title: One hospital, one appendectomy: The cost effectiveness of a standardized doctor's preference card.
abstract: OBJECTIVE
  Appendicitis in children provides a unique opportunity to explore changes that reduce variation, reduce cost, and improve value. In this study we sought to evaluate the effectiveness of standardization of surgical technique and intraoperative disposable device utilization for laparoscopic appendectomy among all surgeons at a tertiary children's hospital.
  
  
  METHODS
  All 6 surgeons at our tertiary children's hospital agreed to standardize to a single technique of performing a laparoscopic appendectomy. We collected data on all pediatric patients who had a laparoscopic appendectomy following implementation of the uniform doctor's preference card (DPC) (March 1, 2013 to February 28, 2014) and compared them to a historical control group.
  
  
  RESULTS
  Implementation of the uniform DPC decreased the device cost per appendectomy from $844.11 to $305.32. Operative times (skin incision to skin closure) were 34.8 minutes prior to the uniform DPC and 37.0 minutes using the uniform DPC. There were no significant differences in postappendectomy outcomes.
  
  
  CONCLUSIONS
  We have demonstrated that implementation of a uniform DPC and technical standardization for laparoscopic appendectomy can significantly reduce cost. Furthermore, this can occur without dramatically increasing operative times, length of stay, or postoperative complications.
authors: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT. Electronic address: david.skarda@imail.org.
authors: David E
authors: DE
authors: Skarda
authors: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT.
authors: Michael
authors: M
authors: Rollins
authors: Systems Improvement, Primary Children's Hospital, Salt Lake City, UT.
authors: Seth
authors: S
authors: Andrews
authors: Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT.
authors: Molly
authors: M
authors: McFadden
authors: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT.
authors: Doug
authors: D
authors: Barnhart
authors: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT.
authors: Rebecka
authors: R
authors: Meyers
authors: Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT.
authors: Eric
authors: E
authors: Scaife
mesh_terms: D001062:Appendectomy / Q000191:economics / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D001064:Appendicitis / Q000191:economics / Q000601:surgery*; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000191:economics; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome; D014589:Utah
keywords: Appendicitis; Cost; Laparoscopy; Pediatric; Standardize; Value