Langell John T, Bledsoe Amber, Vijaykumar Sathya, Anderson Terry, Zawalski Ivy, Zimmerman Joshua
Center for Medical Innovation, University of Utah, Salt Lake City, Utah; Department of Surgery, University of Utah, Salt Lake City, Utah.
Department of Anesthesia, University of Utah, Salt Lake City, Utah.
J Surg Res. 2016 Jun 15;203(2):287-92. doi: 10.1016/j.jss.2016.03.033. Epub 2016 Mar 25.
The financial health care crisis has provided the platform to drive operational improvements at US health care facilities. This has led to adoption of lean operation principles by many health care organizations as a means of eliminating waste and improving operational efficiencies and overall value to patients. We believe that standardized implementation of national practice guidelines can provide the framework to help to reduce financial waste.
We analyzed our institutional preoperative electrocardiogram (ECG) ordering practices for patients undergoing elective surgery at our institution from February-March, 2012 to identify utilization and review compliance with American Heart Association guidelines. We then implemented an ECG ordering algorithm based on these guidelines and studied changes in ordering patterns, associated cost savings and hospital billing for the same period in 2013.
From February-March 2012, 677 noncardiac surgical procedures were performed at our institution, and 312 (46.1%) had a preoperative ECG. After implementation of our evidence-based ECG ordering algorithm for the same period in 2013, 707 noncardiac surgical cases were performed, and 120 (16.9%) had a preoperative ECG. Preoperative ECG utilization dropped 63% with an annual institutional cost savings of $72,906 and $291,618 in total annual health care savings. Based on our data, US-wide implementation of our evidence-based ECG ordering algorithm could save the US health care system >$1,868,800,000 per year.
Here, we demonstrate that standardized application of a national practice guideline can be used to eliminate nearly $2 billion per year in waste from the US health care system.
医疗保健领域的财务危机为推动美国医疗机构的运营改进提供了平台。这促使许多医疗保健组织采用精益运营原则，以消除浪费、提高运营效率并提升对患者的整体价值。我们认为，全国性实践指南的标准化实施能够提供框架，有助于减少财务浪费。
我们分析了2012年2月至3月在本机构接受择期手术患者的术前心电图（ECG）开具情况，以确定其使用情况并审查是否符合美国心脏协会的指南。然后，我们根据这些指南实施了一种心电图开具算法，并研究了2013年同期开具模式的变化、相关成本节约情况以及医院计费情况。
2012年2月至3月，本机构共进行了677例非心脏外科手术，其中312例（46.1%）进行了术前心电图检查。在2013年同期实施基于循证的心电图开具算法后，共进行了707例非心脏外科手术，其中120例（16.9%）进行了术前心电图检查。术前心电图的使用率下降了63%，机构年度成本节约72,906美元，每年医疗保健总节约额为291,618美元。根据我们的数据，在美国范围内实施我们基于循证的心电图开具算法每年可为美国医疗保健系统节省超过18.688亿美元。
在此，我们证明全国性实践指南的标准化应用可用于每年从美国医疗保健系统中消除近20亿美元的浪费。
