Effects of Case Timing and Care Team Composition on Hospital Operating Room Costs for Routine Endovascular Procedures
Rebecca Ur, Tim E Craven, Justin B Hurie, Dedra W Gaines, Dave Davis, Joshua Hirsche, Matthew Corriere, Matthew S Edwards
Wake Forest Baptist Medical Center, Winston-Salem, NC
INTRODUCTION: The contemporary healthcare environment is complex with mounting pressures to perform greater procedural volumes with less support staff to minimize costs and maximize efficiency. This report details an analysis of routine endovascular procedures performed in a hybrid operating room with dedicated vascular support staff during daytime hours compared to similar cases performed after hours with general operating room staff.
METHODS: All lower extremity endovascular cases over a 25 month period were identified using CPT codes from a query of our institutional operating room database. Emergent/urgent cases and cases with associated open surgical procedures were excluded. Cases were divided according to the time of day and available clinical support structure into two groups according to procedure start time: specialty-specific daytime (SS) with case starting between 7am and 3pm weekdays and general staff after hours for all others (AH). The resulting case list was examined by case type according to SS or AH designation and case types occurring disproportionately during either time frame were excluded to create the most similar case-type distribution among the two groups for analytic purposes. Demographics, case specifics, and cost data were then obtained from the electronic health record and our enterprise cost data warehouse. Multivariable mixed linear modeling was used to examine component costs (i.e. anesthesia, supplies, etc.) and total costs controlling for a number of factors that could affect cost.
RESULTS: 275 routine endovascular-only procedures performed on 250 patients were examined (203 SS, 47AH). AH patients were younger, more likely to be female, and less likely to be taking antiplatelet agents at the time of the procedure than SS patients. Scheduled, elective cases made up 86% of SS cases and 55% of AH cases. No significant differences in procedure specifics were observed between the groups [number and location of access site(s), type and number of interventions, etc.]. Multivariable analyses controlled for factors affecting costs (including posting type, ASA class, number of access sites, and interventional vs. diagnostic case status). Costs associated with Anesthesia (Cost Ratio 1.85, p<0.001), operating room supplies (Cost Ratio 1.45, p=0.01), and post anesthesia recovery (Cost Ratio 1.20, p=0.035) were all significantly increased in AH cases compared to SS cases. The average total hospital cost for routine endovascular cases performed AH was $9010 compared to $6143 for SS cases (Cost Ratio 1.47, p<0.001).
CONCLUSIONS:Performance of routine endovascular cases was associated with significantly less cost to the hospital system when performed by specialty specific teams during regular hospital hours with a ~50% increase in total cost associated with AH cases. In the current healthcare environment, investments in specialty-specific teams and process improvements to facilitate case performance with these teams are likely to be cost effective.
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