Elsevier

Surgery

Volume 156, Issue 6, December 2014, Pages 1441-1449
Surgery

American Association of Endocrine Surgeons
Streamlining variability in hospital charges for standard thyroidectomy: Developing a strategy to decrease waste

https://doi.org/10.1016/j.surg.2014.08.068Get rights and content

Background

We assessed the efficiency, consistency, and appropriateness of perioperative processes for standard (total) thyroidectomy and devised a valuable strategy to decrease variability and waste.

Methods

Our multidisciplinary team evaluated <23-hour stay standard thyroidectomy performed by 3 surgical endocrinologists. We used the nominal group technique, process flowcharts, and root cause analysis to evaluate 6 perioperative processes. Anticipated decreases in costs, charges, and resources from improvements were calculated.

Results

Median total charge for standard thyroidectomy was $27,363 (n = 80; $48,727 variation). Perioperative coordination between surgery and anesthesia clinics could eliminate unnecessary testing (potential decrease in charges of $1,505). Nonoperating room time was less in the outpatient operating room (43 vs 52 minutes; P < .001). Consistent scheduling could decrease charges by $585.49 per case. By decreasing 20% of nondisposable instruments on the surgical tray, we could decrease sterile processing costs by $13.30 per case. Modification of postoperative orders could decrease charges by $643 per patient. Overall, this comprehensive analysis identified an anticipated decrease in cost/charge of >$200,000 annually.

Conclusion

Perioperative process analyses revealed wide variability for a single, presumed uniform procedure. Systematic assessment helped to identify opportunities to improve efficiency, decrease unnecessary waste and procedures/instrument usage, and focus on patient-centered, quality care. This multidisciplinary strategy could substantially decrease costs/charges for common operative procedures.

Section snippets

Methods

We formed a multidisciplinary team that included endocrine surgeons (LFM and NDP), an anesthesiologist (JC), mid-level providers (JSB and MO), operating room (OR) and postanesthesia care unit nurses, a clinical business manager, a patient, and an industrial and systems engineer facilitator (CB). We undertook a systems engineering-based study of 6 perioperative processes: Preoperative clinic, preoperative holding area, OR, postanesthesia care unit, overnight observation, and postoperative

Results

Baseline data for all total thyroidectomy cases performed at MD Anderson during 2011 (n = 419) was obtained. Standard thyroidectomy (see Methods for definition) included 80 cases (19%). The key action steps in our process evaluation are listed below.

Discussion

With national emphasis on decreasing the costs of health care, improving quality, and increasing transparency, we investigated comprehensively our process for a single, common procedure performed by 1 academic, high-volume endocrine surgical group. We describe our surgeon-led project: Systematic assessment of perioperative processes that helped us to identify opportunities to improve efficiency, decrease waste, and focus on patient-centered quality of care. This type of comprehensive,

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Disclosures: We have no financial or commercial interests to disclose.

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