1. Reorganizing the system of care surrounding laparoscopic surgery: a cost-effectiveness analysis using discrete-event simulation.
- Author
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Stahl JE, Rattner D, Wiklund R, Lester J, Beinfeld M, and Gazelle GS
- Subjects
- Academic Medical Centers, Appointments and Schedules, Boston, Cholecystectomy, Laparoscopic adverse effects, Computer Simulation, Cost-Benefit Analysis, Efficiency, Organizational, Humans, Organizational Innovation, Outcome Assessment, Health Care, Safety, Anesthesia Department, Hospital organization & administration, Cholecystectomy, Laparoscopic economics, Hospital Restructuring economics, Operating Rooms organization & administration, Recovery Room organization & administration, Surgery Department, Hospital organization & administration
- Abstract
Purpose: To determine the cost-effectiveness of a proposed reorganization of surgical and anesthesia care to balance patient volume and safety., Methods: Discrete-event simulation methods were used to compare current surgical practice with a new modular system in which patient care is handed off between 2 anesthesiologists. A health care system's perspective, using hospital and professional costs, was chosen for the cost-effectiveness analysis. Outcomes were patient throughput, flow time, wait time, and resource use. Sensitivity analyses were performed on staffing levels, mortality rates, process times, and scheduled patient volume., Results: The new strategy was more effective (average 4.41 patients/d [median = 5] v. 4.29 [median = 4]) and had similar costs (average cost/ patient/d = 5327 dollars v. 5289 dollars) to the current strategy with an incremental cost-effectiveness of 318 dollars/additional patient treated/d. Surgical mortality rate must be >4% or hand-off delay >15 min before the new strategy is no longer more effective., Conclusion: The proposed system is more cost-effective relative to current practice over a wide range of mortality rates, hand-off times, and scheduled patient volumes.
- Published
- 2004
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