Yangyang R. Yu

Time-driven activity-based costing to identify opportunities for cost reduction in pediatric appendectomy

PURPOSE As reimbursement programs shift to value-based payment models emphasizing quality and efficient healthcare delivery, there exists a need to better understand process management to unearth true costs of patient care. We sought to identify cost-reduction opportunities in simple appendicitis management by applying a time-driven activity-based costing (TDABC) methodology to this high-volume surgical condition. METHODS Process maps were created using medical record time stamps. Labor capacity cost rates were calculated using national median physician salaries, weighted nurse-patient ratios, and hospital cost data. Consumable costs for supplies, pharmacy, laboratory, and food were derived from the hospital general ledger. RESULTS Time-driven activity-based costing resulted in precise per-minute calculation of personnel costs. Highest costs were in the operating room (

Time-driven activity-based costing: A dynamic value assessment model in pediatric appendicitis☆

747.07), hospital floor (

Can the Diagnosis of Appendicitis Be Made Without a Computed Tomography Scan

388.20), and emergency department (

Use of standardized visual aids improves informed consent for appendectomy in children: A randomized control trial

296.21). Major contributors to length of stay were emergency department evaluation (270min), operating room availability (395min), and post-operative monitoring (1128min). The TDABC model led to

Perioperative determinants of transient hypocalcemia after pediatric total thyroidectomy

1712.16 in personnel costs and

Magnet foreign body ingestion: rare occurrence but big consequences

1041.23 in consumable costs for a total appendicitis cost of

A prospective same day discharge protocol for pediatric appendicitis: Adding value to a common surgical condition

2753.39. CONCLUSION Inefficiencies in healthcare delivery can be identified through TDABC. Triage-based standing delegation orders, advanced practice providers, and same day discharge protocols are proposed cost-reducing interventions to optimize value-based care for simple appendicitis. LEVEL OF EVIDENCE II.

Are Foley catheters needed after minimally invasive repair of pectus excavatum

OBJECTIVES Healthcare reform policies are emphasizing value-based healthcare delivery. We hypothesize that time-driven activity-based costing (TDABC) can be used to appraise healthcare interventions in pediatric appendicitis. METHODS Triage-based standing delegation orders, surgical advanced practice providers, and a same-day discharge protocol were implemented to target deficiencies identified in our initial TDABC model. Post-intervention process maps for a hospital episode were created using electronic time stamp data for simple appendicitis cases during February to March 2016. Total personnel and consumable costs were determined using TDABC methodology. RESULTS The post-intervention TDABC model featured 6 phases of care, 33 processes, and 19 personnel types. Our interventions reduced duration and costs in the emergency department (-41min, -

Injury patterns of child abuse: Experience of two Level 1 pediatric trauma centers

23) and pre-operative floor (-57min, -

Evaluating quality of life of extracorporeal membrane oxygenation survivors using the pediatric quality of life inventory survey

18). While post-anesthesia care unit duration and costs increased (+224min, +