A comparative study using time-driven activity-based costing in single-fraction breast high-dose rate brachytherapy: An integrated brachytherapy suite vs. decentralized workflow

Abstract

INTRODUCTION:Precision breast intraoperative radiation therapy ( PB -IORT) is a novel approach to adjuvant radiation therapy for early-stage breast cancer performed as part of a phase II clinical trial at two institutions. One institution performs the entire procedure in an integrated brachytherapy suite which contains a CT-on-rails imaging unit and full anesthesia capabilities. At the other, breast conserving surgery and radiation therapy take place in two separate locations. Here, we utilize time-driven activity-based costing (TDABC) to compare these two models for the delivery of PB-IORT. METHODS: Process maps were created to describe each step required to deliver PB -IORT at each institution, including personnel, equipment, and supplies. Time investment was estimated for each step. The capacity cost rate was determined for each resource, and total costs of care were then calculated by multiplying the capacity cost rates by the time estimate for the process step and adding any additional product costs. RESULTS: PB -IORT costs less to deliver at a distributed facility, as is more commonly available, than an integrated brachytherapy suite

Lean methodology: contributions to improving work processes in health and nursing

“…During the selection, 10 duplicate (identical) articles were eliminated and 354 articles that did not meet the inclusion criteria were excluded. The full texts of 19 eligible articles were assessed, obtaining a sample of 10 articles (7,(11)(12)(13)(14)(15)(16)(17)(18)(19) .…”

“…The 10 articles analyzed (7,(11)(12)(13)(14)(15)(16)(17)(18)(19) were published in the English language, two with complete translation into Portuguese, according to Chart 1. Studies in journals from the United States of America (50.0%) and Brazil (20.0%) predominated.…”

“…It was found that, although all articles in the sample relate Lean methodology application to the impact on financial aspects, through process improvement and waste reduction, not all of them effectively demonstrated the associated financial gains. Therefore, to provide greater visibility to the results obtained, they will be presented below in three charts: Chart 2 -Benefits/barriers to Lean Healthcare implementation (7,11,15) ; Chart 3 -Economic aspects involving Lean Healthcare implementation (12,14,16) ; and Chart 4 -Process improvements through Lean Healthcare implementation (13,(17)(18)(19) .…”

“…The analysis of the sample studies of this integrative review showed the use of Lean methodology in applied research ( 12 - 14 , 16 , 18 - 19 ) linked to university hospitals, places where the teaching, research and care tripod predominates. Interventions, that contribute to improving the efficiency, efficacy and effectiveness of the health services provided, which underlie the training of human resources and favor the conduct of health research using available, but not unlimited, resources, are needed.…”

“…Results related to savings and earnings, predictors of Lean interventions, were only reported in three studies ( 12 , 14 , 16 ) . Two studies ( 12 , 14 ) , which had evidence of correlation with economic aspects, were carried out in SC, with variables linked to the general work process, but both present limitations regarding the techniques used by medical professionals, denoting a hypothetical barrier in action sustainability, since the results obtained were linked to people and not to processes. One of these studies ( 14 ) , despite demonstrating that Lean methodology application, as a change in the work process, generated financial burden, highlighted that it could be balanced when related to customer satisfaction.…”