A MODEL FOR MANAGEMENT OF PATIENTS WITH STROKE DURING THE ACUTE-PHASE- OUTCOME AND ECONOMIC-IMPLICATIONS

Background and Purpose: The purpose of the study was to develop a clin ical pathway for patients with nonhemorrhagic stroke during the acute hospital phase to improve the quality of care and reduce costs. Method s: The pathway included standard admission orders and a swallow screen on day 1 of hospitalization. Physical therapy, occupational therapy, speech therapy, and social worker assessments were done on day 2. A ph ysiatry consult was performed on day 3 if indicated, and by day 4 a di scharge target date and disposition were addressed. Results: Outcomes for 121 patients during the first year of pathway implementation are r eported. The average length of stay on the acute service decreased fro m 10.9 days to 7.3 days (P<.05), reducing the charges per patient by 1 4.6%. Complications in the form of urinary tract infections and aspira tion pneumonia rates decreased by 63.2% (P<.05) and 38.7%, respectivel y. Conclusions: We conclude that the implementation of a clinical path way for patients with acute, nonhemorrhagic stroke resulted in a signi ficant reduction in length of stay, charges, and complications while i mproving the quality of care.