PROSPECTIVE DEVELOPMENT OF A COST-EFFICIENT PROGRAM FOR RADICAL RETROPUBIC PROSTATECTOMY

Objectives. We designed and implemented a broad-based program to decre ase costs while maintaining quality of care in patients undergoing rad ical retropubic prostatectomy. Methods. This program initially involve d identification of factors that contribute to patient costs after rad ical prostatectomy and elimination or control of items that were deeme d unnecessary. Patient care was standardized with a collaborative care pathway coordinated by a clinical nurse specialist and that served as a goal for each case. Results. Length of total hospital stay was redu ced from a mean of 5.7 days to 5.6 days after full implementation of t he program (p < 0.0001). A reduction in operating room time, material utilization, antibiotic use, routine laboratory studies, and refinemen ts in postoperative pain management contributed significantly to cost savings. Overall, the average adjusted total hospital charges were red uced from $13,785 to $7741 (p < 0.0001) by the implementation of this program, with no discernible adverse effect on morbidity rates. Conclu sions. Careful analysis of the critical components of medical care and implementation of a standardized pathway with emphasis on a collabora tive approach can substantially increase the cost efficiency of medica l care.