Reorganizing the system of care surrounding laparoscopic surgery: a cost-effectiveness analysis using discrete-event simulation.
OBJECTIVE
To determine the cost-effectiveness of a proposed reorganization of surgical and anesthesia care to balance patient volume and safety.


METHODS
Discrete-event simulation methods were used to compare current surgical practice with a new modular system in which patient care is handed off between 2 anesthesiologists. A health care system's perspective, using hospital and professional costs, was chosen for the cost-effectiveness analysis. Outcomes were patient throughput, flow time, wait time, and resource use. Sensitivity analyses were performed on staffing levels, mortality rates, process times, and scheduled patient volume.


RESULTS
The new strategy was more effective (average 4.41 patients/d [median = 5] v. 4.29 [median = 4]) and had similar costs (average cost/ patient/d = 5327 dollars v. 5289 dollars) to the current strategy with an incremental cost-effectiveness of 318 dollars/additional patient treated/d. Surgical mortality rate must be >4% or hand-off delay >15 min before the new strategy is no longer more effective.


CONCLUSIONS
The proposed system is more cost-effective relative to current practice over a wide range of mortality rates, hand-off times, and scheduled patient volumes.
Stahl
James E
JE
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Cambridge, Massachusetts, USA. james@mgh-ita.org
Rattner
David
D
Wiklund
Richard
R
Lester
Jessica
J
Beinfeld
Molly
M
Gazelle
G Scott
GS
D000046:Academic Medical Centers; D000761:Anesthesia Department, Hospital / Q000458:organization & administration*; D001071:Appointments and Schedules; D001900:Boston; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000191:economics*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational; D006754:Hospital Restructuring / Q000191:economics*; D006801:Humans; D009873:Operating Rooms / Q000458:organization & administration*; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D011997:Recovery Room / Q000458:organization & administration*; D012449:Safety; D013503:Surgery Department, Hospital / Q000458:organization & administration*