New study surveys data on operating room efficiency
New study surveys data on operating room efficiency
Bryn Mawr named best performer in OR study
The folks doing knee and hip replacement surgery at Bryn Mawr (PA) Hospital must be doing something right. For the second year in a row, the 330-bed hospital has been named "Best Performer" for operating room effectiveness and efficiency by OR Benchmarks, a Santa Fe, NM-based benchmarking company. The hospital was one of a dozen studied that provided data to OR Benchmarks on 51 cases of total knee replacements. Thus far, the company has collected data on 880 cases over the past five years. Data collected ranged from cost of supplies to use of clinical pathways.
Among the findings for the current year:
- Supply costs ranged from a low of $2,920 per case to $6,388. The median was $3,213, more than $700 lower than the 1999 median of $3,954. The prostheses represented 78% of the supply cost, and 90% of those prostheses had one or more components cemented.
- Implant costs ranged from a low of $2,200 to a high of $4,675. The median was $2,813 or nearly $600 less than the median in last year’s study.
- A third of the cases included the use of patient demand matching protocols. Such protocols allow physicians to provide implants based on patient needs; for example, an athlete would need a high-demand implant. The 33% use of such protocols is a 3% decline over last year but significantly higher than the 21% of cases that used the protocol in 1998.
- Cement costs ranged from $38 to $1,000, with a median of $73.
- Disposable paces were used in every case, with costs ranging from $67.60 for a basic pack to $408.34 for custom systems that might include drapes, cleanup supplies, and other items.
- The use of drapes has nearly doubled from a median of four in 1999 to seven last year.
- Facilities are using autotransfusion equipment less frequently and reinfusion drainage devices more often.
- Labor costs ranged from $195 to $655 per case.
- Four of the 12 participating hospitals used clinical pathways.
- Turnover time, defined as time from setup to cleanup was a median of 66 minutes. The range was from 41 minutes to just over two hours. That is slightly higher than the last five years, when turnover time was a constant 45 minutes.
For total hip replacements, 19 facilities submitted 75 cases, bringing OR Benchmarks’ total number of cases over the last five years to 697. The findings in that study showed that the prostheses represented 81% of the total costs. Cemented implants most often are used in older patients where there might be fears of low bone density. Younger patients are more likely to get the more expensive noncemented models, in part, because they are more likely to need a new replacement later in life, and the noncemented versions are easier to remove.
Other findings include:
- Supply costs ranged from $2,723 to $6,901, with a median of $4,272. That was nearly $100 higher than in the 1999 study, and a $462 increase over 1996, the first year the study was done.
- Implant costs ranged from $1,571 to $6,923. The median was $3,159, or about $400 less than the 1999 median.
- Only a quarter of the cases for hip-replacement surgery included use of a demand matching protocol. That’s down from more than a third in 1999.
- All cases used disposable packs, with costs ranging from $35 for a basic pack to $552 for a custom pack that included a cement kit.
- Draping practices are varied, with a median of 20 and a range of eight to 45 drapes. Last year’s median was 13.
- Labor costs ranged from $177 to $548.
- Five of the 19 facilities used clinical pathways.
- Turnover time ranged from 34 minutes to 139 minutes. The median was 57 minutes, up from 45 minutes in previous years.
Robert Good, MD, chief of the division of orthopedic surgery at Bryn Mawr Hospital says his facility consistently fell at the low end in all of the key categories. But while the good performance at Bryn Mawr is a pat on the back, Good says he and his team need to look carefully at the data "to see what we can do better."
Good was particularly pleased with his facility’s turnover time and the low costs for implants that he had negotiated with vendors. "We have a real team effort here with administration, surgeons, and social workers," he says. "But I think we can do better in our turnover time. And there is a big problem with pain control, particularly in the total knee replacement." Another area he says could be improved is setting up better in-home and outpatient rehabilitation programs.
The whole report will be disseminated to key hospital administrators, orthopedists, and OR nurses. "You never really know how you are doing until you look at the data," he explains. "We used to do an operation for recurrent shoulder dislocation and thought patients did really well. But after five years, we decided to review the cases and found out that wasn’t true. You have to look at the data and reevaluate it. Just thinking you have an acceptable infection rate isn’t enough. You have to see how you compare to others."
[For more information, contact:
• OR Benchmarks, P.O. Box 5303, Santa Fe, NM 87502-5303. Telephone: (877) 877-4031.
• Robert Good, MD, Chief of Division of Orthopedic Surgery, Bryn Mawr Hospital, 130 S. Bryn Mawr Ave., Bryn Mawr, PA 19010. Telephone: (610) 527-2727.]
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