title: Applying cost accounting to operating room staffing in otolaryngology: time-driven activity-based costing and outpatient adenotonsillectomy.
abstract: OBJECTIVE
  (1) To describe the application of a detailed cost-accounting method (time-driven activity-cased costing) to operating room personnel costs, avoiding the proxy use of hospital and provider charges. (2) To model potential cost efficiencies using different staffing models with the case study of outpatient adenotonsillectomy.
  
  
  METHODS
  Prospective cost analysis case study.
  
  
  METHODS
  Tertiary pediatric hospital.
  
  
  METHODS
  All otolaryngology providers and otolaryngology operating room staff at our institution.
  
  
  RESULTS
  Time-driven activity-based costing demonstrated precise per-case and per-minute calculation of personnel costs. We identified several areas of unused personnel capacity in a basic staffing model. Per-case personnel costs decreased by 23.2% by allowing a surgeon to run 2 operating rooms, despite doubling all other staff. Further cost reductions up to a total of 26.4% were predicted with additional staffing rearrangements.
  
  
  CONCLUSIONS
  Time-driven activity-based costing allows detailed understanding of not only personnel costs but also how personnel time is used. This in turn allows testing of alternative staffing models to decrease unused personnel capacity and increase efficiency.
authors.affiliation: Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA Balakrishnan.Karthik@mayo.edu.
authors.forename: Karthik
authors.initials: K
authors.lastname: Balakrishnan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Goico
authors.affiliation: Department of Otolaryngology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Ellis M
authors.initials: EM
authors.lastname: Arjmand
mesh_terms: D000233:Adenoidectomy / Q000191:economics*; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D000776:Anesthesiology / Q000458:organization & administration; D057191:Capacity Building; D003365:Costs and Cost Analysis; D017598:Efficiency, Organizational; D006801:Humans; D009719:Nurse Anesthetists / Q000458:organization & administration; D009871:Operating Room Nursing / Q000458:organization & administration; D009873:Operating Rooms / Q000191:economics / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000191:economics*; D014068:Tonsillectomy / Q000191:economics*
keywords: adenotonsillectomy; cost; efficiency; operating room; staffing; unused capacity