A model to determine staff levels, cost, and productivity of hospital units

Assessing the relationships between hospital resources and activities: a systematic review

Face the challenge of minimizing their resource utilization without reducing the quality of healthcare. Achieving this aim requires precise analysis and optimization of various inputs and outputs. This paper presents a systematic review of the relationships between hospital resources (considered productivity inputs) and financial and activity outcomes (considered productivity outputs). Several electronic bibliographic databases and the Internet were searched for articles published between January 1990 and December 2013 that examined the relationships between hospital resources and financial and activity outcomes. We assessed the quality of the study design, the nature of the sample, input and output indicators, and the statistical methods used for each selected study. Thirty-eight original papers were selected. Data Envelopment Analysis (DEA) and Stochastic Frontier Analysis (SFA) were the most statistical methods used. Based on our analysis, we retained 18 input and 19 output indicators that could constitute the basis for hospital productivity benchmarking. Selecting a small set of shared economic and activity indicators is relevant for assessing the productivity of a hospital, measuring trends and performing national or international benchmarking. Such indicators should be combined with quality measures for a comprehensive evaluation approach.

Development and Validation of a Scale to Measure Work-Related Fatigue and Recovery: The Occupational Fatigue Exhaustion/Recovery Scale (OFER)

OBJECTIVE

Various empirical studies link persistent failure to recover from acute fatigue to the evolution of chronic fatigue. However, existing fatigue measurement scales do not tend to distinguish between acute and chronic fatigue elements well, and none include a measure of effective recovery from fatigue.

METHODS

The 15 item Occupational Fatigue Exhaustion Recovery (OFER) scale has been developed and validated in three study populations specifically to measure work-related fatigue.

RESULTS

The OFER scale possesses robust, gender-bias free psychometric characteristics. Its three subscales identify and distinguish between chronic work-related fatigue traits, acute end-of-shift states and effective fatigue recovery between shifts.

CONCLUSION

These studies confirm the mediating role of intershift-shift recovery in the evolution of adaptive end-of-shift fatigue states to maladaptive persistent fatigue traits. The OFER scale is suggested as a potentially valuable new tool for use in work-related fatigue research.

Conventional radiography, rapid MR imaging, and conventional MR imaging for low back pain: activity-based costs and reimbursement

PURPOSE

To incorporate personnel and equipment use time in an activity-based cost comparison of conventional radiography and conventional and rapid magnetic resonance (MR) imaging for low back pain (LBP).

MATERIALS AND METHODS

At each of four Seattle Lumbar Imaging Project (SLIP) sites, patients were randomized to undergo conventional radiography or rapid MR imaging of the lumbar spine. For sample SLIP patients and for similar non-SLIP patients undergoing conventional lumbar spine MR imaging as usual care in calendar year 2000, measured imaging room use and technologist and radiologist times were multiplied by costs per minute of standard equipment acquisition, personnel compensation, and related expenses. Resulting provider-perspective costs and Seattle area Medicare reimbursements for conventional MR imaging and radiography for calendar year 2001 were used to estimate future "normative" reimbursement for rapid MR imaging.

RESULTS

For 23 conventional radiography, 27 rapid MR imaging, and 38 conventional MR imaging examinations timed in calendar year 2000, all rapid MR imaging times exceeded those of conventional radiography but were less than those of conventional MR imaging. All 0.3- and 0.35-T MR imaging room and technologist times exceeded those for 1.5-T MR imaging. Average costs (in 2001 dollars) were $44 for conventional radiography, 126 US dollars for 1.5-T rapid MR imaging, 128 US dollars for 0.3-0.35-T rapid MR imaging, 267 US dollars for 1.5-T conventional MR imaging, and 264 US dollars for 0.3-0.35-T conventional MR imaging. Conclusions regarding cost differences between conventional radiography and rapid MR imaging were robust to plausible parameter value changes evaluated in sensitivity analyses. Conventional radiography reimbursement was 44 US dollars. Applying the ratio of reimbursement (620 US dollars) to costs (264-267 US dollars) for conventional MR imaging to rapid MR imaging costs predicted reimbursement of 292-300 US dollars for the new modality.

CONCLUSION

Times and costs for rapid MR imaging are roughly three times those for conventional radiography but about half those for conventional MR imaging for LBP. While current conventional radiography costs exceed reimbursement, current conventional MR and projected rapid MR imaging reimbursements exceed costs.

Distribution of emergency department costs

STUDY OBJECTIVE

To report the distribution of emergency department costs by category of expense and level of patient urgency.

METHODS

Cost-to-charge and relative-value methods were used to determine direct and indirect physician, facility, supply, pharmacy, laboratory, radiology, and miscellaneous costs for 24,010 ED patients. Explicit criteria were used to classify patient visits as nonurgent, semiurgent, or urgent.

RESULTS

For all patients, the average costs were physician, $64; facility, $84; laboratory, $21; radiology, $24, and total, $209. Laboratory and radiology costs accounted for 5% of the total costs for nonurgent visits and 23% of the total costs for urgent visits.

CONCLUSION

The distribution of ED costs varies significantly according to the urgency of the medical condition. For nonurgent patient visits, most costs are represented by the hospital facility and ED physicians' costs. Ancillary services represent a much greater proportion of costs for patients with urgent conditions. Although reduced test-ordering might result in some savings among patients with urgent conditions, overall improved cost efficiency can be achieved only through reductions in the fixed costs of operation of hospital EDs.

Applications of staffing, scheduling, and budgeting methodologies to hospital ancillary units

A computer-aided methodology for integrating the budgeting, staffing, and labor productivity systems of Ancillary Services using Respiratory Therapy as an example is presented. The data needed, staffing computations and schedules, and productivity analysis are presented and discussed. A summary of the predicted savings and other benefits for the application hospital are presented with comparisons to present productivity systems.