基于时间的作业成本法对高周转率手术清单中并行诱导再设计的效用进行建模。

Time-driven activity-based costing to model the utility of parallel induction redesign in high-turnover operating lists.

机构信息

Department of Anaesthetics, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia; University of Melbourne, Parkville, Melbourne, Victoria 3010, Australia.

Department of Anaesthetics, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.

出版信息

Healthc (Amst). 2019 Sep;7(3):100355. doi: 10.1016/j.hjdsi.2019.01.003. Epub 2019 Feb 13.

DOI:10.1016/j.hjdsi.2019.01.003

PMID:30770190

Abstract

BACKGROUND

Value-based healthcare is strongly advocated to reduce the spiralling rise in healthcare expenditure. Operating room efficiency is an important focus of value-based healthcare delivery due to high costs and associated hospital revenue derived from procedural streams of care. A parallel induction design, utilising induction rooms for anesthetising patients, may improve operating room efficiency and optimise revenue. We used time-driven activity-based costing (TDABC) to model personnel costs for a high-turnover operating list to assess value of parallel induction redesign.

METHODS

We prospectively captured activity data from high-turnover surgery allocated to induction of anesthesia within the operating room (serial design) or within induction rooms prior to completion of preceding surgery (parallel design). Personnel costs were constructed using TDABC following assignment of a case-mix that integrated our activity data. This was contrasted against procedural revenue to assess value of projected case throughput.

RESULTS

Under a parallel induction design, projected operating list duration was reduced by 55 min at marginal increase (1.6%) in personnel costs as assessed by TDABC. This could facilitate an additional short duration surgical case (e.g. Wide Local Excision, with potential additional revenue of $2818 per day and $0.73 M per annum per operating room.

CONCLUSIONS

Parallel induction design reduces non-operative time at minimal increase in personnel costs for all-day, high turnover surgery. An additional short duration surgical case is likely feasible under this model and represents a value investment with minimal requirement for additional personnel resources.

IMPLICATIONS

A parallel induction design, within the constraints of finite healthcare funding, may help alleviate some of the global increase in demand for surgical capacity that accompanies an expanding and aging population.

摘要

背景

基于价值的医疗保健受到大力提倡，以降低医疗支出的螺旋式上升。由于手术过程的高成本和相关医院收入，手术室效率是基于价值的医疗保健提供的一个重要焦点。并行诱导设计，利用诱导室对患者进行麻醉，可以提高手术室效率并优化收入。我们使用时间驱动的作业成本法（TDABC）对高周转率手术清单的人员成本进行建模，以评估并行诱导重新设计的价值。