PDF(Pubmed)
Abstract：
Background With the ever-increasing complexity of today\'s healthcare environment, it is evident that there is a higher demand to deliver high-quality, accessible, efficient, and affordable healthcare. At the same time, these changes are accompanied by decreasing rates of reimbursement. This can be attributed to the shift from fee-for-service to value-based payment methods in the industry. The reception of such changes in the appropriate manner is crucial to improvement and the much-demanded reform in our healthcare system. To adapt to this changing landscape, hospitals and healthcare systems must incorporate proper measures to identify extraneous spending, control costs, and streamline patient care. Our goal in this study was to use the time-driven, activity-based costing (TDABC) model to quantify the costs at every step as an inpatient goes through the care process in an interventional radiology department. Methodology After identification and mapping of all the steps involved from interventional radiology (IR) consult placement to patient transport to the postoperative recovery area, time data were collected for each step of the process. One of the steps was then selected for intervention. Our focus was on the time interval between one patient leaving after a completed procedure and the next scheduled patient entering the IR suite (heretofore referred to as idle time). To decrease the idle room time between patients, the interventional radiologists, IR administrations, nurse manager, transportation manager, and charge nurse first met as a group to set a realistic initial goal. Pre-intervention data were collected. Results After the collection of pre-intervention data, the average idle time of the IR suite was found to be 40 minutes. After a multidisciplinary discussion, our goal was to reduce this time to 25 minutes. Post-intervention data found the average time decreased to 24 minutes. Calculation of average costs per unit time for staff, IR room, and equipment yielded an approximate cost of $57 per minute of time in the IR suite. Conclusions Considering the near 40% decrease in suite idle time as well as the cost per minute of material, equipment, and staff (at ~80% capacity), this study proves that the TDABC system is a viable method of targeting bottlenecks in operations and streamlining patient care by reducing costs while optimizing the process patients go through during care continuum.
摘要：
背景随着当今医疗环境的日益复杂,显然，对提供高质量的产品的需求更高，可访问,高效,负担得起的医疗保健。同时,这些变化伴随着偿还率的下降。这可以归因于行业中从按服务收费到基于价值的支付方式的转变。以适当的方式接受这种变化对于我们的医疗体系的改善和急需的改革至关重要。为了适应这种变化的景观，医院和医疗保健系统必须采取适当的措施来识别无关的支出，控制成本,简化病人护理。我们在这项研究中的目标是使用时间驱动，基于活动的成本计算（TDABC）模型，用于量化住院患者在介入放射科的护理过程中每个步骤的成本。方法在识别和绘制从介入放射学（IR）咨询放置到患者运输到术后恢复区域的所有步骤之后，收集每个步骤的时间数据.然后选择其中一个步骤进行干预。我们的重点是一名患者在完成手术后离开与下一名计划患者进入IR套件之间的时间间隔（迄今为止称为空闲时间）。为了减少患者之间的空闲时间，介入放射科医生,IR管理部门，护士经理,运输经理,和收费护士第一次作为一个群体见面，以设定一个现实的初始目标。收集干预前数据。结果收集干预前资料后,发现IR套件的平均空闲时间为40分钟。经过多学科的讨论,我们的目标是把这个时间减少到25分钟。干预后的数据发现平均时间减少到24分钟。员工单位时间平均成本的计算，红外室,在IR套件中，设备的成本约为每分钟57美元。结论考虑到套件空闲时间减少了近40%，以及每分钟的材料成本，设备,和员工（约80%容量），这项研究证明,TDABC系统是一种可行的方法,通过降低成本,同时优化患者在连续护理过程中所经历的流程,从而瞄准操作瓶颈并简化患者护理.
