Quality care and cost-effectiveness. An organized approach to problem solving.

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.