Relevance of quality improvement methods to surgical practice: prospective assessment of carotid endarterectomy.
Continuous quality improvement methods are increasingly being applied to health care systems, yet demonstration of outcome and cost benefits for surgical patients remains sparse. We used continuous quality improvement principles to specifically identify potential opportunities to reduce patient charges for carotid endarterectomy in our academic vascular surgery practice without compromising results. The targeted opportunities included: 1) limitation of laboratory examination, 2) selective cardiac stress testing, 3) discharge on 1st postoperative day, and 4) substitution of outpatient carotid duplex imaging for inpatient angiography. After 1 year, reductions in the average patient charge ($7700 versus $13,900, P < 0.001) and increases in payment/charge ratio (1.2 versus 0.8; P < 0.001) were observed. These changes were primarily due to a reduction in length of stay (2.2 versus 5.7 days; P < 0.001). No significant difference in patient morbidity occurred. Reductions in charges occurred within the targeted areas of laboratory (-77%), cardiac testing (-73%), hospital room (-60%), and radiology (-81%) utilization. Attention to the four factors identified by continuous quality improvement methods significantly reduced total patient charges without detrimental effects on patient outcome.
Brothers
T E
TE
Department of Surgery, Medical University of South Carolina, Charleston 29425, USA.
Robison
J G
JG
Elliott
B M
BM
D000368:Aged; D019091:Critical Pathways; D016894:Endarterectomy, Carotid / Q000191:economics / Q000592:standards*; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D013022:South Carolina; D017749:Total Quality Management