The Christiana Care Health System in Delaware was concerned it was spending too much on cardiac monitoring for patients who didn’t need it. So it changed its system to encourage doctors to follow American Heart Association guidelines for using the monitors. The number of patients using the monitors, and the group’s daily costs for such monitoring, fell by 70% without any harm to patient care.
The effort is part of a push by some hospitals across the nation to cut costs by standardizing care, reports The Wall Street Journal (Sept. 22, 2014). Although professional bodies such as the AHA publish numerous guidelines advising doctors how best to treat various diseases, many doctors deviate from guidelines, which can lead to overuse of some tests and procedures. Doctors cite various reasons for deviating, from personal preference to institutional custom.
Cardiac telemetry is one of AHA’s procedures in its “Choosing Wisely” campaign. In cardiac telemetry, electrodes are used to monitor the heart for abnormal rhythms. To try to cut inappropriate use of the monitoring at Christiana Care, physicians redesigned the electronic system that doctors use to order tests and other care. First, they removed the option to order telemetry for conditions not included in the AHA guidelines. Then, they attached a fixed AHA-recommended time period for telemetry duration in the computer system. After the changes, the hospital group’s mean daily number of patients monitored with telemetry fell from 357.5 to 109.1, while the mean daily cost for delivering telemetry fell from $18,971 to $5,772. The changes had no negative effect on patient care; mortality rates at the hospital remained stable, as did the number of “code blue” emergency calls to resuscitate patients. “It is remarkable to achieve such a substantial reduction in the use of this resource without significantly increased adverse outcomes,” says one medical expert.
Classroom discussion questions:
1. In what other ways can hospitals become more efficient? (Hint: see Chapter 5, page 175).
2. Why are some doctors opposed to these system changes?