C. E. Kein1, S. S. Yang1, S. Gupta1, A. S. Manjunathan1, A. A. Mazurek1, R. M. Reddy1 1University Of Michigan,Ann Arbor, MI, USA
Introduction: Many studies have shown benefits in studying clinical workflows to improve efficiency and patient satisfaction. We have had different clinics emphasize efficiencies without understanding patient benefit. We hypothesized that a consolidated workflow in the preoperative workup for hiatal hernia repair would be associated with a reduced cost and time burden on patients.
Methods: A retrospective chart review was performed for all adult patients who underwent elective laparoscopic hiatal hernia repair in the Thoracic and General Surgery (GS) clinics at the same tertiary care institution in 2016. The Thoracic clinic was designed to consolidate preoperative workup into fewer individual appointments. Demographic information, number of preoperative visits, number of phone calls during workup, and number of days from initial consult to surgery were collected. Distance traveled to appointments, cost and hours of travel, and time spent in clinics were estimated using historic data. Descriptive statistics for these variables were compared using t-tests.
Results: The patient cohorts in the Thoracic (N=80) and GS (N=24) services were found to be similar in age at surgery (60.5 vs. 60.4, p=0.9710), and a majority were uninsured or relied on Medicare or Medicaid (68.8% vs. 66.7%, p=1.0000). Patients undergoing workup in the Thoracic clinic required significantly fewer preoperative appointments, compared to patients in the GS clinic who had extra visits for preoperative testing (2.0 vs. 3.5, p=0.0001). There was no significant difference in the average number of patient phone calls received by the Thoracic and GC clinic during the workup period (2.5 vs. 3.5, p=0.0618). Although the average distance in miles traveled to each appointment by Thoracic and MIS patients was not significantly different (72.7 vs. 88.1, p=0.2829), Thoracic patients incurred less burden in the total miles traveled for workup (287.7 vs. 531.5, p=0.0024) and in the associated estimated total cost of gas ($28.11 vs. $51.94, p=0.0024). In addition, Thoracic patients spent fewer estimated hours traveling and being present in clinic when compared to GS patients (8.6 vs. 14.6, p=0.001), and the Thoracic clinic achieved a significantly shorter workup period than GS, as measured in days from first consult to surgery (64.9 vs. 240.1, p=0.0001).
Conclusion: The efforts of the Thoracic Surgery service to consolidate preoperative workflow are associated with a lower estimated cost and time burden to patients undergoing laparoscopic hiatal hernia repair without an associated increase in the use of clinical resources to field phone calls. A streamlined workflow may decrease cost to this largely financially vulnerable populations (uninsured, Medicaid, or Medicare) while also decreasing the time during which patients remain symptomatic. These results should urge surgical departments to identify and trim inefficiencies that impact patient finances and quality of life.