Using data to measure improvement efforts.
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Data Collection↗
Biomedical subjects
K Hargrave
Publications and source records attributed to K Hargrave.
Standardizing laparoscopic procedure time and determining the effect of patient age/gender and presence or absence of surgical residents during operation. A prospective multicenter trial.
BACKGROUND: Most of the expense of laparoscopic cholecystectomy (LC) is incurred while the patient is in the operating room (OR). Half of this operating room cost is equipment and the other half is personnel. What is an acceptable LC procedure time and how much variation is there? What are the effects of age, gender, and expertise on the mean LC procedure time? METHODS: A prospective, multicenter gathering of LC procedure times and task component times was performed through the cooperative effort of members of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) at 11 hospitals. The effect of LC time of age, gender, and surgical resident was recorded. RESULTS: The mean LC time for 359 cases was 73 +/- 28 min. The percent of this LC time for the following component tasks included: to place and remove trocars, 34%; total dissection time, 40%; intraoperative cholangiogram, 15%; and removing the gallbladder, 7%. Age and gender did not change LC time, but the presence of a surgical resident prolonged LC time from 53 to 79 min due to an increase in all LC component task times. CONCLUSIONS: LC time was globally calibrated in 11 North American hospitals and was found to be affected by expertise but not by gender or age. The mean and standard deviation of LC time can be used for purposes of self-assessing quality performance.
Age Factors↗
A prospective cost analysis of pancreatoduodenectomy.
BACKGROUND: In our cost-conscious health care system hospitals are finding that costs are as important as charges or reimbursements, especially as hospitals compete for managed care contracts. We have prospectively gathered cost data for more than 60 common operations performed at our institution over the last 3 years. METHODS: Over a 25-month period, from January 1993 to February 1995, 30 pancreaticoduodenectomy procedures were performed for which cost data were available. Cases were divided according to diagnosis (neoplastic or benign) and were evaluated for complications which prolonged length of stay (LOS). Costs were analyzed by an item-by-item prospective micro-cost analysis technique. Items were grouped into two areas: operating room (OR) costs and hospital (ward) costs. OR costs included disposable equipment, nondisposable equipment, OR room, OR staff, postanesthesia care, and anesthesia costs. Ward costs included hospital room, pharmacy, and radiology costs. RESULTS: OR costs for the 30 PD patients were similar and represented approximately 21% of total hospital costs. Of the 30 patients, complications resulting in a prolonged LOS occurred in 10 (33%): intra abdominal abscess in 3 (2 with pancreatic leaks), superficial marginal ulceration in 2, delayed return of gastrointestinal function in 2 (1 with pulmonary edema) and 1 each of bile leak, urosepsis, and chylous ascites. No cost differences were observed when comparing neoplasm versus chronic pancreatitis for all parameters. When comparing patients who had complications versus those who did not, however, there was a statistically significant cost difference for both hospital ward or total costs. Regardless of whether a PD was performed for neoplastic or benign disease, postoperative complications increased hospital ward costs by 76% due to increased LOS. CONCLUSIONS: This cost analysis study is an example of the methodology that would allow surgeons to investigate any common surgical procedure by first identifying areas of increased costs. This quantitative knowledge focuses the clinician on areas to improve quality which will then lower costs.
Chronic Disease↗
A prospective cost analysis of laparoscopic cholecystectomy.
BACKGROUND: In order to improve the value of laparoscopic cholecystectomy (LC), we completed a prospective micro-cost analysis at a large, multispecialty referral hospital. METHODS: After a line-item cost database had been established, the following cost data were retrieved over a 1-year period (May 1993 through May 1994): operating room (OR), radiology, pharmacy, anesthesia supplies, recovery room, and hospital room. OR cost data was further divided into costs for room-staff, room setup, radiology, plus disposable and nondisposable equipment. Sixty uncomplicated LC cases were collected (30 cases each for 2 surgeons to examine the surgeon variable). RESULTS: Sixty percent of the hospital costs occurred in the OR. Disposable laparoscopic equipment accounted for 17% of the total hospital costs and 28% of the OR costs. Staff charges in the OR (cost estimated by the hospital using minutes in the LC room) represented 24% and 41%, respectively, of the above costs to the hospital. CONCLUSIONS: The areas in which hospitals and surgeons can improve the surgical value package (ie, decrease costs while maintaining quality) are in disposable equipment and efficient minimization of in-the-room time.
Cholangiography↗