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The Business Case for TCAB: A Cost-Benefit Analysis

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Publication Date: February 2009

Publisher(s): Robert Wood Johnson Foundation

Author(s): M. Agrawal; L. Unruh

Topic: Health (Hospitals and other health care facilities)


This white paper provides a cost-benefit analysis for Transforming Care at the Bedside (TCAB). TCAB is a program funded by the Robert Wood Johnson Foundation (RWJF), to improve processes and outcomes in hospital medical and surgical units. While those involved with TCAB believe that the program has improved patient care and nurse satisfaction, the financial costs and benefits of the program are not fully understood.

The authors use data from 13 TCAB units to estimate the net benefits of implementing TCAB. Benefits were measured in registered nurse (RN) turnover rates, patient falls with harm and RN overtime. TCAB units were tracked over time to see if any of these measures changed, and were also compared with non-TCAB units to see if TCAB units had lower costs.

Key Findings:

* TCAB units showed a consistent reduction in the number of falls with harm between 2005 and 2007. RN turnover and RN overtime did not change significantly over time within the TCAB units.
* TCAB units had significantly lower costs from falls, overtime and turnover than non-TCAB units. Using this comparison, each TCAB unit saved on average $847,861.
* The average cost of implementing and maintaining TCAB in a unit came to $222,258.

The results of this study must be used with caution as the study did not evaluate whether TCAB caused the lower costs relative to non-TCAB units. The results suggest, however, that TCAB units have reduced costs due to lower RN turnover, fewer falls with harm and less RN overtime.


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