Abstract No. 599 Time-driven activity-based costing in interventional radiology: a pilot study

Abstract

Healthcare represents 17% of the US’s GDP and is riddled with waste. Before managing or improving high costs, more effective methods are needed to measure them. Time-driven, activity-based costing (TDABC) aims to measure true costs throughout a patient’s care cycle using two inputs: (1) the amount of time that specific resources (e.g., physician, equipment, etc.) are used, and (2) their cost rate per unit time. This pilot study aims to apply this empirical costing tool to characterize resource allocation in an interventional radiology (IR) department at a tertiary care center. Our ultimate goal is to determine opportunities for improving efficiency of IR procedural delivery. Two IR rooms from staff arrival (7:30) to dismissal (17:30) for 6 randomly selected, non-consecutive days were observed; 66 procedures were performed over 180 hours of observation. The time-points measured included preparation time, attending time spent, procedural time, room turn-over time, and idle time. The staff did not know the independent observer was tracking these variables. Second, we modeled potential solutions and used cost rates to calculate the effect of improving inefficiencies. Average daily room usage, peak-time room usage, idle time, procedural time, and room-turnover time were computed revealing significant opportunities for improvement. Moreover, room usage fluctuated throughout the day, with low usage from 7:30 to 8:30, lunch time and 15:30 to 17:30. Not counted as idle, time spent waiting for the operator with the patient on the table averaged was also computed averaging 18.8 min per case. Extensive modeling was performed demonstrating that a reduction of idle time and attending waiting time by 10% could add approximately 500 cases per year. Idle time between cases is large; staggering lunch could reduce waste and operator-specific scheduling could eliminate overestimations of procedure time. Improved communication with physicians would prevent waiting and improve care delivery. Such simple observational studies demonstrate the importance of measuring waste to identify solutions and predict quantitative effects. TDABC is a critical first step to improving IR efficiency.