CONTACT: JENNIFER CRONIN
2130 Medical Laboratories
Iowa City IA 52242
(319) 335-5661; fax (319) 335-9917
Release: July 1, 1999
Information technology is key to decreasing surgery
costs, UI researcher finds
IOWA CITY, Iowa In the era of managed health
care, controlling costs has become crucial. Some health care economists have
suggested that achieving financial savings in the operating room could mean
patients in the future will have to wait longer for elective surgery
as much as a year in some cases, which most Americans would be unwilling to
However, a University of Iowa Health Care researcher
has found a better way to satisfy both insurance companies and patients. It
is all about using information technologies to increase operating room staff
productivity, said Franklin Dexter, M.D., Ph.D., UI associate professor of
anesthesia. Articles about Dexters approach to controlling operating
room costs for elective surgeries appear in the July issues of Anesthesiology,
and Anesthesia and Analgesia. An accompanying editorial in Anesthesia and
Analgesia calls Dexters research a "landmark study."
"There has been no evidence of any increase in
productivity of the operating room perioperative workforce over the years,"
Dexter said. "The only way you can substantively increase operating room
productivity is to ensure that you never have down time. The problem is there
is a lot of down time on the order of 35 percent."
The solution in other fields to increase productivity
without increasing costs has been to use information technology, Dexter said.
In addition to coming up with this idea for health care, Dexter and his colleagues
from the UI, Stanford University and Duke University have developed software
that hospital operating room managers can use with their existing information
systems to identify how much down time the staff is experiencing and why.
"What the software will do is let you know what
the source of the problems is and how much it is costing the operating room,"
Dexter said. "Hospitals, anesthesiologists and surgeons can then decide,
based on data, what changes should be made."
Dexter suspects that at most hospitals, the choice
of the day on which each patient has elective surgery is the most critical
factor in assuring high productivity. In other countries, the solution to
higher productivity has been to increase patients waiting times, with
some patients waiting a year for surgery. The logic being that when an operating
room staff has a large queue of patients, the operating room manager can choose
the day on which each patient has surgery so as to achieve high operating
room utilization. However, the long waiting time would never be acceptable
in the United States. According to a survey of patients that Dexter and his
colleagues conducted, the longest wait patients would consider acceptable
averages about two weeks.
Using information technologies, the United States
can achieve the same high productivity without the same long waits seen in
Europe, Dexter said. Although buying a cheeseburger is hardly like having
an operation, the principle of patients waiting for elective surgery can be
compared to customers standing in an order line, Dexter said.
"To keep the counter cashier always busy,"
he explained, "you have to have at least three customers in line. If
you get less than three or four people in line, every once in awhile the cashier
is not going to be busy. On the other hand, you never need more than say six
people in line to keep the cashier occupied. The cashier is analogous to an
operating room planned for a surgeon every other week. If the surgeon cares
for two or three patients during his or her planned sessions, then with an
average of six patients in line, the average wait for surgery will be two
to three weeks, which is much less than the European wait."
Dexters data suggest that there is dramatic
improvement in productivity when the maximum wait time goes from two weeks
to four weeks. There is a slight improvement from four weeks to six weeks.
"With information technologies, it should be
possible for the United States to improve productivity by increasing the maximum
length of time that patients wait for surgery to something like four weeks,"
Dexter said. "If you use information technologies, it shouldnt
really be necessary to have waits of three months to a year."
By using Dexters suggested four-week wait, the
increase in productivity would decrease the cost of each surgery by $150.
"When you think of the millions of elective surgical
procedures performed in the United States each year, a savings of $150 per
case is a lot of money," Dexter said. "Right now, you hear about
how managed care companies are interested in decreasing pharmaceutical costs.
The savings to be gained from changes in each patients scheduling are
more than twice as much as the total costs of all drugs used for a persons