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Release: April 30, 1999

UI researcher shows economic benefit of hospitals fast-tracking patients varies

IOWA CITY, Iowa -- Patients used to spend several hours, sometimes days, in the hospital following surgery. Now, many individuals walk out the hospital door less than an hour or two after waking up from procedures. The speedy process is due largely to fast-tracking, which involves keeping patients who are under general anesthesia in a lighter anesthetized state so they regain consciousness sooner.

Many hospitals and health care centers have embraced this new fast-tracking approach as a way to decrease staffing costs while maintaining quality care. However, a University of Iowa researcher, working with colleagues at Stanford and Duke universities, has found that the financial benefits of fast-tracking may vary among institutions.

In an article that appears in the May 1 issue of the journal Anesthesia and Analgesia, Franklin Dexter, Ph.D., M.D., UI associate professor of anesthesia, showed that whether fast-tracking allows a hospital to reduce staffing costs depends highly upon the institution's labor payment structure. Fast-tracking can decrease an institution's costs because less staffing time is required. Patients wake up more quickly and can leave the operating room sooner. In addition, the patients might not have to stay in the recovery room as long. If a hospital pays its ambulatory surgery center staff an hourly rate and the fast-tracking reduces substantial overtime, the decrease in labor costs can be significant. If a hospital pays its staff a set salary, the time savings may not translate into financial savings.

Despite the varied financial implications, Dexter said fast-tracking is here to stay.

"From the patient's point-of-view, it's an advantage because it gets them out of the hospital quicker so they can be at home, be with their families," Dexter said. "From a hospital's point-of-view, even if large decreases in costs cannot be expected, fast-tracking will increase the productivity of the workforce so staff members can do other things with their time. It may not decrease costs but rest assured that it is going to increase productivity."

Dexter and his colleagues were funded in part by Aspect Medical Systems Inc. to determine whether fast-tracking could save an institution money. Aspect Medical Systems has developed technology to measure a patient's level of consciousness during surgery. The monitor is useful for fast-tracking because it helps anesthesia staff give patients just enough medicine so they are unconscious during surgery but in a state from which they can awaken soon after the procedure.

Aspect Medical Systems representatives were interested in studying fast-tracking's financial savings to help hospitals better understand how their monitors can decrease staffing costs. Dexter set out to determine under what circumstances fast-tracking could save an institution money.

"What we really found is there is no one, single answer," Dexter said. "The economic impact is going to vary among institutions depending on how people are paid. Many hospitals and ambulatory surgery centers are considering the adoption of new medicines and monitors so that their patients can leave within an hour or two after surgery. These institutions can use our analysis to better predict the financial impact of this fast-tracking."