Lilah F Morris1, Minerva A Romero Arenas2, Jeffrey Cerny3, Joel S Berger3, Connie M Borror4, Meagan Ong2, Ashley K Cayo2, Paul H Graham2, Elizabeth G Grubbs2, Jeffrey E Lee2, Nancy D Perrier5. 1. Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Northwest Medical Center, Tucson, AZ. 2. Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX. 3. Department of Anesthesiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX. 4. School of Mathematical and Natural Sciences, Arizona State University West, Phoenix, AZ. 5. Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX. Electronic address: NPerrier@mdanderson.org.
Abstract
BACKGROUND: We assessed the efficiency, consistency, and appropriateness of perioperative processes for standard (total) thyroidectomy and devised a valuable strategy to decrease variability and waste. METHODS: Our multidisciplinary team evaluated <23-hour stay standard thyroidectomy performed by 3 surgical endocrinologists. We used the nominal group technique, process flowcharts, and root cause analysis to evaluate 6 perioperative processes. Anticipated decreases in costs, charges, and resources from improvements were calculated. RESULTS: Median total charge for standard thyroidectomy was $27,363 (n = 80; $48,727 variation). Perioperative coordination between surgery and anesthesia clinics could eliminate unnecessary testing (potential decrease in charges of $1,505). Nonoperating room time was less in the outpatient operating room (43 vs 52 minutes; P < .001). Consistent scheduling could decrease charges by $585.49 per case. By decreasing 20% of nondisposable instruments on the surgical tray, we could decrease sterile processing costs by $13.30 per case. Modification of postoperative orders could decrease charges by $643 per patient. Overall, this comprehensive analysis identified an anticipated decrease in cost/charge of >$200,000 annually. CONCLUSION: Perioperative process analyses revealed wide variability for a single, presumed uniform procedure. Systematic assessment helped to identify opportunities to improve efficiency, decrease unnecessary waste and procedures/instrument usage, and focus on patient-centered, quality care. This multidisciplinary strategy could substantially decrease costs/charges for common operative procedures.
BACKGROUND: We assessed the efficiency, consistency, and appropriateness of perioperative processes for standard (total) thyroidectomy and devised a valuable strategy to decrease variability and waste. METHODS: Our multidisciplinary team evaluated <23-hour stay standard thyroidectomy performed by 3 surgical endocrinologists. We used the nominal group technique, process flowcharts, and root cause analysis to evaluate 6 perioperative processes. Anticipated decreases in costs, charges, and resources from improvements were calculated. RESULTS: Median total charge for standard thyroidectomy was $27,363 (n = 80; $48,727 variation). Perioperative coordination between surgery and anesthesia clinics could eliminate unnecessary testing (potential decrease in charges of $1,505). Nonoperating room time was less in the outpatient operating room (43 vs 52 minutes; P < .001). Consistent scheduling could decrease charges by $585.49 per case. By decreasing 20% of nondisposable instruments on the surgical tray, we could decrease sterile processing costs by $13.30 per case. Modification of postoperative orders could decrease charges by $643 per patient. Overall, this comprehensive analysis identified an anticipated decrease in cost/charge of >$200,000 annually. CONCLUSION: Perioperative process analyses revealed wide variability for a single, presumed uniform procedure. Systematic assessment helped to identify opportunities to improve efficiency, decrease unnecessary waste and procedures/instrument usage, and focus on patient-centered, quality care. This multidisciplinary strategy could substantially decrease costs/charges for common operative procedures.
Authors: Richard Capra; Stefano A Bini; Dawn E Bowden; Katherine Etter; Matt Callahan; Richard T Smith; Thomas Parker Vail Journal: Medicine (Baltimore) Date: 2019-02 Impact factor: 1.817
Authors: Ian Hill; Lindsey Olivere; Joshua Helmkamp; Elliot Le; Westin Hill; John Wahlstedt; Phillip Khoury; Jared Gloria; Marc J Richard; Laura H Rosenberger; Patrick J Codd Journal: JAMIA Open Date: 2022-01-19
Authors: Bruno Miranda Dos Santos; Flavio Sanson Fogliatto; Carolina Melecardi Zani; Fernanda Araujo Pimentel Peres Journal: BMC Health Serv Res Date: 2021-02-20 Impact factor: 2.655