Impacting cost and appropriateness of stress ulcer prophylaxis at a university medical center

• Published in: Critical care medicine Vol. 25; no. 10; pp. 1678 - 1684
• Main Authors: Erstad, Brian L, Camamo, James M, Miller, Michael J, Webber, Anthony M, Fortune, John
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Williams & Wilkins 01-10-1997; Lippincott
• Subjects: Academic Medical Centers - economics; Academic Medical Centers - statistics & numerical data; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Ulcer Agents - economics; Anti-Ulcer Agents - therapeutic use; Arizona; Biological and medical sciences; Female; Histamine H2 Antagonists - economics; Histamine H2 Antagonists - therapeutic use; Hospital Bed Capacity, 300 to 499; Hospital Costs - statistics & numerical data; Hospitalization - economics; Humans; Intensive care medicine; Male; Medical sciences; Medical Staff, Hospital - economics; Medical Staff, Hospital - education; Middle Aged; Miscellaneous; Peptic Ulcer - economics; Peptic Ulcer - prevention & control; Practice Guidelines as Topic; Stress, Psychological - economics; Stress, Psychological - prevention & control; Sucralfate - economics; Sucralfate - therapeutic use; Arizona; Human; Evaluation; Intensive care; Health staff; Physician; Stress; Educational program; Prevention; Gastroduodenal; Health economy; Digestive diseases; Intestinal disease; Complication; Ulcer; Cost analysis; Comparative study; Public health; Gastric disease
• ISSN: 0090-3493; 1530-0293
• DOI: 10.1097/00003246-199710000-00017

OBJECTIVE To determine the appropriateness and medication cost of stress ulcer prophylaxis before and after a targeted educational intervention.
DESIGN In the preintervention cohort (phase 1), 264 patients were evaluated over 2 months, using stress ulcer prophylaxis guidelines developed by a comprehensive literature search. Targeted educational programs were subsequently used to inform trauma housestaff on appropriate usage of stress ulcer prophylaxis medications with emphasis on using sucralfate. The postintervention cohort (phase 2) involved concurrent evaluation of 279 patients. Length of inappropriate stress ulcer prophylaxis (i.e., did not meet approved guidelines) between phases was compared using a Student's t-test for independent samples (alpha = .05).
SETTING A 365-bed university medical center.
PATIENTS Patients admitted to any of the intensive care units and all patients who were placed on histamine-2-antagonists or sucralfate for stress ulcer prophylaxis.
INTERVENTIONS Educational intervention regarding appropriate stress ulcer prophylaxis directed at the trauma service.
MEASUREMENTS AND MAIN RESULTS Patient demographics in the two phases were similar and there was no difference in the number of patient risk factors for stress-induced bleeding. The mean length of inappropriate stress ulcer prophylaxis was 5.78 +/- 4.36 days in phase 1 and 4.66 +/- 3.10 days in phase 2 (p < .05). Eighty-nine patients in phase 1 received inappropriate stress ulcer prophylaxis for a drug cost of $2,272.00 (mean $25.53 +/- 25.52) compared with 90 patients in phase 2 with a drug cost of $1,417.00 (mean $15.75 +/- 13.06). Three patients in each phase had clinically important bleeding (hemodynamic compromise or transfusion); all were receiving ranitidine. The mean total cost (fixed and variable) of hospitalization was $69,288.00 and $74,709.00 for the three patients who bled in each phase compared with $19,850.00 and $15,812.00 for all patients admitted to the intensive care unit in phases 1 and 2, respectively. The mean length of hospital stay was 30.00 days and 29.33 days for the three patients who bled in each phase compared with 11.54 days and 10.27 days for all patients admitted to the intensive care unit in phases 1 and 2, respectively.
CONCLUSIONS Cost savings are associated with more appropriate stress ulcer prophylaxis. Clinically important bleeding is uncommon but results in prolonged hospital stays and increased costs. (Crit Care Med 1997; 25:1678-1684)