Related Experiment Videos
Reduction of hospital resources utilization in vascular surgery: a four-year experience
S P Roddy1, T F O'Donnell, M D Iafrati
1Division of Vascular Surgery, New England Medical Center, Boston, Mass, USA.
Insights
Implementing best practice plans in vascular surgery significantly reduced hospital resource utilization and costs for carotid endarterectomy and infrainguinal bypass grafting over four years.
Area of Science:
- Vascular Surgery
- Health Services Research
- Healthcare Management
Background:
- Managed care models, including risk and capitated contracts, aim to reduce healthcare resource utilization.
- Increasing enrollment of Medicare beneficiaries in managed care necessitates efficient resource management in vascular surgery.
- Academic vascular surgery practices can implement best practice plans to optimize resource use.
Purpose of the Study:
- To evaluate the impact of a 4-year experience with best practice plans on resource management in an academic vascular surgery setting.
- To assess changes in hospital length of stay, resource utilization, and costs for specific vascular procedures.
- To identify factors contributing to resource reductions and cost savings.
Main Methods:
- Analysis of hospital cost data for 257 carotid endarterectomies and 175 infrainguinal bypass procedures from FY1994-1997.
- Inclusion of total hospital and ICU length of stay, laboratory, pharmacy, radiology, and operating room costs.
- Implementation of best practice plans focused on optimizing patient care pathways and resource allocation.
Main Results:
- Carotid endarterectomy: 66% decrease in length of stay, 86% reduction in radiology, and 55% in pharmacy utilization by FY97.
- Significant cost savings of 30% for carotid endarterectomies, reducing average direct hospital costs.
- Infrainguinal bypass grafts showed a 28% cost decrease for uncomplicated cases; resource utilization metrics remained stable.
- Key changes included eliminating routine postoperative labs and shifting diagnostic preferences.
Conclusions:
- Integrated case management involving vascular surgeons, house staff, nurses, and social workers dramatically reduced length of stay and resource use.
- Operating room costs became a more significant proportion of total direct costs as other resources were reduced.
- Future cost reductions for these vascular procedures will largely depend on optimizing operating room efficiency and time.
Purpose:
Managed care whether through risk or through capitated contracts results in reduction in resources, reduced length of hospital stay, and reduced utilization of hospital resources (collectively referred to as resource reductions). These resource reductions will become even more noticeable as a greater proportion of Medicare patients who need vascular operations select a managed-care senior product. We examined the results of a 4-year experience with resource management in an academic vascular surgery practice during which best practice plans were developed and implemented.
Methods:
We analyzed hospital cost data, which included both total hospital and intensive care unit length of stay, average units per operation for laboratory, pharmacy, and radiology services and operating room and direct hospital costs for 257 carotid endarterectomies performed over fiscal years (FY) 1994, 1995, 1996, and 1997 (6 month data) and 175 infrainguinal bypass procedures performed during the same period.
Results:
For carotid endarterectomy, length of stay decreased 66% over the 4-year period to an average of 2.07 days in FY97. Both radiology and pharmacy utilization were reduced after the first year of institution of best practice plans (56% and 32% respectively) with 4-year total reductions of 86% and 55% by FY97. The most notable changes included elimination of routine postoperative laboratory testing, use of aspirin rather than low-molecular-weight dextran, emphasis on oral rather than intravenous vasoactive drugs, and routine use of duplex scanning alone rather than angiography for diagnosis after FY94-95. The length of operating room time for carotid endarterectomy remained relatively constant from FY94 to FY97. As a result of these multiple factors, our study showed a 30% decrease in total average direct hospital costs for carotid endarterectomy from $9974 to $7002 in this 4-year period. Infrainguinal bypass graft procedures showed a progressive decrease in total cost of 28% for patients without complications to $15,186 but remained unchanged for those with complications. Laboratory use, pharmacy use, and radiology use were not significantly different.
Conclusions:
Case management for patients undergoing carotid endarterectomy and infrainguinal bypass grafting involving an integrated team of vascular surgeons, surgical house staff, a dedicated vascular nurse, and a social work case manager resulted in dramatic reductions both in length of stay and hospital resource utilization. As these costs decreased, operating room expenses assumed increasing importance. Operating room costs account for 60% of the direct costs of carotid endarterectomy and a comparable percentage for uncomplicated infrainguinal bypass grafting. Further substantial reductions in direct hospital costs will depend primarily on reductions in operating room costs, particularly those related to length of time in the operating room.