Abstract P187: Level One Cardiac Arrest Centers are Clinically and Cost Effective: a Phase One Study

Introduction/Hypothesis: Specialized care after cardiac arrest in Level One Cardiac Arrest Centers (L1CAC) may provide improved care in a cost-effective manner for this gravely ill patient population in an analogous manner to Level One Trauma Centers. Methods: In December 2005 a regional referring hospital in central Minnesota (St. Cloud Hospital) established and implemented protocols for all patients admitted following out-of-hospital cardiac arrest that included standardized treatment with hypothermia (if comatose upon admission and regardless of initial arrest rhythm), 24/7 percutaneous cardiac interventions (PCI), critical care management and specialized electrophysiological evaluation and treatment. Hospital discharge rates were compared to historical controls one year prior to the new interventions. Cost effectiveness data were obtained from reviewing the individual billing, collection and revenue generation from all patients after the new program was implemented over the subsequent 19-month period of time. A Standard Chi-Square Test was performed. Results: Between 11/04–11/05, 33 patients were admitted alive to the hospital and 11 (33.3%) survived to hospital discharge versus 54/104 (51.9%) admitted between 12/05–12/07 (p=0.062 for historical control vs intervention group). Mean age (72 vs 76) and male gender (58% vs 72%) were similar between the historical control and intervention group, respectively. During the intervention year, 70% of admitted patients were treated with therapeutic hypothermia. The revenues associated with billing for 69 patients treated with hypothermia averaged $57,783/patient who survived to hospital discharge with a direct margin after direct costs of $20,684/patient. The direct revenue and margins for those who expired in the hospital were $12,014 and $3,329, respectively. Conclusions: In this phase one evaluation a L1CAC that specialized in care for patients after cardiac arrest, includeing hypothermia, 24/7 PCI, critical care management and specialized electrophysiological treatment, had a 50% higher hospital discharge rate compared with historical controls. This specialized care was cost effective and resulted in a direct margin of >$20,000 for every patient who was discharged alive.