Reducing Operating Room Costs through Real Time Cost Information Feedback: A Pilot Study

Purpose: To create a protocol for providing real-time operating room (OR) cost feedback to surgeons. We hypothesize that this protocol will reduce costs in a responsible way without sacrificing quality of care. Methods: All OR costs were obtained and recorded for robot-assisted partial nephrectomy and laparoscopic donor nephrectomy. Before the beginning of this project, costs pertaining to the 20 most recent cases were analyzed. Items were identified from previous cases as modifiable for replacement or omission. Timely feedback of total OR costs and cost of each item used was provided to the surgeon after each case, and costs were analyzed. Results: A cost analysis of the robot-assisted partial nephrectomy before the washout period indicates expenditures of $5243.04 per case. Ten recommended modifiable items were found to have an average per case cost of$1229.33 representing 23.4% of the total cost. A postwashout period cost analysis found the total OR cost decreased by $899.67 (17.2$3530.05 with $457.54 attributed to modifiable items. After the washout period, modifiable items costs were reduced by$289.73 (8.0%). No complications occurred in the donor nephrectomy cases while one postoperative complication occurred in the partial nephrectomy group. Conclusion: Providing surgeons with feedback related to OR costs may lead to a change in surgeon behavior and decreased overall costs. Further studies are needed to show equivalence in patient outcomes

Status reports to the Paper Properties and Uses Project Advisory Committee

"April 2-3, 1985."Measurement of fiber properties and fiber-to-fiber bonding: project 3527 / K. W. Hardacker , G. A. Baum ; Fundamentals of internal strength enhancement: project 3526 / R. A. Stratton , J. J. Becher ; Compressive strength: project 3469 / W. J. Whitsitt , J. F. Waterhouse ; Board properties and performance: project 3571 / W. J. Whitsitt / R. A. Halcomb ; Combined stress and failure processes (formerly shear deformation and failure): project 3500 / J. F. Waterhouse ; Process, properties, product relationships: project 3467 / G. A. Baum / C. C. Habeger ; On-line measurements of paper mechanical properties: project 3332 / G. A. Baum , C. C. Habeger

Application of Alvimopan as a Component of Enhanced Recovery After Surgery (ERAS) Protocol for Patients Undergoing Radical Cystectomy and Diversion (C&D)

Introduction Radical cystectomy with urinary diversion (C&D) is performed for patients with muscle-invasive bladder cancer (MIBC) or refractory carcinoma in situ (CIS) C&D patients receive one of several types of diversion depending on their age, comorbidities, functional status, and extent of disease (Figure 1) Post-operative length of stay (LOS) can be prolonged (9-11 days) and 30 day readmission rates and mortality elevated (30% and 1.5%); return of bowel function usually the rate-limiting step to discharge Enhanced Recovery After Surgery (ERAS) protocols utilize pre-, intra-, and postoperative elements in order to improve return of bowel function and decrease LOS Alvimopan is a μ-opioid receptor antagonist commonly included in ERAS, and limits deleterious effects of narcotics on the GI system The goal of this analysis was to determine the effect of Alvimopan on post-operative LOS and 30 day readmission in patients undergoing C&Dhttps://jdc.jefferson.edu/patientsafetyposters/1131/thumbnail.jp