Economic Analysis of Perioperative Surgical Processes

Abstract

IntroductionThe health care sector in Germany is facing several challenges in recent years. These mostly restrictive legal actions are answered by the hospitals using cost-cutting instruments, like outsourcing, reducing personnel or even closing inefficient departments. Nevertheless, it has shown that these rationalization potentials are predominantly exhausted. Therefore, for hospitals it is highly important to focus more closely on the structure of treatment processes, which is one of the keys to hospitals success. By continuous reconsideration of hospital organization, which is beside the holistic view of the patient's treatment, process management (PM), which is described as planning, organizing and controlling measures to provide a purposeful control over hospital performance (Dahlgaard and Stratmeyer, 2006) can provide a substantial improvement of the treatment at all (Zapp, 2002). The objective of PM is to secure and improve the economic competitiveness of a hospital. Furthermore, it intends to increase the quality of treatment and decrease costs (Zapp, 2002). Particularly in the cost-intensive surgical area, where up to 35% of hospital's budget is generated and on average cost per hour between 650 and 800 Euro arise a PM is needed. In the operating area, PM furthermore tries to increase the quality of surgical performance and to stabilize planning and calculation of these surgeries (Greiling, 2005 and Zapp, 2002). Thus, there is a need of the analysis of the resources used and the time-related processes of a hospital to overcome the cost pressure and to achieve efficient use of the operating room (Boldt, 2009). However, little is known about the time-related perioperative processes of hospitals and the resources used for these processes. Thus, the objectives of this analysis were (1) to analyze the time-related preoperative, operative and postoperative clinical pathways of a general hospital concerning the quality of the patient's treatment focusing process delays. Furthermore, the aim was (2) to identify delays in processes and the vacancies in operating rooms as savings potentials for cost to improve the efficiency of the hospital focusing on (i) anaesthesiological process-times, (ii) OR-changing-time/ vacancy of the OR and (iii) the validity of the planned surgery in comparison with real times of surgeries.1. Methods1.1. Study designThe present study is an analysis of the time-related perioperative processes of a general hospital of Mecklenburg-Western Pomerania. The investigated general hospital with its less than 200 beds in total consists of six medical departments, surgery, internal medicine, gynecology, anesthesia and intensive care medicine, pediatrics and the department for ear-nose-throat disorders. The OR-capacity of the hospital consists of three operating rooms, which normally are operating from 07.30 a.m. until 3.30 p.m. The analyzed treatment process covered the entire perioperative process from patient's entrance and registration in the hospital to the entrance in the ward after the surgery. To analyze and measure the perioperative treatment process the whole process was divided into three main parts - first the pre-operative-section, second the operating-section and third the post-operative-section (illustrated in Figure 1). The pre-operative-section included the inpatient admission and the transportation to the operating area. This process was followed by the transportation of the patient into the operating room. All activities before, during and after the surgery until the transfer to the different wards of the hospital were related to this operating-section. The post-operative-section included the transportation back to the ward.The data of the three main processes were collected within four weeks using the time measuring method. In the pre- and post-operative-section the time measurement was conducted by two persons. The treatment processes in the operating-section were collected within a full sample survey of the time-related processes by eight persons taking measurement covering all surgeries of the hospital between 7. …