J. T. Langell1, J. T. Langell1 1University Of Utah,Department Of Surgery,Salt Lake City, UT, USA
Introduction: The financial healthcare crisis has significantly reduced operating revenues for healthcare organizations. Hospitals are now seeking better operational efficiency models within their organizations. The successful application of Lean operation principles in manufacturing and other service sectors has resulted in its adoption by several healthcare organizations. Lean focuses on a culture change that promotes creation of a continuous learning organization and empowers all employees to make changes that will ultimately lead to improved customer value. One of the critical aspects of Lean is removing waste from a system to optimize the value equation.
The practice of evidence-based medicine improves the value to patients through the application of proven patient management principles that improve outcomes and may reduce the costs. Historical data shows that even the strongest leels of evidence-based medicine do not have uniform adoption by practitioners, even when mandated and tracked by federal payers and quality organizations. We believe that the uniform application of evidence-based medicine provides a simple and data-driven approach to Lean implementation.
Methods: We performed a literature search of the Cochrane database for evidence-based perioperative surgical care. This identified several publications that conducted a systematic review and meta-analysis of the use of incentive spirometers (IS) to prevent pulmonary complications after abdominal and thoracic operations. The data show that IS provides no efficacy in preventing these complications. We then studied the use of IS in our hospital system including total IS used and annual cost of purchase.
Results: We found broad use of IS and IS-teaching by surgeons across all disciplines in our hospital. A review of IS purchasing noted that our 526 bed tertiary care hospital used a total of 11,051 incentive spirometers in 2013 at a purchase cost of $2.27 each, totaling $25,086. The cost data does not include the additional cost of nursing teaching time, product stocking space or procurement resources. There are 5,686 hospitals registered with the American Hospital Association and 914,513-staffed beds in the US and according to the CDC over 100 million surgical procedures performed in the United States annually. If our medical center’s IS ordering practices and IS costs are relatively representative of US hospitals as a whole, the elimination of IS could save the healthcare system as much as $227,000,000 per year for a product that has evidence it provides no benefit to the general postoperative patient population.
Conclusion: The application of evidence-based medicine has greatly improved clinical outcomes, but has been shown to have variable adoption curves by healthcare practitioners. Here we demonstrate that the application of evidence based medicine can also be use a tool to eliminate financial waste and improve hospital operations.