Ann Thorac Surg 1996;61:1139-1140
© 1996 The Society of Thoracic Surgeons
See also page 1136.
DR CLINTON E. BAISDEN (Temple, TX): We have a similar situation in Temple, Texas, in that about a third of our patients come from our immediate surrounding area, about a third of them come from the rest of Texas, and about a third from the southwest United States. It is unreasonable to have patients who are 70 to 80 years old get up in the middle of the night and drive 2 or 3 hours for admission.
One thing that we have done is to buy a motel that is just a block away from the hospital. I encourage my patients to go there and spend the night. It costs them about $45. They get room service, they get a real nice bed to stay in, they do not have to drive all night, and it is cheaper than the hospital.
DR AROM: We have the same setup that you are talking about, but owned by the hospital. This center is located near the hospital and patients have to pay for staying overnight. I was surprised that according to our recent follow-up survey, the majority of patients like to stay at their own home and sleep in their own bed rather than come to stay at a motel or the accommodations near the hospital. This is opposite to my original thinking.
DR FREDERICK L. GROVER (Denver, CO): We also found that same-day admission for coronary artery bypass grafting was amazingly well accepted after most of us fought this concept for years. The patients must be carefully selected, but a great majority of elective patients fall in this group. What would you consider to be absolute or relative contraindications?
DR AROM: According to our analyses, the only two contraindications would be New York Health Association functional class IV and advanced age.
DR GROVER: Is that failure class or angina class?
DR AROM: Failure class.
DR FRANK C. DETTERBECK (Chapel Hill, NC): How do you arrive at your cost savings of $6,000? Aren't you talking about a lot of cost shifting that is not charged as an inpatient fee because the preoperative tests, such as typing and crosstyping of blood and so on, are just put on an outpatient bill?
DR AROM: You are right about the cost shifting. It is also difficult to identify direct or indirect cost, and hospitals are very reluctant to give out the numbers. To the best of our knowledge, we could save between $2,700 and $4,000 per patient in the same-day admission group. The hospital charges, however, were more realistic, because we could compare hospital bills with hospital bills, and we found that the same-day admission group had an average of $6,600 less hospital charge.
DR DETTERBECK: I have one other comment that I think is more directed toward hospital administrators. We have a mind-set that when patients come into the hospital, they need to have a number of vital signs checked and they need to have the nurses look after them to get all the preparations done. And there is a usual charge for an inpatient. Perhaps our mind-set, or the mind-set of the hospital administrators, should be that if patients are going to be admitted for a preoperative night, they do not need most of that. They just need a motel-type room somewhere near the hospital that is paid for by the hospital, perhaps. The hospital would probably make a lot of money if they would absorb $45 of an overnight motel fee and tell all the patients that their preoperative night is free.
DR AROM: That is probably true.
DR GROVER: It sounds too logical.
Ann. Thorac. Surg. 1996 61: 1136-1139.
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