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An Anesthesia Medication Cost Scorecard – Concepts for Individualized Feedback

  • Systems-Level Quality Improvement
  • Published:
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Abstract

There is a growing emphasis on both cost containment and better quality health care. The creation of better methods for alerting providers and their departments to the costs associated with patient care is one tool for improving efficiency. Since anesthetic medications used in the OR setting are one easily monitored factor contributing to OR costs, anesthetic cost report cards can be used to assess the cost and, potentially the quality of care provided by each practitioner. An ongoing challenge is the identification of the most effective strategies to control costs, promote cost awareness and at the same time maximize quality. To test the scorecard concept, we utilized existing informatics systems to gather and analyze drug costs for anesthesia providers in the OR. Drug costs were analyzed by medication class for each provider. Individual anesthesiologist’s anesthetic costs were collected and compared to the average costs of the overall group and individual trends over time were noted. We presented drug usage data in an electronic report card format. Real-time individual reports can be provided to anesthesiologists to allow for anesthetic cost feedback. Data provided can include number of cases, average case time, total anesthetic medication costs, and average anesthetic cost per case. Also included can be subcategories of pre-medication, antibiotics, hypnotics, local anesthetics, neuromuscular blocking drugs, analgesics, vasopressors, beta-blockers, anti-emetics, volatile anesthetics, and reversal agents. The concept of anesthetic cost report card should be further developed for individual feedback, and could include many other dimensions. Such a report card can be utilized to encourage lower anesthetic costs, quality improvement among anesthesia providers, and for cost containment in the operating room.

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References

  1. Krupka, D. C., and Sandberg, W. S., Operating room design and its impact on operating room economics. Curr Opin Anaesthesiol 19(2):185–91, 2006.

    Article  Google Scholar 

  2. Cima, R. R., Brown, M. J., Hebl, J. R., Moore, R., Rogers, J. C., Kollengode, A., et al., Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center. J Am Coll Surg 213(1):83–92, 2011. discussion 3–4.

    Article  Google Scholar 

  3. Kodali, B. S., Kim, D., Bleday, R., Flanagan, H., and Urman, R. D., Successful strategies for the reduction of operating room turnover times in a tertiary care academic medical center. J Surg Res 187(2):403–11, 2014.

    Article  Google Scholar 

  4. Webster, C. S., Merry, A. F., Larsson, L., McGrath, K. A., and Weller, J., The frequency and nature of drug adminstration error during anaesthesia. Anaesthesia and Intensive Care 29(5):494–500, 2001.

    Google Scholar 

  5. Fasting, F., and Gisvold, S. E., Adverse drug errors in anesthesia, and the impact of coloured syringe labels. Can J Anaesth 47(11):1060–1067, 2000.

    Article  Google Scholar 

  6. Orser, B. A., Chen, R. J. B., and Yee, D. A., Medication errors in anesthetic practice: a survey of 687 practitioners. Can J Anaesth 48(2):139–146, 2001.

    Article  Google Scholar 

  7. Gottlieb, O., Anesthesia information management systems in the ambulatory setting: benefits and challenges. Anesthesiol Clin 32(2):559–576, 2014.

    Article  Google Scholar 

  8. Avidan, A., Dotan, K., Weissman, C., Cohen, M. J., and Levin, P. D., Accuracy of manual entry of drug administration data into an anesthesia information management system. Can J Anaesth 61(11):979–985, 2014.

    Article  Google Scholar 

  9. Willig, J. H., Krawitz, M., Panjamapirom, A., Ray, M. N., Nevin, C. R., English, T. M., et al., Closing the feedback loop: an interactive voice response system to provide follow-up and feedback in primary care settings. Journal of medical systems 37(2):9905, 2013.

    Article  Google Scholar 

  10. van der Veer, S. N., de Keizer, N. F., Ravelli, A. C., Tenkink, S., and Jager, K. J., Improving quality of care. A systematic review on how medical registries provide information feedback to health care providers. Int J Med Inform. 79(5):305–23, 2010.

    Article  Google Scholar 

  11. de Vos, M., Graafmans, W., Kooistra, M., Meijboom, B., Van Der Voort, P., and Westert, G., Using quality indicators to improve hospital care: a review of the literature. Int J Qual Health Care 21(2):119–29, 2009.

    Article  Google Scholar 

  12. Hysong, S. J., Meta-analysis: audit and feedback features impact effectiveness on care quality. Med Care 47(3):356–63, 2009.

    Article  Google Scholar 

  13. Jamtvedt, G., Young, J. M., Kristoffersen, D. T., O’Brien, M. A., and Oxman, A. D., Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback. Qual Saf Health Care 15(6):433–6, 2006.

    Article  Google Scholar 

  14. Veloski, J., Boex, J. R., Grasberger, M. J., Evans, A., and Wolfson, D. B., Systematic review of the literature on assessment, feedback and physicians’ clinical performance: BEME Guide No. 7. Med Teach 28(2):117–28, 2006.

    Article  Google Scholar 

  15. Mugford, M., Banfield, P., and O’Hanlon, M., Effects of feedback of information on clinical practice: a review. BMJ 303(6799):398–402, 1991.

    Article  Google Scholar 

  16. Kaye, A. D., Okanlawon, O. J., and Urman, R. D., Clinical performance feedback and quality improvement opportunities for perioperative physicians. Adv Med Educ Pract. 5:115–23, 2014.

    Google Scholar 

  17. Peccora, C. D., Gimlich, R., Cornell, R. P., Vacanti, C. A., Ehrenfeld, J. M., and Urman, R. D., Anesthesia report card - a customizable tool for performance improvement. Journal of medical systems 38(9):105, 2014.

    Article  Google Scholar 

  18. Gabriel, R. A., Gimlich, R., Ehrenfeld, J. M., and Urman, R. D., Operating room metrics score card-creating a prototype for individualized feedback. J Med Syst 38(11):144, 2014.

    Article  Google Scholar 

  19. Heidegger, T., Husemann, Y., Nuebling, M., Morf, D., Sieber, T., Huth, A., et al., Patient satisfaction with anaesthesia care: development of a psychometric questionnaire and benchmarking among six hospitals in Switzerland and Austria. British Journal of Anaesthesia 89(6):863–72, 2002.

    Article  Google Scholar 

  20. Ehrenfeld, J. M., McEvoy, M. D., Furman, W. R., Snyder, D., and Sandberg, W. S., Automated near-real-time clinical performance feedback for anesthesiology residents: one piece of the milestones puzzle. Anesthesiology 120(1):172–84, 2014.

    Article  Google Scholar 

  21. Hindle, T. Idea: The Hawthorne effect. The Economist: Guide to Management Ideas and Gurus: 2008, 322.

  22. Srigley, J. A., Gardam, M., Fernie, G., Lightfood, D., Lebovic, G., and Muller, M. P., Hand hygiene monitoring technology: a systematic review of efficacy. Journal of Hospital Infection 89(1):51–60, 2015.

    Article  Google Scholar 

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Correspondence to Richard D. Urman.

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This work attributed to: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston MA

This article is part of the Topical Collection on Systems-Level Quality Improvement

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Malapero, R.J., Gabriel, R.A., Gimlich, R. et al. An Anesthesia Medication Cost Scorecard – Concepts for Individualized Feedback. J Med Syst 39, 48 (2015). https://doi.org/10.1007/s10916-015-0226-2

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  • DOI: https://doi.org/10.1007/s10916-015-0226-2

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