Complexity of care processes in a radiation oncology service and its implications concerning the distribution of work...

Among several different instruments developed to compare the complexity of healthcare processes, relative value units (RVUs) are among the most well-known and widely used in hospitals, but despite being a recognized management tool, in our setting, the few studies published have been based on theoretical assumptions. Our objective was to assess the level of complexity of each process in our service and to determine the RVUs generated, in order to relate complexity and costs.

During 2014, data were retrospectively collected for 840 cancer patients from the Radiation Oncology Department, Araba University Hospital. Activity times and costs were subsequently assigned to calculate RVUs for each activity, cancer subtype and treatment option.

The activity associated with the lowest cost, assigned an RVU of 1, was simulation (phase changes) in treatment, with an annual cost of €9933, while that with the highest cost, assigned the greatest number of RVUs, was administration of treatment by radiotherapy technicians (RTTs) (€633,754 and 63.80 RVUs). The care process that consumed the most resources was adjuvant treatment of breast cancer (€998,070), equivalent to 364.62 RVUs compared to the cheapest subtype of adjuvant treatments or 2440 RVUs compared to the care process that used the fewest resources overall.

The most expensive activities are those which are the most complex or consume the most resources. Knowledge of RVUs may be employed to analyse our activity and assess the possibility of increasing the efficiency of our service without prejudicing quality.