Abstract
ABSTRACT Background: The financial healthcare crisis has led hospitals to turn to Lean operational principles to improve value within their organizations. The practice of evidence-based medicine also improves value through medical management principles that improve outcomes and may reduce costs. The application of evidence-based medicine may provide an effective and data-driven approach to Lean healthcare. Methods: A literature review was performed for publications conducting systematic reviews and meta-analyses of incentive spirometry (IS) to prevent pulmonary complications after surgery. We also studied the utilization and costs of IS in our institution. Results: An analysis of the literature revealed no compelling evidence to support the use of IS to prevent pulmonary complications associated with upper abdominal and coronary artery bypass surgeries. A review of IS at our institution showed 10,332 incentive spirometers used in 2013 at a cost of $21,331. The additional cost of nursing time resulted in an associated cost of $97,766. Conclusion: Incentive spirometry continues to be widely used despite evidence demonstrating a lack of efficacy. Our institutional use of IS resulted in annual financial waste of $97,766. Based on our data, US-wide elimination of using perioperative IS could save the US healthcare system as much as $946,764,000 annually.
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