Quality care and cost-effectiveness. An organized approach to problem solving
C. H. Nightingale, J. Robotti, P. J. Deckers, P. D. Allmendinger, R. Lowe and H. B. Low
The reflexive approach to rising hospital costs and decreased revenue is to
balance the budget by curtailing expenses. This places budgetary
limitations on personnel, supplies, and equipment and ultimately has an
impact on the quality of care. An alternative approach is to modify
traditional practice patterns so that quality is preserved and costs are
reduced. We reviewed elective class I and II coronary artery bypass graft
surgery on a cost basis to identify potential problems. High costs in blood
and blood-product usage were identified. An in-depth analysis of practice
patterns was conducted, and comparisons were made between data from our
hospital and other institutions. Modifications that improved quality and
reduced costs were designed. Blood and blood-product usage was reduced from
an average of 9.2 U to 3.4 U per case, resulting in an estimated cost
avoidance of $111,286 per year. No cost advantage was observed with the use
of cell savers, membrane oxygenators, or automated coagulation analysis in
these routine short pump run surgeries. Though not cost-effective, the cell
saver did allow the salvage of 2 U of blood per case. Mediastinal drainage
systems (Sorenson) as well as reeducation regarding the safe, albeit low,
hematocrit (no transfusions for hematocrits above 25% [0.25]) were
effective in eliminating unnecessary use of potentially dangerous and
expensive blood products.
