Lowering hospital charges in the trauma intensive care unit while maintaining quality of care by increasing resident and attending physician awareness.

OBJECTIVE: The goal of this study was to determine if trauma intensive care unit (TICU) charges could be reduced through informal daily bedside resident-attending physician discussions regarding relative patient costs of diagnostic and therapeutic alternatives. DESIGN: This was a prospective pre- and postinterventional study. SETTING: The study took place in a TICU in a level I, community-based, university-affiliated teaching hospital. PATIENTS: Ninety-one consecutive patients were admitted to the TICU during a 6-month period. MATERIALS AND METHODS: The TICU charges were tracked over two consecutive 3-month periods. The first 3 months served as control. No attempt was made to alter cost of care, and residents were unaware that a study was in progress. During the ensuing 3-month period, attendings explicitly discussed with residents relative costs of diagnostic and therapeutic interventions in an attempt to lower charges. Composition of the surgical trauma team remained constant throughout the study. MEASUREMENT AND MAIN RESULTS: The median and mean age, Injury Severity Score, intensive care unit length of stay, and sex ratio were not statistically different between the two study groups. Total median daily charges of the postintervention group were reduced over the control group by $818/intensive care unit day (p = 0.0002). The major categories in which charges were reduced included medications ($151/day, p = 0.003), laboratory tests ($120/day, p = 0.072), chest x-ray films ($61/day, p = 0.001), respiratory therapy ($185/day, p = 0.21), and miscellaneous charges ($141/day, p = 0.055). Mortality rates and number of major complications were not statistically different between groups. CONCLUSIONS: Increased awareness of cost factors and specific attempts to achieve patient cost reduction resulted in a demonstrable decrease in daily TICU charges, without compromising the quality of care.

Eliminating duplication in home health care for the elderly: the Guale Project.

Fragmentation in funding has created an artificial separation and duplication in the delivery of health and social services for the elderly. The authors report on a demonstration project that not only proved the feasibility of having one homemaker--home health aide provide both types of services, but eliminated duplication of services and improved the quality of care as well.