Pediatric intensive care unit or main OR for bilateral myringotomy and tympanostomy tube: Which is more cost-effective, efficient, and safe?

Abstract

Objectives: To ascertain if a cost savings, time efficiency, and parental/patient satisfaction differential exists between bilateral myringotomy and tympanostomy tube (BMTT) procedures performed in the main operating arena compared to the Pediatric Intensive Care Unit (PICU) at our institution over a 6-month period; with ultimate implication for performance improvement implementation. Methods: Over a 6-month period at our institution (NMCP), children meeting criteria for bilateral myringotomy and tympanostomy tube placement (BMTT) were enrolled through either: (1)the standard route requiring an initial otolaryngologic evaluation, a separate preoperative evaluation, a third anesthesia/administrative appointment, and the subsequent surgery/procedure occurring in the main operating arena; or (2)through an alternative route consisting of initial otolaryngologic evaluation, phone follow-up soon thereafter and a subsequent surgical/procedural date for the BMTT to be performed in the PICU, still under general anesthesia by board certified anesthesiologists. Exact time differential, personnel hours, and estimated cost differential were compared between the two “routes for enrollment” and sites for the BMTT. Parental postprocedural questionnaires were completed and analyzed for qualitative data. Results: As per discussion/ordinal data. Conclusion: The performance of pediatric BMTTs in the PICU, compared to the accepted route at our institution via the main operating arena, has produced a significant cost savings, improved efficiency in terms of time and man-hours, and improved overall parental satisfaction regarding the efficiency, safety, and quality of care delivered at our institution for this routine, commonly performed procedure. This has implications for policy and procedural modifications for our institution in general, as well as national relevance.