Portal de Periódicos da CAPES

Streamlining variability in hospital charges for standard thyroidectomy: Developing a strategy to decrease waste

2014; Elsevier BV; Volume: 156; Issue: 6 Linguagem: Inglês

10.1016/j.surg.2014.08.068

1532-7361

Lilah F. Morris, Minerva A. Romero Arenas, J Cerný, Joel S. Berger, Connie M. Borror, M. C. C. Ong, Ashley K. Cayo, Paul H. Graham, Elizabeth G. Grubbs, Jeffrey E. Lee, Nancy D. Perrier,

Health Systems, Economic Evaluations, Quality of Life

We assessed the efficiency, consistency, and appropriateness of perioperative processes for standard (total) thyroidectomy and devised a valuable strategy to decrease variability and waste.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.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.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.