Study: Two-hour delay in OR increases costs by 39%
A two-hour delay in operating room availability for urgent cases increases costs to the hospital by 39 percent, according to a study published in the August issue of Surgery. The authors found the longer gap times and higher costs occurred during peak business hours, and suggested that strategies to maximize daytime OR use with elective surgeries at the expense of urgent cases ultimately result in inefficient care.
Rajeev Dhupar, MD, MBA, of the Department of Surgery at University of Pittsburgh Medical Center in Pittsburgh, and colleagues conducted a retrospective review of 453 patients who underwent appendectomies for appendicitis between 2004 and 2009 at a single hospital. They used an OR database matched with hospital data and chart reviews to determine patient demographics, operative characteristics and pathologic diagnoses. Gap time was defined as time from scheduling the case to surgery start, and total loaded costs included direct and indirect costs for caring for the patient.
They found that cases with gap times of more than two hours cost an average of $9,558 while the cost for cases with gap times under two hours was on average $6,862. Surgery, nursing and laboratory costs were statistically significant contributors to the cost differences.
Patients in each time gap group had similar medical and surgical complexity and a similar duration of stay when duration was modified to include gap times. Shortest time gaps occurred between 11 p.m. and 7 a.m. The authors noted that 7 a.m. to 3 p.m. typically accommodates elective cases and is filled to capacity to maximize resources, followed by a wind-down period. At night, the OR is organized to handle only urgent and emergent cases.
“It seems that less OR availability for urgent cases is associated with increased costs, which suggests inefficient care when the OR volume is at or near peak capacity and not caused by differences in staffing strategy or other factors,” Dhupar et al wrote. They called this finding surprising and counterintuitive, and attributed it to management practices.
“Although maximum daytime operating room use might offset fixed costs in that single cost center, this could be negated by a higher overall cost of care for urgent cases and begs the question whether this inefficiency also impacts elective procedures,” they wrote.
The study analyzed costs to the hospital and not to payors, but the authors argued that it is reasonable to believe hospital costs will impact healthcare costs. They acknowledged that the total loaded hospital costs did not represent variable costs. The study did not include data from the emergency department, which the researchers deemed unreliable because of changes that occurred in the IT system during the study period.
They concluded that the findings for the care of patients who underwent appendectomies should hold true in most other urgent care scenarios, and recommended additional research to change management’s model from optimal capacity to optimal efficiency.
Rajeev Dhupar, MD, MBA, of the Department of Surgery at University of Pittsburgh Medical Center in Pittsburgh, and colleagues conducted a retrospective review of 453 patients who underwent appendectomies for appendicitis between 2004 and 2009 at a single hospital. They used an OR database matched with hospital data and chart reviews to determine patient demographics, operative characteristics and pathologic diagnoses. Gap time was defined as time from scheduling the case to surgery start, and total loaded costs included direct and indirect costs for caring for the patient.
They found that cases with gap times of more than two hours cost an average of $9,558 while the cost for cases with gap times under two hours was on average $6,862. Surgery, nursing and laboratory costs were statistically significant contributors to the cost differences.
Patients in each time gap group had similar medical and surgical complexity and a similar duration of stay when duration was modified to include gap times. Shortest time gaps occurred between 11 p.m. and 7 a.m. The authors noted that 7 a.m. to 3 p.m. typically accommodates elective cases and is filled to capacity to maximize resources, followed by a wind-down period. At night, the OR is organized to handle only urgent and emergent cases.
“It seems that less OR availability for urgent cases is associated with increased costs, which suggests inefficient care when the OR volume is at or near peak capacity and not caused by differences in staffing strategy or other factors,” Dhupar et al wrote. They called this finding surprising and counterintuitive, and attributed it to management practices.
“Although maximum daytime operating room use might offset fixed costs in that single cost center, this could be negated by a higher overall cost of care for urgent cases and begs the question whether this inefficiency also impacts elective procedures,” they wrote.
The study analyzed costs to the hospital and not to payors, but the authors argued that it is reasonable to believe hospital costs will impact healthcare costs. They acknowledged that the total loaded hospital costs did not represent variable costs. The study did not include data from the emergency department, which the researchers deemed unreliable because of changes that occurred in the IT system during the study period.
They concluded that the findings for the care of patients who underwent appendectomies should hold true in most other urgent care scenarios, and recommended additional research to change management’s model from optimal capacity to optimal efficiency.