Original researchTime-driven activity-based costing to model the utility of parallel induction redesign in high-turnover operating lists
Section snippets
Background
Optimising costs in operating rooms is of increasing importance amidst rising demand for increased surgical capacity that accompanies globally expanding and aging populations.1., 2. Although operating room running costs are high, the associated revenue from procedural streams of care form a significant source of funding for hospitals performing elective surgery.3., 4. Improving throughput of cases within existing budgetary constraints may represent an enormous cost-saving measure for hospitals
Developing process times following observational trial within operating rooms
Following institutional ethics committee approval (HREC No: LNR/16/PMCC/141), we allocated parallel or serial processing randomly across 19 all-day operating lists that predominantly comprised breast or melanoma procedures. The principal investigator recorded all process times in the operating room using a preconceived case report form. To facilitate modelling of our operating list, process time was dichotomised into operative and non-operative time periods. Operative time was defined from the
Analysis of operative and non-operative process times
In our trial of operating room redesign we observed a median non-operative duration of 35 min under a serial model of induction, compared to 24 min under a parallel design, a 31.43% improvement (Fig. 3).
The median additional anesthetic exposure time (as assessed from the completion of induction of anesthesia until entry into the operating room) under the parallel induction design was 8 min. Divided chronologically, the median duration was 15 min for the first fifteen attempts and 3 min for the
Discussion
Attempts to improve operating room suite (theatre) efficiency requires the capacity to model the surgical process times of a heterogenous case-mix and relate resource costs with surgical throughput. Our activity data yielded a median 11-min reduction in non-operative time that complements the improvements in non-operative time of 23 and 24 min in two previous studies that incorporated parallel processing alongside several other efficiency improvements (serial duration: 35 IQR 29–44 min vs.
Conclusion
Improvements to efficiency in operating rooms are an opportunity for hospitals to optimise revenue and reduce surgical waiting lists within existing budgetary confines. By combining surgical process times to model an operating list of multiple minor procedures we have facilitated application of costs using TDABC alongside projections of case throughput and admission revenue. Application of this system to assess value improvement of parallel induction redesign demonstrates an all-day operating
Acknowledgements
The authors would like to thank the operating theatre staff of the Peter MacCallum Cancer Centre (trial assistance); Prof. Thomas Feeley and Prof. Franklin Dexter (consultation), Ariel Tong and Clinton Kitt (financial data collection); the Melbourne Clinical and Translational Sciences research platform (health economics grant support), and the reviewers of Healthcare: The Journal of Delivery Science and Innovation for their contribution to this research.
Ethics approval details
Peter MacCallum Project No: 16/99LAU RED HREC Reference No: LNR/16/PMCC/141.
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