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A Time-Driven Activity-Based Costing Analysis of Minor Hand Procedure Room Utilization at a Single Military
Karolina A Serhan1, George C Balazs1,2, Nicholas H Lake1
1Bone & Joint Sports Medicine Institute, Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA.
Journal of Hand Surgery Global Online
|April 20, 2026
Summary
Implementing a minor procedure room for hand surgeries significantly reduced costs and patient time. This shift led to a 73.2% decrease in personnel costs and a 63.5% reduction in patient hospital time.
Area of Science:
- Healthcare Management
- Surgical Efficiency
- Cost Analysis
Background:
- Operating rooms (ORs) are often utilized for minor hand surgeries performed under local anesthesia.
- This can lead to inefficiencies in resource allocation and increased patient wait times.
- Alternative settings like minor procedure rooms (MPRs) may offer a more cost-effective solution.
Purpose of the Study:
- To quantify the financial and time-saving impact of transitioning four common hand surgeries from the OR to an MPR.
- To utilize a time-driven activity-based costing model for accurate financial assessment.
Main Methods:
- Retrospective cohort study using the Military Health System Data Repository.
- Analysis of carpal tunnel releases (CTR), deQuervian releases (dQR), trigger finger releases (TFR), and ganglion excisions (DWG) from Jan 2022 to Oct 2024.
- Development of a time-driven activity-based costing model to assess personnel costs and time.
Main Results:
- OR procedures cost significantly more per case than MPR procedures across all surgery types.
- MPR procedures resulted in substantially lower personnel-associated costs compared to OR procedures.
- MPR cohort showed a mean total hospital time of 69.22 minutes versus 189.52 minutes for the OR cohort.
- MPR cohort had a mean patient waiting time of 38.17 minutes versus 115.57 minutes for the OR cohort.
Conclusions:
- Transitioning local anesthesia hand cases from OR to MPR significantly reduced personnel-associated costs by 73.2%.
- Overall patient time in the hospital on procedure day decreased by 63.5%.
- Personnel required to support cases decreased by 42.9%.
