trauma housestaff on appropri ate usage of stress ulcer prophylaxis medications with emphasis on usi ng sucralfate. The postintervention cohort (phase 2) involved concurre nt evaluation of 279 patients. Length of inappropriate stress ulcer pr ophylaxis (i.e., did not meet approved guidelines) between phases was compared using a Student's t-test for independent samples (alpha=.05). Setting: A 365-bed university medical center. Patients: Patients admit ted to any of the intensive care units and all patients who were place d on histamine-2-antagonists or sucralfate for stress ulcer prophylaxi s. Interventions: Educational intervention regarding appropriate stres s ulcer prophylaxis directed at the trauma service. Measurements and M ain Results: Patient demographics in the two phases were similar and t here was no difference in the number of patient risk factors for stres s-induced bleeding. The mean length of inappropriate stress ulcer prop hylaxis was 5.78 +/- 4.36 days in phase 1 and 4.66 +/- 3.10 days in ph ase 2 (p < .05). Eighty nine patients in phase 1 received inappropriat e stress ulcer prophylaxis for a drug cost of $2,272.00 (mean $25.53 /- 25.52) compared with 90 patients in phase 2 with a drug cost of $1, 417.00 (mean $15.75 +/- 13.06). Three patients in each phase had clini cally important bleeding (hemodynamic compromise or transfusion); all were receiving ranitidine. The mean total cost (fixed and variable) of hospitalization was $69,288.00 and $74,709.00 for the three patients who bled in each phase compared with $19,850.00 and $15,812.00 for all patients admitted to the intensive care unit in phases 1 and 2, respe ctively. The mean length of hospital stay was 30.00 days and 29.33 day s for the three patients who bled In each phase compared with 11.54 da ys and 10.27 days for all patients admitted to the intensive care unit in phases 1 and 2, respectively. Conclusions: Cost savings are associ ated with more appropriate stress ulcer prophylaxis. Clinically import ant bleeding is uncommon but results in prolonged hospital stays and i ncreased costs.