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Doing Well by Doing Good

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Scott M. Goldman, M.D., was skeptical when he heard about the cerebral oximeter, a device manufactured by Troy, Mich.-based Somanetics that measures blood flow-or more specifically, oxygen flow-to the brain during surgery. Especially for high-risk patients, the device helps ensure that the brain is receiving enough oxygen to prevent delirium or even brain damage during certain high-risk invasive surgeries. Ed McKillip was similarly skeptical. But Main Line Health, a three-hospital system in the Philadelphia area, is now using the device and has drastically reduced the incidence of stroke during high-risk surgeries-mainly invasive heart procedures. The system does more than 500 of those per year and has reduced its stroke count at its flagship, The Lankenau Hospital, from 14 the year before the device was implemented to one the year after. McKillip, the system's director of finance, says as a result, he's able to better allocate nursing resources on the floors, as well as cut the length of stay for patients who require the invasive surgery. Goldman, chairman of the department of surgery at Main Line's Lankenau Hospital, says the system's heart surgeons previously used formulas to determine the appropriate blood flow and oxygen to the brain during such surgeries. "Cookbook methods are fine for 90 percent of the patients," he says. But for the other 10 percent, the device can make a big difference. After a six-month preliminary trial showed strokes dropped by two-thirds, "we decided to adopt it," Goldman says. "During that period of time, we got even higher risk patients, but as the patients got sicker, we saw better outcomes."McKillip is cautious about extrapolating the financial benefits of any one device, but says the hospital also saw a marked decrease in length of stay after the medical staff adopted the oximeter. He is quick to stress that the hospital would have used the device simply for its patient benefits, but as finance director, he also worries about length of stay issues at his hospitals. Main Line, paid on a case-rate basis for most procedures, gets no extra reimbursement for increased length of stay. "We think there's a fairly strong case that we're avoiding using some scarce hospital resources," he says of the device's impact on staff time.-Philip Betbeze