Morris Lilah F, Romero Arenas Minerva A, Cerny Jeffrey, Berger Joel S, Borror Connie M, Ong Meagan, Cayo Ashley K, Graham Paul H, Grubbs Elizabeth G, Lee Jeffrey E, Perrier Nancy D
Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Northwest Medical Center, Tucson, AZ.
Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
Surgery. 2014 Dec;156(6):1441-9; discussion 1449. doi: 10.1016/j.surg.2014.08.068. Epub 2014 Nov 11.
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.
我们评估了标准（全）甲状腺切除术围手术期流程的效率、一致性和适宜性，并制定了一项有价值的策略来减少变异性和浪费。
我们的多学科团队评估了由3名外科内分泌学家实施的住院时间<23小时的标准甲状腺切除术。我们使用名义组技术、流程图表和根本原因分析来评估6个围手术期流程。计算了改进措施预计带来的成本、费用和资源减少情况。
标准甲状腺切除术的总费用中位数为27,363美元（n = 80；差异为48,727美元）。手术科室与麻醉科室之间的围手术期协调可以消除不必要的检查（费用可能减少1,505美元）。门诊手术室的非手术时间较短（43分钟对52分钟；P <.001）。一致的排班可以使每例费用减少585.49美元。通过将手术托盘上20%的非一次性器械减少，我们可以使每例无菌处理成本降低13.30美元。修改术后医嘱可以使每位患者的费用减少643美元。总体而言，这项综合分析表明预计每年成本/费用减少超过20万美元。
围手术期流程分析显示，对于单一的、假定统一的手术，存在很大的变异性。系统评估有助于发现提高效率、减少不必要的浪费和程序/器械使用的机会，并专注于以患者为中心的优质护理。这种多学科策略可以大幅降低常见手术的成本/费用。
