Division of Pediatric Surgery, Department of Surgery University of Washington, Seattle Children's Hospital, Seattle, WA 98105, USA.
J Pediatr Surg. 2013 Sep;48(9):1843-9. doi: 10.1016/j.jpedsurg.2012.11.045.
We hypothesize that standardizing operative equipment, and reducing variability can safely achieve cost reduction.
We retrospectively measured supply costs, operative time, intra-operative complications, and length of stay in a cohort of 145 patients at a children's hospital who underwent a laparoscopic appendectomy. A standardized preference card for laparoscopic appendectomy was developed and implemented. Data were prospectively collected on 101 consecutive patients and compared to the retrospective cohort using multiple linear regression. A survey assessing the perception of surgeons, nurses and scrub technologists of the impact of standardization on patient safety, patient care, OR efficiency, and cost was conducted. Wilcoxon rank sum test was used to evaluate associations between clinical role and years of experience with the total level of agreement on the survey.
A 20% average reduction was achieved in supply cost per case, with no significant change in operative time (p=0.14), total time in OR (p=0.15), or length of stay (p=0.60). No intra-operative complications were identified in either group. Survey participants agreed that standardization improves cost and safety. Nurses tended to have greater agreement that standardization improved efficiency and patient care compared to other roles (p=0.06).
Standardization of operative equipment can result in a significant cost reduction without impacting quality or delivery of care. Based on average case number per year, a total annual cost savings of >$41,000 could be realized. Survey participants agree that standardization improves cost and patient safety, yet perceptions regarding the impact on efficiency and patient care varied by occupation.
我们假设，标准化手术设备并减少变异性可以安全地实现成本降低。
我们回顾性地测量了一家儿童医院 145 例腹腔镜阑尾切除术患者的供应成本、手术时间、术中并发症和住院时间。制定并实施了腹腔镜阑尾切除术标准化偏好卡。前瞻性收集了 101 例连续患者的数据，并使用多元线性回归与回顾性队列进行比较。对外科医生、护士和手术室技师进行了一项调查，评估他们对标准化对患者安全、患者护理、手术室效率和成本的影响的看法。使用 Wilcoxon 秩和检验评估临床角色与经验年限与对调查的总一致性之间的关联。
每个病例的供应成本平均降低 20%，手术时间无显著变化（p=0.14），手术室总时间（p=0.15）或住院时间（p=0.60）无变化。两组均未发生术中并发症。调查参与者认为标准化提高了成本和安全性。与其他角色相比，护士更倾向于认为标准化提高了效率和患者护理（p=0.06）。
标准化手术设备可以显著降低成本，而不会影响质量或护理的提供。基于每年的平均病例数，每年可节省超过 41,000 美元的总成本。调查参与者认为标准化提高了成本和患者安全性，但对效率和患者护理的影响的看法因职业而异。
