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Quality care and cost-effectiveness. An organized approach to problem solving
Insights
Modifying surgical practices for coronary artery bypass graft surgery significantly reduced blood product usage and costs. This approach preserved patient care quality while achieving substantial annual cost savings.
Area of Science:
- Cardiovascular Surgery
- Health Economics
- Quality Improvement
Background:
- Rising hospital costs and decreased revenue necessitate budget balancing through expense reduction.
- Curtailing expenses impacts personnel, supplies, equipment, and ultimately, the quality of patient care.
- An alternative is modifying practice patterns to reduce costs while preserving quality.
Purpose of the Study:
- To review elective class I and II coronary artery bypass graft (CABG) surgery on a cost basis.
- To identify potential cost-saving opportunities, particularly in blood and blood-product usage.
- To design and implement practice modifications that improve quality and reduce costs.
Main Methods:
- In-depth analysis of practice patterns for CABG surgery.
- Comparison of hospital data with other institutions.
- Implementation of modified practices including mediastinal drainage systems and revised transfusion protocols.
- Evaluation of cost-effectiveness of cell savers, membrane oxygenators, and automated coagulation analysis.
Main Results:
- Blood and blood-product usage reduced from 9.2 U to 3.4 U per case.
- Estimated annual cost avoidance of $111,286.
- Cell savers, membrane oxygenators, and automated coagulation analysis showed no cost advantage in routine short pump run surgeries.
- Mediastinal drainage systems and revised transfusion guidelines (no transfusions for hematocrits >25%) effectively reduced unnecessary blood product use.
Conclusions:
- Modifying traditional practice patterns in CABG surgery can significantly reduce costs without compromising quality.
- Targeted interventions, such as revised transfusion protocols and optimized drainage systems, are effective in minimizing blood product utilization.
- Not all technological interventions (e.g., cell savers) are cost-effective for routine procedures.
Abstract:
The reflexive approach to rising hospital costs and decreased revenue is to balance the budget by curtailing expenses. This places budgetary limitations on personnel, supplies, and equipment and ultimately has an impact on the quality of care. An alternative approach is to modify traditional practice patterns so that quality is preserved and costs are reduced. We reviewed elective class I and II coronary artery bypass graft surgery on a cost basis to identify potential problems. High costs in blood and blood-product usage were identified. An in-depth analysis of practice patterns was conducted, and comparisons were made between data from our hospital and other institutions. Modifications that improved quality and reduced costs were designed. Blood and blood-product usage was reduced from an average of 9.2 U to 3.4 U per case, resulting in an estimated cost avoidance of $111,286 per year. No cost advantage was observed with the use of cell savers, membrane oxygenators, or automated coagulation analysis in these routine short pump run surgeries. Though not cost-effective, the cell saver did allow the salvage of 2 U of blood per case. Mediastinal drainage systems (Sorenson) as well as reeducation regarding the safe, albeit low, hematocrit (no transfusions for hematocrits above 25% [0.25]) were effective in eliminating unnecessary use of potentially dangerous and expensive blood products.