In-Hospital Delays Result in Worse Patient Outcomes and Higher Cost After Cardiac Surgery

Contemporary reimbursement systems allow hospitals to maintain profitability by offering procedural services. However, increasing procedural volume can be met with structural inefficiencies that in turn cause delays, worse patient outcomes, and increased cost.

A multidisciplinary team assessed operations and outcomes at the Heart and Vascular Center at Yale New Haven Hospital, a tertiary academic medical center. Data were analyzed retrospectively to assess delays in transferring patients between care environments, patient outcomes, and cost. An intervention was implemented over 90 days, with follow-up analysis. Interventions were based off principles of dynamic work design-an emerging management science framework promoting human-centered work design.

Before intervention, delay in patient transfer from operating rooms to the intensive care unit (ICU) was associated with statistically significantly longer ICU length of stay (13% increase) and higher blood loss (16% increase). Also increased were the 30-day readmission rate (10%) and 30-day mortality rate (34%). Delays imposed an additional cost of $3,509,621. A tipping point of weekly surgical volume was identified above which delays occurred. After implementing operational changes, 16% fewer patients were delayed, and ICU length of stay decreased by 19%. No significant change occurred in surgical volume, 30-day mortality, 30-day readmission, or readmission to the operating room or ICU. However, costs decreased by 19%.

Operational assessment and dynamic work design can be used to help staff manage increasing case volume by improving efficiency while maintaining quality of care at reduced cost to the system.