PAPS PaperTime-driven activity-based costing to identify opportunities for cost reduction in pediatric appendectomy☆,☆☆
Section snippets
Material and methods
The study protocol was reviewed and approved by the institutional review board (H-37947). We performed a retrospective review of all simple appendicitis patients who underwent an appendectomy at our institution during a 6-month period in 2013. We first identified the phases of care for a simple appendicitis hospital episode. To create a preliminary process map, we held process mapping sessions with personnel involved in each phase of care to understand the clinical workflows. The goal of these
Phases of care for simple appendicitis
We identified seven phases of care for a complete simple appendicitis cycle of care. The phases in order from admission to discharge were waiting room, ED, pre-operative floor, holding, OR, PACU, and hospital floor. Time stamp data for 149 simple appendicitis patients were included in this analysis and total duration of each phase of care is shown in Table 1. Monitoring on the hospital floor before and after surgery (24 h and 51 min) and evaluation in the emergency department (4 h and 30 min)
Discussion
Time-driven activity-based costing provides detailed information on resource utilization and cost and can be used to identify areas of inefficiency. These then can be targeted by patient-centered healthcare management initiatives. Additionally, the determination of individual resource capacity cost rates allowed us to understand the impact reallocating resources have on cost.
We found the operating room phase of care to be the highest contributor to costs. The high cost of this phase of care is
Conclusions
We report our experience with applying TDABC to the management of a large volume pediatric surgical condition such as simple appendicitis. We found that critical appraisal of resource utilization during process mapping sessions can successfully engage providers in process assessment. In addition, TDABC can be used to identify inefficiencies in healthcare delivery by highlighting processes that currently are redundant or lead to unnecessary wait times. The interventions we propose: triage-based
Acknowledgement
We acknowledge Professor Robert S. Kaplan and Professor Michael Porter along with their staff at the Harvard Business School Institute for Strategy and Competitiveness, in particular Mahek Shah and Derek Haas, for their support and guidance of our work.
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2020, Journal of Pediatric UrologyCitation Excerpt :Prospective stopwatch timing was performed from June 2017 until October 2017 for 13 unilateral RALP cases to validate and elucidate retrospective time stamps. As previously performed by Yu et al. [11], the prospective data was applied to the retrospective data from RALP procedures from FY16, calculating the average fraction of time each professional is involved in each time stamp. Cost analyses were performed to calculate the cost of personnel, room time and equipment for each of the FY16 RALP cases.
Advances in Value-Based Healthcare by the Application of Time-Driven Activity-Based Costing for Inpatient Management: A Systematic Review
2020, Value in HealthCitation Excerpt :Healthcare strategies oriented toward value can generate a positive impact on patients and providers, contributing to a more efficient health system.16 Among the possible contributions of the TDABC methodology are cost savings achieved by improved schedule management of operating rooms,23,37 better education of professionals in patient-centered care achieved by the providers’ engagement in the design of the patient care trajectory,38 the redesign and optimization of clinical and administrative activities during the entire perioperative process,31,36 the identification of care benchmarks when the method is applied in multiple centers,35 and the reduction in time spent in the postanesthesia care unit. These are some of the examples that were identified in the sample of studies reviewed.
Time-Driven Activity-Based Costing in Radiology: An Overview
2020, Journal of the American College of RadiologyCitation Excerpt :TDABC has gained popularity in health care as a method of quantifying direct costs associated with specific health-related operations or care processes. Processes can be large or small and are defined as care- or operations-related episodes, such as patient flow through an outpatient CT department, routine laboratory testing, or surgical workflow for an appendectomy [3-7]. Cost in this paradigm is commonly viewed from the perspective of costs incurred by the department, hospital, or health system, rather than costs to payers or patients.
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Disclosures: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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Type of study: Economic analysis.