Tomatis L A, Schlosser R J, Riahi M, Stockinger F S, Kanten R
J Thorac Cardiovasc Surg. 1979 Mar;77(3):448-51.
Hospital costs and the fees of the surgeon, assistant, anesthesiologist, and cardiologist were reviewed in a community hospital doing 425 cardiac operations in the year 1977. Each item of the bill was analyzed and discussed with each department of the hospital. Changes made in the routine saved approximately $1000 per patient--16% for patients having mitral valves replacement (MVR), 15% for those having aortic valve replacement (AVR), 21% for those having saphenous vein bypass grafts (SVBG), and 23% for pediatric cases. The areas most likely to yield economic reductions without alteration of the quality of care are operating room, patient room, respiratory therapy, and pharmacy. Making the nurses, scrub technicians, surgical assistants, residents, and staff surgeons aware of the cost of each item and periodically discussing the alternatives could yield surprisingly large savings.
1977年，一家社区医院开展了425例心脏手术，对医院成本以及外科医生、助手、麻醉师和心脏病专家的费用进行了审查。账单的每一项都经过分析，并与医院的各个科室进行了讨论。常规操作的改变为每位患者节省了约1000美元——二尖瓣置换术（MVR）患者节省了16%，主动脉瓣置换术（AVR）患者节省了15%，大隐静脉旁路移植术（SVBG）患者节省了21%，儿科病例节省了23%。在不改变护理质量的情况下，最有可能实现成本降低的领域是手术室、病房、呼吸治疗和药房。让护士、刷手技师、手术助手、住院医生和外科 staff surgeons（这里staff surgeons不太明确准确意思，可结合语境理解为在职外科医生之类）了解每项物品的成本，并定期讨论替代方案，可能会节省惊人的大量费用。
