Standardization of Disposable Instruments in Microvascular Breast Reconstruction: A Case Study in Cost Reduction

Brady R. Still; Laura W. Christianson; Julie M. Mhlaba; Ian P. O'Malley; David H. Song; Alexander J. Langerman

doi:10.1055/s-0036-1592427

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2017; 33(02): 092-096
DOI: 10.1055/s-0036-1592427

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Standardization of Disposable Instruments in Microvascular Breast Reconstruction: A Case Study in Cost Reduction

Brady R. Still^*

¹Pritzker School of Medicine, The University of Chicago, Chicago, Illinois

,

Laura W. Christianson^*

¹Pritzker School of Medicine, The University of Chicago, Chicago, Illinois

,

Julie M. Mhlaba

¹Pritzker School of Medicine, The University of Chicago, Chicago, Illinois

,

Ian P. O'Malley

²Department of Strategic Sourcing, Operative Performance Research Institute, The University of Chicago Medical Center, Chicago, Illinois

,

David H. Song

³Section of Plastic and Reconstructive Surgery, Operative Performance Research Institute, The University of Chicago Medical Center, Chicago, Illinois

,

Alexander J. Langerman

⁴Section of Otolaryngology–Head and Neck Surgery, Operative Performance Research Institute, The University of Chicago Medical Center, Chicago, Illinois

› Institutsangaben

Abstract

Background A key avoidable expense in the surgical setting is the wastage of disposable surgical items, which are discarded after cases even if they go unused. A major contributor to wastage of these items is the inaccuracy of surgeon preference cards, which are rarely examined or updated. The authors report the application of a novel technique called cost heatmapping to facilitate standardization of preference cards for microvascular breast reconstruction.

Methods Preference card data were obtained for all surgeons performing microvascular breast reconstruction at the authors' institution. These data were visualized using the heatmap.2 function in the gplot package for R. The resulting cost heatmaps were shown to all surgeons performing microvascular breast reconstruction at our institution; each surgeon was asked to classify the items on the heatmap as “always needed,” “sometimes needed,” or “never needed.” This feedback was used to generate a lean standardized preference card for all surgeons. This card was validated by all surgeons performing the case and by nursing leadership familiar with the supply needs of microvascular breast reconstruction before implementation. Cost savings associated with implementation were calculated.

Results Implementation of the preference card changes will lead to an estimated per annum savings of $17,981.20 and a per annum reduction in individual items listed on preference cards of 1,693 items.

Conclusion Cost heatmapping is a powerful tool for increasing surgeon awareness of cost and for facilitating comparison and standardization of surgeon preference cards.

Keywords

heat mapping - preference cards - standardization

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References
1 Matthews JB. Cost containment: think globally, act locally. Arch Surg 2010; 145 (12) 1136-1137
2 King D, Greaves F, Vlaev I, Darzi A. Approaches based on behavioral economics could help nudge patients and providers toward lower health spending growth. Health Aff (Millwood) 2013; 32 (4) 661-668
3 Stall NM, Kagoma YM, Bondy JN, Naudie D. Surgical waste audit of 5 total knee arthroplasties. Can J Surg 2013; 56 (2) 97-102
4 Kagoma Y, Stall N, Rubinstein E, Naudie D. People, planet and profits: the case for greening operating rooms. CMAJ 2012; 184 (17) 1905-1911
5 Neumann L. Streamlining the supply chain. Healthc Financ Manage 2003; 57 (7) 56-62
6 Ngu JC. Improving OR efficiency in a university medical center arthroplastic surgery service. AORN J 2010; 92 (4) 425-435
7 Farrokhi FR, Gunther M, Williams B, Blackmore CC. Application of lean methodology for improved quality and efficiency in operating room instrument availability. J Healthc Qual 2015; 37 (5) 277-286
8 Gehlenborg N, O'Donoghue SI, Baliga NS , et al. Visualization of omics data for systems biology. Nat Methods 2010; 7 (3, Suppl) S56-S68