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Filiberto AC, Loftus TJ, Crippen CJ, Hu D, Balch JA, Efron PA, Sarosi GA, Upchurch GR. Operating Room Supply Cost and Value of Care after Implementing a Sustainable Quality Intervention. J Am Coll Surg 2024; 238:404-413. [PMID: 38224109 DOI: 10.1097/xcs.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
BACKGROUND Variability in operating room supply cost is a modifiable cause of suboptimal resource use and low value of care (outcomes vs cost). This study describes implementation of a quality improvement intervention to decrease operating room supply costs. STUDY DESIGN An automated electronic health record data pipeline harmonized operating room supply cost data with patient and case characteristics and outcomes. For inpatient procedures, predicted mortality and length of stay were used to calculate observed-to-expected ratios and value of care using validated equations. For commonly performed (1 or more per week) procedures, the pipeline generated figures illustrating individual surgeon performance vs peers, costs for each surgeon performing each case type, and control charts identifying out-of-control cases and surgeons with more than 90th percentile costs, which were shared with surgeons and division chiefs alongside guidance for modifying case-specific supply instructions to operating room nurses and technicians. RESULTS Preintervention control (1,064 cases for 7 months) and postintervention (307 cases for 2 months) cohorts had similar baseline characteristics across all 16 commonly performed procedures. Median costs per case were lower in the intervention cohort ($811 [$525 to $1,367] vs controls: $1,080 [$603 to $1,574], p < 0.001), as was the incidence of out-of-control cases (19 (6.2%) vs 110 (10.3%), p = 0.03). Duration of surgery, length of stay, discharge disposition, and 30-day mortality and readmission rates were similar between cohorts. Value of care was higher in the intervention cohort (1.1 [0.1 to 1.5] vs 1.0 [0.2 to 1.4], p = 0.04). Pipeline runtime was 16:07. CONCLUSIONS An automated, sustainable quality improvement intervention was associated with decreased operating room supply costs and increased value of care.
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Affiliation(s)
- Amanda C Filiberto
- From the Department of Surgery, University of Florida Health, Gainesville, FL (Filiberto, Loftus, Crippen, Balch, Efron, Sarosi, Upchurch)
| | - Tyler J Loftus
- From the Department of Surgery, University of Florida Health, Gainesville, FL (Filiberto, Loftus, Crippen, Balch, Efron, Sarosi, Upchurch)
- Intelligent Critical Care Center (IC3), University of Florida, Gainesville, FL (Loftus, Hu)
| | - Cristina J Crippen
- From the Department of Surgery, University of Florida Health, Gainesville, FL (Filiberto, Loftus, Crippen, Balch, Efron, Sarosi, Upchurch)
| | - Die Hu
- Intelligent Critical Care Center (IC3), University of Florida, Gainesville, FL (Loftus, Hu)
| | - Jeremy A Balch
- From the Department of Surgery, University of Florida Health, Gainesville, FL (Filiberto, Loftus, Crippen, Balch, Efron, Sarosi, Upchurch)
| | - Philip A Efron
- From the Department of Surgery, University of Florida Health, Gainesville, FL (Filiberto, Loftus, Crippen, Balch, Efron, Sarosi, Upchurch)
| | - George A Sarosi
- From the Department of Surgery, University of Florida Health, Gainesville, FL (Filiberto, Loftus, Crippen, Balch, Efron, Sarosi, Upchurch)
| | - Gilbert R Upchurch
- From the Department of Surgery, University of Florida Health, Gainesville, FL (Filiberto, Loftus, Crippen, Balch, Efron, Sarosi, Upchurch)
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Desai V, Cottrell J, Sowerby L. No longer a blank cheque: a narrative scoping review of physician awareness of cost. Public Health 2023; 223:15-23. [PMID: 37595425 DOI: 10.1016/j.puhe.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES Healthcare costs have been steadily rising, and attention to cost containment in healthcare systems is increasingly important. It has been previously established that physicians lack adequate awareness of cost in health care and that by increasing awareness, costs can be reduced. This scoping review examines cost awareness of medications, investigations and procedures and identifies potential interventions that may serve to improve physician awareness. STUDY DESIGN A scoping review was performed to evaluate the literature based on established Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS A review of electronic databases was performed for studies regarding physician awareness of cost, including PubMed, Embase, Cochrane Central Register of Controlled Trials and Google Scholar. RESULTS An initial 4350 citations were identified, and 76 articles were included for full text analysis. Combined, these studies assessed 18,901 physicians. The overwhelming majority (91%) found cost awareness in physicians was low and demonstrated significant room for cost reduction. Eighteen of the 76 studies assessed an intervention to improve physician awareness of cost and used either a price list (89%) or a teaching session (11%) as the primary intervention. CONCLUSIONS Research demonstrates that there is still a lack of awareness among physicians of the costs of medications, investigations and procedures/consumables. Initial approaches using price display and teaching sessions have shown promise. Further research into best practices for education around cost, beginning in medical school and continuing into established medical and surgical practices, may lead to increased cost savings in health care.
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Affiliation(s)
- V Desai
- School of Medicine, Queen's University, Kingston, ON, Canada.
| | - J Cottrell
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - L Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
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Kushner BS, Hall B, Pierce A, Mody J, Guth RM, Martin J, Blatnik JA, Eckhouse SR. Reducing Operating Room Cost: Comparing Attending and Surgical Trainee Perceptions About the Implementation of Supply Receipts. J Am Coll Surg 2021; 233:710-721. [PMID: 34530125 DOI: 10.1016/j.jamcollsurg.2021.08.690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND As operating room (OR) expenditures increase, faculty and surgical trainees will play a key role in curbing future costs. However, supply cost utilization varies widely among providers and, despite requirements for cost education during surgical training, little is known about trainees' comfort discussing these topics. To improve OR cost transparency, our institution began delivering real-time supply "receipts" to faculty and trainees after each surgical case. This study compares faculty and surgical trainees' perceptions about supply receipts and their effect on individual practice and cultural change. STUDY DESIGN Faculty and surgical trainees (residents and fellows) from all adult surgical specialties at a large academic center were emailed separate surveys. RESULTS A total of 120 faculty (30.0% response rate) and 119 trainees (35.7% response rate) completed the survey. Compared with trainees, faculty are more confident discussing OR costs (p < 0.001). Two-thirds of trainees report discussing OR costs with faculty as opposed to 77.0% of faculty who acknowledge having these conversations (p = 0.08). Both groups showed a strong commitment to reduce OR expenditures, with 87.3% of faculty and 90.0% of trainees expressing a responsibility to curb OR costs (p = 0.84). After 1 year of implementation, faculty continue to have high interest levels in supply receipts (82.4%) and many surgeons review them after each case (67.7%). In addition, 74.3% of faculty are now aware of how to lower OR costs and 52.5% have changed the OR supplies they use. Trainees, in particular, desire additional cost-reducing efforts at our institution (p < 0.001). CONCLUSIONS Supply receipts have been well received and have led to meaningful cultural changes. However, trainees are less confident discussing these issues and desire a greater emphasis on OR cost in their curriculum.
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Affiliation(s)
| | - Bruce Hall
- Department of Surgery, Washington University; BJC HealthCare
| | - Andrew Pierce
- Perioperative Services, Barnes Jewish Hospital, St Louis, MO
| | - Jessica Mody
- Perioperative Services, Barnes Jewish Hospital, St Louis, MO
| | | | - Jackie Martin
- Perioperative Services, Barnes Jewish Hospital, St Louis, MO
| | | | - Shaina R Eckhouse
- Department of Surgery, Washington University; Perioperative Services, Barnes Jewish Hospital, St Louis, MO
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Sorber R, Dougherty G, Stobierski D, Kang C, Hicks CW, Lum YW. Cost Awareness of Common Supplies Is Severely Impaired Among All Members of the Surgical Team. J Surg Res 2020; 251:281-286. [PMID: 32199336 DOI: 10.1016/j.jss.2020.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/07/2020] [Accepted: 02/16/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Increased health care spending concerns have generated interest in reducing operating room (OR) costs, but the cost awareness of the surgical team selecting intraoperative supplies remains unclear. This work characterizes knowledge of supply cost among surgeons and OR staff in a large academic hospital and seeks to examine the role of experience and training with regards to cost insight. METHODS This work is a cross-sectional study of surgeons, trainees, nurses, and surgical technicians (n = 372) across all surgical specialties at a large academic hospital. Participants completed a survey reporting frequency of use and estimated cost for 11 common surgical supplies as well as opinions on access to cost information in the OR. Cost estimation error was expressed as the ratio of estimated-to-actual cost, and groups were compared with one-way analysis of variance and chi-squared testing. Spearman correlation (ρ) was used to describe the relationship between monotonic variables. RESULTS Overestimation error was universal and ranged widely (3.80-49.79). There was no significant difference in estimation accuracy when stratified by role or years of experience. Less expensive items had higher rates of estimation error than more expensive items (P < 0.001), and a moderately strong relationship was found between decreased item cost and increased estimation error (ρ: 0.49). The overwhelming majority (91%) of respondents expressed a desire to learn more about supply pricing. CONCLUSIONS Price knowledge of common supplies is globally impaired for entire surgical team but coexists with a strong desire to augment cost awareness. Improved access to cost information has a high potential to inform surgical decision-making and decrease OR waste.
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Affiliation(s)
- Rebecca Sorber
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
| | - Geoff Dougherty
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Damian Stobierski
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Christina Kang
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Caitlin W Hicks
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Ying Wei Lum
- Department of Surgery, The Johns Hopkins Hospital, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Kimmelstiel C, Udelson JE. Striking a balance between quality and cost in PCI. Catheter Cardiovasc Interv 2017; 89:1213-1214. [PMID: 28612419 DOI: 10.1002/ccd.27139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 11/09/2022]
Abstract
Procedural cost control will continue to be increasingly important to the bottom line of health care institutions. Reducing cost in PCI need not compromise clinical outcomes. Cost awareness can alter physician behavior, enabling monetary savings.
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Affiliation(s)
- Carey Kimmelstiel
- The Cardiac Catheterization Laboratory, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - James E Udelson
- The Cardiac Catheterization Laboratory, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
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