SSET Project: Cost-effectiveness Analysis of Surgical Specialty Emergency Trays in the Emergency Department

An Economic Analysis of Direct Costs of Distal Radius Fixation and the Implications of a Disposable Distal Radius Kit

OBJECTIVE

To assess the direct costs of distal radius fracture volar plate (VP) fixation and to create a model to examine the effect of these cost drivers.

MATERIALS AND METHODS

Retrospectively, 744 distal radius fractures treated with open reduction and internal fixation (ORIF) were identified. The outcomes assessed included (1) the direct costs related to distal radius ORIF and (2) if a VP alone was amenable. Costs were represented as a cost ratio relative to the average cost of distal radius ORIF, where the average value is set as 1.0. Simulation models were run with all cost drivers (sex, age, open fracture, intra-articular fracture, and ancillary fixation) and with only ancillary fixation as a cost driver.

RESULTS

The cost ratio ranged from 0.61 to 1.81 and ancillary fixation was associated with increased implant costs in multivariable analysis. In the simulations, the cost ratio ranged from 0.96 to 1.23 when all cost drivers were included and from 0.99 to 1.20 if only ancillary fixation was included as a cost driver, a reduction of the range by 22.2%. Older patients, females, closed fractures, and extra-articular fractures were more amenable to VP fixation alone.

CONCLUSIONS

Eighty-three percent of the surgically treated distal radius fractures were treated with VP fixation alone. A disposable kit could help limit cost variance per case by roughly 22%, as only ancillary fixation varies these costs. Closed fractures and extra-articular fractures in older patients or female patients are more amenable to VP fixation alone.

LEVEL OF EVIDENCE

Economic Level III. See Instructions for Authors for a complete description of levels of evidence.

Approaches to the rationalization of surgical instrument trays: scoping review and research agenda

BACKGROUND

Surgical Tray Rationalization (STR) consists of a systematic reduction in the number of surgical instruments to perform specific procedures without compromising patient safety while reducing losses in the sterilization and assembly of trays. STR is one example of initiatives to improve process performance that have been widely reported in industrial settings but only recently have gained popularity in healthcare organizations.

METHODS

We conduct a scoping review of the literature to identify and map available evidence on surgical tray management. Five methodological stages are implemented and reported; they are: identifying research questions, identifying relevant studies, study selection, charting the data, and collating, summarizing and reporting the results.

RESULTS

We reviewed forty-eight articles on STR, which were grouped according to their main proposed approaches: expert analysis, lean practices, and mathematical programming. We identify the most frequently used techniques within each approach and point to their potential contributions to operational and economic dimensions of STR. We also consolidate our findings, proposing a roadmap to STR with four generic steps (prepare, rationalize, implement, and consolidate) and recommended associated techniques.

CONCLUSIONS

To the best of our knowledge, ours is the first study that reviews and systematizes the existing literature on the subject of STR. Our study closes with the proposition of future research directions, which are presented as nine research questions associated with the four generic steps proposed in the STR roadmap.

Development of a Plastic Surgery Supply Cart: Patient Outcomes and Quality of Care

Background

Plastic surgeons experience unique quality issues related to the specialty nature of patient procedures. Lack of accessibility to specialty supplies is a rate-limiting variable that impacts treatment efficiency and hospital resources. This study had the following goals: (1) to develop a mobile plastic surgery cart and (2) to assess the impact of a plastic surgery cart on time to treatment of consults.

Methods

Two plastic carts were developed using preexisting hospital supplies. Cart composition was designed and approved by hospital staff. A prospective study was conducted to assess overall time to treatment of patient consults throughout the hospital comparing a plastics cart versus a traditional hunt and gather methodology. One surgeon recorded time to treatment with and without the plastics cart for each consult during on-call duty hours over a 6-month period.

Results

A total of 40 patients were treated for either head or neck (60%) or hand-related (40%) cases. The average time (minutes) to treatment across all procedures with the plastics cart was 3.7 ± 1.9 versus 46.3 ± 60.0 without the plastics cart. The maximum time to treatment was 9.5 minutes with the plastics cart and 3 hours without the plastics cart. Usage of the plastics cart resulted in a significant reduction in total time to treatment of 42.5 ± 60.3 minutes (P < 0.0001).

Conclusions

A specialty supplies cart has quality improvement implications for patients, physicians, and hospitals. Increased accessibility of specialty supplies may significantly reduce the time to treatment for plastic surgery patient consults throughout a hospital.