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An Organized Approach to Problem Solving

Charles H. Nightingale, PhD; Judith Robotti, RN; Peter J. Deckers, MD; Philip D. Allmendinger, MD; Robert Lowe, MD; Henry B. C. Low, MD

Arch Surg. 1987;122(4):451-456.

Abstract
• 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.

(Arch Surg 1987;122:451-456)

Author Affiliations
From the Departments of Pharmacy Services (Dr Nightingale) and Surgery (Drs Deckers, Allmendinger, Lowe, and Low), the Value Improvement Program (Dr Nightingale and Ms Robotti), and Central Sterile Supply (Ms Robotti), Hartford (Conn) Hospital; the University of Connecticut School of Pharmacy, Storrs (Dr Nightingale); and the Department of Surgery, University of Connecticut School of Medicine, Farmington (Drs Deckers and Low).

Footnotes
Accepted for publication Dec 16, 1986.

Read before the 67th Annual Meeting of the New England Surgical Society, Dixville Notch, NH, Sept 28, 1986.

Reprint requests to Director of Pharmacy Services, 80 Seymour St, Hartford, CT 06115 (Dr Nightingale).

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