Implementation of 24/7 radiology services in an academic medical centre level 1 trauma centre: Impact on trauma resuscitation unit length of stay and economic benefit analysis

BackgroundReducing costs while increasing or maintaining quality is crucial to delivering high value care.ObjectiveTo assess the impact of a hospital value-based management programme on cost and quality.DesignTime series analysis of non-psychiatric, non-rehabilitation, non-newborn patients discharged between 1 September 2011 and 31 December 2017 from a US urban, academic medical centre.InterventionNYU Langone Health instituted an institution-wide programme in April 2014 to increase value of healthcare, defined as health outcomes achieved per dollar spent. Key features included joint clinical and operational leadership; granular and transparent cost accounting; dedicated project support staff; information technology support; and a departmental shared savings programme.MeasurementsChange in variable direct costs; secondary outcomes included changes in length of stay, readmission and in-hospital mortality.ResultsThe programme chartered 74 projects targeting opportunities in supply chain management (eg, surgical trays), operational efficiency (eg, discharge optimisation), care of outlier patients (eg, those at end of life) and resource utilisation (eg, blood management). The study cohort included 160 434 hospitalisations. Adjusted variable costs decreased 7.7% over the study period. Admissions with medical diagnosis related groups (DRG) declined an average 0.20% per month relative to baseline. Admissions with surgical DRGs had an early increase in costs of 2.7% followed by 0.37% decrease in costs per month. Mean expense per hospitalisation improved from 13% above median for teaching hospitals to 2% above median. Length of stay decreased by 0.25% per month relative to prior trends (95% CI −0.34 to 0.17): approximately half a day by the end of the study period. There were no significant changes in 30-day same-hospital readmission or in-hospital mortality. Estimated institutional savings after intervention costs were approximately $53.9 million.LimitationsObservational analysis.ConclusionA systematic programme to increase healthcare value by lowering the cost of care without compromising quality is achievable and sustainable over several years.

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Cost-Benefit Analysis of Vaccination Against Influenza of Employees from an Academic Medical Centre

Disease Management & Health Outcomes ◽

10.2165/00115677-200210090-00006 ◽

2002 ◽

Vol 10 (9) ◽

pp. 579-587 ◽

Cited By ~ 3

Author(s):

Wilma Parlevliet ◽

Corianne de Borgie ◽

Gerard Frijstein ◽

Henk-Jan Guchelaar

Keyword(s):

Cost Benefit Analysis ◽

Cost Benefit ◽

Medical Centre ◽

Benefit Analysis ◽

Academic Medical Centre ◽

Academic Medical

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Drivers of hospital expenditure and length of stay in an academic medical centre: a retrospective cross-sectional study

BMC Health Services Research ◽

10.1186/s12913-019-4248-1 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Nabilah Rahman ◽

Sheryl Hui-Xian Ng ◽

Sravan Ramachandran ◽

Debby D. Wang ◽

Srinath Sridharan ◽

...

Keyword(s):

Length Of Stay ◽

Cross Sectional Study ◽

Medical Centre ◽

Sectional Study ◽

Cross Sectional ◽

Academic Medical Centre ◽

Hospital Expenditure ◽

Academic Medical

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Cohort study of impact on length of stay of individual enhanced recovery after surgery protocol components

BMJ Surgery, Interventions, & Health Technologies ◽

10.1136/bmjsit-2021-000087 ◽

2021 ◽

Vol 3 (1) ◽

pp. e000087

Author(s):

Rachel C. Sisodia ◽

Dan Ellis ◽

Michael Hidrue ◽

Pamela Linov ◽

Elena Cavallo ◽

...

Keyword(s):

Cohort Study ◽

Length Of Stay ◽

Minimally Invasive ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Fluid Administration ◽

Medical Centre ◽

Academic Medical Centre ◽

Process Measure ◽

Academic Medical

ObjectiveThe goal of this study was to explore which enhanced recovery after surgery (ERAS) bundle items were most associated with decreased length of stay after surgery, most likely associated with decreased length of stay after surgery.DesignA cohort study.SettingLarge tertiary academic medical centre.ParticipantsThe study included 1318 women undergoing hysterectomy as part of our ERAS pathway between 1 February 2018 and 30 January 2020 and a matched historical cohort of all hysterectomies performed at our institution between 3 October 2016 and 30 January 2018 (n=1063).InterventionThe addition of ERAS to perioperative care.This is a cohort study of all patients undergoing hysterectomy at an academic medical centre after ERAS implementation on 1 February 2018. Compliance and outcomes after ERAS roll out were monitored and managed by a centralised team. Descriptive statistics, multivariate regression, interrupted time series analysis were used as indicated.Main outcome measuresImpact of ERAS process measure adherence on length of stay.ResultsAfter initiation of ERAS pathway, 1318 women underwent hysterectomy. There were more open surgeries after ERAS implementation, but cohorts were otherwise balanced. The impact of process measure adherence on length of stay varied based on surgical approach (minimally invasive vs open). For open surgery, compliance with intraoperative antiemetics (−30%, 95% CI −18% to 40%) and decreased postoperative fluid administration (−12%, 95% CI −1% to 21%) were significantly associated with reduced length of stay. For minimally invasive surgery, ambulation within 8 hours of surgery was associated with reduced length of stay (−53%, 95% CI −55% to 52%).ConclusionsWhile adherence to overall ERAS protocols decreases length of stay, the specific components of the bundle most significantly impacting this outcome remain elusive. Our data identify early ambulation, use of antiemetics and decreasing postoperative fluid administration to be associated with decreased length of stay.

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