RELEVANCE OF QUALITY IMPROVEMENT METHODS TO SURGICAL PRACTICE - PROSPECTIVE ASSESSMENT OF CAROTID ENDARTERECTOMY

Continuous quality improvement methods are increasingly being applied to health care systems, yet demonstration of outcome and cost benefits for surgical patients remains sparse. We used continuous quality impr ovement principles to specifically identify potential opportunities to reduce patient charges for carotid endarterectomy in our academic vas cular surgery practice without compromising results. The targeted oppo rtunities included: 1) limitation of laboratory examination, 2) select ive cardiac stress testing, 3) discharge on Ist postoperative day, and 4) substitution of outpatient carotid duplex imaging for inpatient an giography. After 1 year, reductions in the average patient charge ($77 00 versus $13,900, P <0.001) and increases in payment/charge ratio (1. 2 versus 0.8; P <0.001) were observed. These changes were primarily du e to a reduction in length of stay (2.2 versus 5.7 days; P < 0.001). N o significant difference in patient morbidity occurred. Reductions in charges occurred within the targeted areas of laboratory (-77%), cardi ac testing (-73%), hospital room (-60%), and radiology (-81%) utilizat ion. Attention to the four factors identified by continuous quality im provement methods significantly reduced total patient charges without detrimental effects on patient outcome.