title: Streamlining variability in hospital charges for standard thyroidectomy: Developing a strategy to decrease waste.
abstract: BACKGROUND
  We assessed the efficiency, consistency, and appropriateness of perioperative processes for standard (total) thyroidectomy and devised a valuable strategy to decrease variability and waste.
  
  
  METHODS
  Our multidisciplinary team evaluated <23-hour stay standard thyroidectomy performed by 3 surgical endocrinologists. We used the nominal group technique, process flowcharts, and root cause analysis to evaluate 6 perioperative processes. Anticipated decreases in costs, charges, and resources from improvements were calculated.
  
  
  RESULTS
  Median total charge for standard thyroidectomy was $27,363 (n = 80; $48,727 variation). Perioperative coordination between surgery and anesthesia clinics could eliminate unnecessary testing (potential decrease in charges of $1,505). Nonoperating room time was less in the outpatient operating room (43 vs 52 minutes; P < .001). Consistent scheduling could decrease charges by $585.49 per case. By decreasing 20% of nondisposable instruments on the surgical tray, we could decrease sterile processing costs by $13.30 per case. Modification of postoperative orders could decrease charges by $643 per patient. Overall, this comprehensive analysis identified an anticipated decrease in cost/charge of >$200,000 annually.
  
  
  CONCLUSIONS
  Perioperative process analyses revealed wide variability for a single, presumed uniform procedure. Systematic assessment helped to identify opportunities to improve efficiency, decrease unnecessary waste and procedures/instrument usage, and focus on patient-centered, quality care. This multidisciplinary strategy could substantially decrease costs/charges for common operative procedures.
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Northwest Medical Center, Tucson, AZ.
authors.forename: Lilah F
authors.initials: LF
authors.lastname: Morris
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Minerva A
authors.initials: MA
authors.lastname: Romero Arenas
authors.affiliation: Department of Anesthesiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cerny
authors.affiliation: Department of Anesthesiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Berger
authors.affiliation: School of Mathematical and Natural Sciences, Arizona State University West, Phoenix, AZ.
authors.forename: Connie M
authors.initials: CM
authors.lastname: Borror
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Meagan
authors.initials: M
authors.lastname: Ong
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Ashley K
authors.initials: AK
authors.lastname: Cayo
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Graham
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Grubbs
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX. Electronic address: NPerrier@mdanderson.org.
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Perrier
mesh_terms: D000328:Adult; D000368:Aged; D017046:Cost Savings; D003430:Cross-Sectional Studies; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D019990:Perioperative Care / Q000191:economics*; D018570:Risk Assessment; D013965:Thyroidectomy / Q000191:economics* / Q000592:standards; D014481:United States