{"id":6451,"date":"2015-12-09T21:47:06","date_gmt":"2015-12-10T02:47:06","guid":{"rendered":"https:\/\/digital.hbs.edu\/platform-rctom\/submission\/the-dana-farber-successfully-sutures-up-the-surgical-efficiency-gap\/"},"modified":"2015-12-09T21:47:06","modified_gmt":"2015-12-10T02:47:06","slug":"the-dana-farber-successfully-sutures-the-surgical-efficiency-gap","status":"publish","type":"hck-submission","link":"https:\/\/d3.harvard.edu\/platform-rctom\/submission\/the-dana-farber-successfully-sutures-the-surgical-efficiency-gap\/","title":{"rendered":"The Dana-Farber Successfully Sutures the Surgical Efficiency Gap"},"content":{"rendered":"

Unlike many capital expenditures in medicine that implicate more layers of costly care, the sedation suite at the Dana-Farber Cancer Institute (DFCI) allows for the reallocation of capital and labor resources to promote patient value and process efficiency.[1]<\/a>\u00a0Traditionally, patients at medical centers such as the DFCI receive all surgical care at an affiliate hospital. For DFCI\u2019s pediatric patients, this was Boston Children\u2019s Hospital (BCH). However, the resource-intensity at a major hospital such as BCH is often unnecessary for routine procedures.[2]<\/a> By shifting the site of care from BCH to its own sedation suite, the DFCI has executed a series of strategies that successfully promote its mission of providing high-value care to patients.[3]<\/a><\/p>\n

I. Patient Stratification.<\/strong> The DFCI recognizes that different patients require different types of care. For \u201chigh-risk\u201d patients, as classified by the American Society of Anesthesiologists, care continues to be provided at BCH. However, for patients without anesthesia risks, a value-based alternative is used, optimizing clinical outcomes and patient satisfaction as a function of cost. Stratification was successful in assigning patients of lower risk classifications to receive care at the DFCI, as there were no differences between the outcomes of patients randomized to the traditional system versus the sedation suite.[3]<\/a><\/p>\n

II. Predictable Procedure Schedule. <\/strong>The sedation clinic offers a small selection of procedures, all of which are routine and predictable. While the sedation suite houses much of the same equipment as a traditional operating room, the setup and the range of resources required in the room is more limited. Most importantly, the procedures that are undertaken in the suite are extremely predicable in length, thus minimizing the cycle time of an episode of surgical care. Since emergency procedures are not scheduled at the sedation suite, the operating schedule does not have to allocate provisionary time-slots for potential emergencies.[3]<\/a><\/span>\u00a0By knowing with more certainty the procedure length and the occupancy of each space during the various phases of the procedure, labor and capital use can be optimized.<\/span><\/p>\n

III. Fewer Patient Handoffs.<\/strong> In traditional surgical settings, each clinical staff member has a specific set of roles at a very specific point during the care process. While the process works in managing large numbers of highly complex procedures, it can be unnecessarily time consuming for shorter and simpler procedures.[2]<\/a>\u00a0In contrast, the DFCI model has a single duo of nurses in addition to the core physician team see a patient through all phases of care, thus minimizing handoff time.<\/p>\n

IV.\u00a0<\/strong>Patient Satisfaction.<\/strong> Patients and their parents express advantages to receiving surgical care at the DFCI, including feeling less apprehensive about the surgery and more confident in the team\u2019s execution of care. These sentiments appear to drive perceived quality of care and cause parents to feel more comfortable leaving the recovery area after their child has been stabilized instead of unnecessarily lingering.<\/span>[3]<\/a>\u00a0This behavior thus potentially shortens the average throughput time of the recovery phase, leading to time and cost savings.<\/span><\/p>\n

V. Precise Value Measurement. <\/strong>While the precision of clinical outcomes has long been a focus of the medical community, less attention has been paid to satisfaction and true costs of care. The DFCI and BCH jointly evaluated all three of these elements in order to measure how the implementation of the sedation suite and its processes were optimizing value. Importantly, costs are not measured using the hospital-based algorithmic allocation based on charges. Rather, true costs derived from Time-Driven Activity Based Costing studies are used to derive more accurate value measurement.<\/span>[4]<\/a>,<\/span>[5]<\/a><\/p>\n

*\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 *\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 *<\/p>\n

Delivering on patient value is becoming increasingly more important as insurance companies negotiate contracts that reward value, patient outcomes\/unit cost, and penalize low-value care. Through the sedation suite initiative, the DFCI has been able to impact both components of the value equation. With respect to outcomes, the model has improved patient satisfaction while maintaining clinical outcomes. With respect to costs, there has been a dramatic reduction in costs (upward of 20%).[3]<\/a>\u00a0These cost savings can be used to cross-subsidize other procedures that are inherently more complicated, and thus may not be amenable to alternative care structures. Additionally, the time savings can facilitate more expedient surgical care at BCH, as the current surgical schedule is limited in its capacity to serve patient demands.[3]<\/a><\/p>\n

Value-based performance is a reality that will universally hit almost all healthcare institutions.[6]<\/a> Thus, continuous process innovation initiatives like the sedation suite will help to position the DFCI to excel in this new healthcare compensation climate.<\/p>\n

\n

 <\/p>\n

[1]<\/a> Moses, Hamilton, et al. “The anatomy of health care in the United States.” JAMA<\/em>\u00a0310.18 (2013): 1947-1964.<\/p>\n

[2]<\/a> Dhupar, R. et al. Delayed operating room availability significantly impacts the total hospital costs of an urgent surgical procedure. Surgery<\/em> 150, 299\u2013305 (2011).<\/p>\n

[3]<\/a> Devji, T. et al. Safety and Cost-Effectiveness of Port Removal Outside of the Operating Room among Pediatric Patients.\u00a0Journal of Surgical Research<\/em>. Submitted for Publication.<\/p>\n

[4]<\/a> Kaplan, R. S. & Porter, M. E. How to solve the cost crisis in health care. Harv. Bus. Rev.<\/em> (2011).<\/p>\n

[5]<\/a> Chan, Y. C. Improving hospital cost accounting with activity-based costing. Health Care Manage. Rev.<\/em> 18, 71\u201377 (1993).<\/p>\n

[6]<\/a> Gordon, J. E., Leiman, J. M., Deland, E. L. & Pardes, H. Delivering value: provider efforts to improve the quality and reduce the cost of health care. Annu. Rev. Med.<\/em> 65, 447\u2013458 (2014).<\/p>\n

Image courtesy of Dana-Farber.org<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

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