Time-driven activity-based costing to identify opportunities for cost reduction in pediatric appendectomy

Yu, Yangyang R.; Abbas, Paulette I.; Smith, Caroline J.; Carberry, Kathleen E.; Ren, Hui; Patel, Binita; Nuchtern, Jed G.; López, Mónica E.

doi:10.1016/j.jpedsurg.2016.09.019

Cited by 40 publications

(38 citation statements)

References 18 publications

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“…For example, Cleveland Clinic’s cardiac surgery team implemented TDABC with mixed results, finding small but significant differences in cost calculations compared to RVU costing [21]. In addition, TDABC has been applied to pediatric appendectomies and the pre-operative assessment process, demonstrating reduced cost in each setting without affecting outcomes, thereby increasing value [22, 23]. …”

Section: Discussionmentioning

confidence: 99%

Using Time-Driven Activity-Based Costing as a Key Component of the Value Platform: A Pilot Analysis of Colonoscopy, Aortic Valve Replacement and Carpal Tunnel Release Procedures

et al. 2018

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BackgroundTime-driven activity-based costing (TDABC) is a methodology that calculates the costs of healthcare resources consumed as a patient moves along a care process. Limited data exist on the application of TDABC from the perspective of an anesthesia provider. We describe the use of TDABC, a bottom-up costing strategy and financial outcomes for three different medical-surgical procedures.MethodsIn each case, a multi-disciplinary team created process maps describing the care delivery cycle for a patient encounter using the TDABC methodology. Each step in a process map delineated an activity required for delivery of patient care. The resources (personnel, equipment and supplies) associated with each step were identified. A per minute cost for each resource expended was generated, known as the capacity cost rate, and multiplied by its time requirement. The total cost for an episode of care was obtained by adding the cost of each individual resource consumed as the patient moved along a clinical pathway.ResultsWe built process maps for colonoscopy in the gastroenterology suite, calculated costs of an aortic valve replacement by comparing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR) techniques, and determined the cost of carpal tunnel release in an operating room versus an ambulatory procedure room.ConclusionsTDABC is central to the value-based healthcare platform. Application of TDABC provides a framework to identify process improvements for health care delivery. The first case demonstrates cost-savings and improved wait times by shifting some of the colonoscopies scheduled with an anesthesiologist from the main hospital to the ambulatory facility. In the second case, we show that the deployment of an aortic valve via the transcatheter route front loads the costs compared to traditional, surgical replacement. The last case demonstrates significant cost savings to the healthcare system associated with re-organization of staff required to execute a carpal tunnel release.

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Section: Discussionmentioning

confidence: 99%

Using Time-Driven Activity-Based Costing as a Key Component of the Value Platform: A Pilot Analysis of Colonoscopy, Aortic Valve Replacement and Carpal Tunnel Release Procedures

et al. 2018

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“…Despite lasting only a short part of the whole inpatient process, operating room care usually takes highest costs [25]. In the United States, each minute of operating theatre time has been estimated to be worth $22-$80 [26].…”

Section: Discussionmentioning

confidence: 99%

Comparison of two surgical suture techniques in uvulopalatopharyngoplasty and expansion sphincter pharyngoplasty

Steinbichler

Bender

Giotakis

et al. 2017

Eur Arch Otorhinolaryngol

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Background Uvulopalatopharyngoplasty (UPPP) and expansion sphincter pharyngoplasty (ESP) are two standard surgical procedures for treatment of snoring and sleep apnea. In a prospective clinical trial, we compared a standard simple interrupted suture technique for closure of the tonsillar pillars with a running locked suture. Methods Each suture technique was randomly assigned either to the left or the right tonsillar pillars in 28 patients. During the first week, patients were daily checked for suture dehiscence and again on days 10 and 21, the end of followup. Time to perform the sutures was measured intraoperative and surgical complications were recorded. Results During followup, suture dehiscence was observed in 15/28 interrupted and 16/28 running sutures (p > 0.5). If a dehiscence occurred during the observation period, the median day of dehiscence was 10 (1 and 3 quartile: 5.75 and 17) days for the interrupted suture and 10 (5-11) days for the running locked suture technique (p > 0.05). The mean (± SD) surgical time for the interrupted suture was 5.2 ± 1.9 and 3.5 ± 1.8 min for the running locked suture (p < 0.001). Postoperative bleedings occurred in 4/28 running sutures and 2/28 interrupted sutures. Conclusion The running locked suture technique is an equally safe and time saving way of wound closure in UPPP and ESP.

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“…Yu et al conducted a time-driven activity-based costing of pediatric appendectomies, including consumable and labor costs. 71 The cost per minute in the OR was found to be $25.55 for this procedure. Similarly, Childers and Maggard-Gibbons performed a review of hospitals in California, completing analysis that the mean cost per minute of OR time was $37.45 for inpatient and $36.12 for ambulatory procedures.…”

Section: Additional Considerationsmentioning

confidence: 92%

Current State of Surgical Lighting

Curlin

Herman

2020

Surg J (N Y)

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AbstractSurgical performance in the operating room (OR) is supported by effective illumination, which mitigates the inherent environmental, operational, and visual challenges associated with surgery. Three critical components are essential to optimize operating light as illumination: (1) centering on the surgeon's immediate field, (2) illuminating a wide or narrow field with high-intensity light, and (3) penetrating into a cavity or under a flap. Furthermore, optimal surgical illumination reduces shadow, glare, and artifact in visualization of the surgical site. However, achieving these principles is more complex than at first glance, requiring a detailed examination of the variables that comprise surgical illumination. In brief, efficacious surgical illumination combines sufficient ambient light with the ability to apply focused light at specific operative stages and angles. But, brighter is not always merely better; rather, a nuanced approach, cognizant of the challenges inherent in the OR theater, can provide for a thoughtful exploration of how surgical illumination can be utilized to the best of its ability, ensuring a safe and smooth surgery for all.

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Time-driven activity-based costing to identify opportunities for cost reduction in pediatric appendectomy

Cited by 40 publications

References 18 publications

Using Time-Driven Activity-Based Costing as a Key Component of the Value Platform: A Pilot Analysis of Colonoscopy, Aortic Valve Replacement and Carpal Tunnel Release Procedures

Using Time-Driven Activity-Based Costing as a Key Component of the Value Platform: A Pilot Analysis of Colonoscopy, Aortic Valve Replacement and Carpal Tunnel Release Procedures

Comparison of two surgical suture techniques in uvulopalatopharyngoplasty and expansion sphincter pharyngoplasty

Current State of Surgical Lighting

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