title: Standardization of Disposable Instruments in Microvascular Breast Reconstruction: A Case Study in Cost Reduction.
abstract: BackgroundA key avoidable expense in the surgical setting is the wastage of disposable surgical items, which are discarded after cases even if they go unused. A major contributor to wastage of these items is the inaccuracy of surgeon preference cards, which are rarely examined or updated. The authors report the application of a novel technique called cost heatmapping to facilitate standardization of preference cards for microvascular breast reconstruction.MethodsPreference card data were obtained for all surgeons performing microvascular breast reconstruction at the authors' institution. These data were visualized using the heatmap.2 function in the gplot package for R. The resulting cost heatmaps were shown to all surgeons performing microvascular breast reconstruction at our institution; each surgeon was asked to classify the items on the heatmap as "always needed," "sometimes needed," or "never needed." This feedback was used to generate a lean standardized preference card for all surgeons. This card was validated by all surgeons performing the case and by nursing leadership familiar with the supply needs of microvascular breast reconstruction before implementation. Cost savings associated with implementation were calculated.ResultsImplementation of the preference card changes will lead to an estimated per annum savings of $17,981.20 and a per annum reduction in individual items listed on preference cards of 1,693 items.ConclusionCost heatmapping is a powerful tool for increasing surgeon awareness of cost and for facilitating comparison and standardization of surgeon preference cards.
authors.affiliation: Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Brady R
authors.initials: BR
authors.lastname: Still
authors.affiliation: Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Laura W
authors.initials: LW
authors.lastname: Christianson
authors.affiliation: Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Mhlaba
authors.affiliation: Department of Strategic Sourcing, Operative Performance Research Institute, The University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Ian P
authors.initials: IP
authors.lastname: O'Malley
authors.affiliation: Section of Plastic and Reconstructive Surgery, Operative Performance Research Institute, The University of Chicago Medical Center, Chicago, Illinois.
authors.forename: David H
authors.initials: DH
authors.lastname: Song
authors.affiliation: Section of Otolaryngology-Head and Neck Surgery, Operative Performance Research Institute, The University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Langerman
mesh_terms: D001291:Attitude of Health Personnel; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004209:Disposable Equipment / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005568:Forms and Records Control; D006801:Humans; D016462:Mammaplasty / Q000191:economics* / Q000295:instrumentation* / Q000592:standards; D061214:Patient Safety; D013525:Surgical Instruments / Q000191:economics*