Economic Benefits Attributed to Opening a Preoperative Evaluation Clinic for Outpatients

Pollard, Joy S.; Zboray, Ann L.; Mazze, Richard I.

doi:10.1097/00000539-199608000-00035

Cited by 53 publications

(41 citation statements)

References 14 publications

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“…[1][2][3][4] The ROI method is easy to compute and understand (Table 1). However, it measures risk rather than investment returns.…”

Section: To the Editormentioning

confidence: 99%

Capital budgeting decisions using the discounted cash flow method

Sinclair

2010

Can J Anesth/J Can Anesth

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To the Editor,The return on investment (ROI) method is commonly quoted in the analysis of capital investments affecting the practice of anesthesiology, such as the Anesthesia Information Management System (AIMS), handheld computer technology, and the Preoperative Evaluation Clinic. [1][2][3][4] The ROI method is easy to compute and understand (Table 1). However, it measures risk rather than investment returns. The ROI method is biased against long-term projects and is based on an arbitrary, short-term cut-off date that ignores the investment's performance after the cut-off point and disregards the possibility of growing cash flows after that point. For example, one cannot disregard the cost reductions and cost savings of an AIMS resulting from reductions in anesthetic-related drug costs and increases in hospital reimbursement occurring beyond a cut-off period. Expressing these future cash flows in terms of their value today is known as the discounted cash flow (DCF) method. The DCF method is superior to the ROI method for analyzing capital investment decisions because it incorporates the time value of money. 5 The DCF method estimates the value of an investment's projected future cash flows as if the cash flows were available today. It includes two main methods of discounting future cash flow. The discounted payback period rule includes the time value of money; however, like the ROI method, it is limited by an arbitrary short-term cut-off period that is biased against long-term investments. The net present value (NPV) method includes the time value of money and is a superior method for long-term projects, such as those commonly encountered in the practice of anesthesiology. The NPV method is a measure of financial value and one approach to assessing the profitability of a proposed investment. The calculation of NPV can result in one of three possible scenarios (Table 1). First, a NPV that is greater than zero adds monetary value to the organization. The capital budgeting process can be viewed as a search for investments with a positive NPV. 5 From a financial standpoint, these projects should be undertaken because they add value. Second, a NPV that is less than zero would represent a loss of value to the organization if the investment were undertaken. From a financial standpoint, the investment should not be made. Third, a NPV that is equal to zero represents an indifference towards the project and the need to consider other non-monetary factors before proceeding with the investment.The NPV should not be used to the exclusion of other variables that influence capital investment decisions simply because it is superior to the ROI method. In clinical practice, many non-economic factors take precedence over capital investment calculations, including medical evidence, quality and safety, governmental regulations, incentives, penalties, and compliance requirements. Despite the NPV of the proposed investment, the improvement in a hospital's welfare may exceed the expenditure on the project. In addition, the annual oper...

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“…[1][2][3][4] The ROI method is easy to compute and understand (Table 1). However, it measures risk rather than investment returns.…”

Section: To the Editormentioning

confidence: 99%

Capital budgeting decisions using the discounted cash flow method

Sinclair

2010

Can J Anesth/J Can Anesth

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“…3 Cancellation rates vary not only between different hospital types and sizes, 1 but also depends significantly on surgical leslie et al specialty and individual surgeons. 4,5,19,20 Comparatively high cancellation rates have been reported in specific services, such as urology and otolaryngology, [19][20][21] perhaps due to a bias of those with complex and variable case durations. 20 Given the documented increase in wait times in urology, 9 further investigation in a contemporary urological setting appears justified given the nature and scope of our specialty in an aging population.…”

Section: Introductionmentioning

confidence: 99%

Day of surgery cancellation rates in urology: identification of modifiable factors

Leslie

Beiko

Vlymen

2013

CUAJ

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Objective: Day-of-surgery cancellations have a negative effect on operating room (OR) resources, as well as on patient satisfaction and perception of quality of care. Given increasing wait times in a universal healthcare system and the nature of urological surgery in our aging population, it should be a priority to identify modifiable risks of OR cancellations to assure timely and efficient delivery of care. We explore the rate and reasons for elective surgery cancellations in a Canadian urological practice. Methods: We evaluated the rate and reason of urological surgery cancellation at a single academic institution, prospectively collected in our centre's Operating Room Scheduling Office System (ORSOS) database. Documented reasons for cancellations were divided into 3 components: (1) structural factors (e.g., no hospital bed); (2) patient factors (e.g., patient unwell); and (3) process factors (e.g., scheduling error). Rates and reasons for cancellations were compared to those of General Surgery and Gynecology. The documented reasons for cancellation in the ORSOS database were confirmed or extended by chart review and interviews with a subset of cancelled patients. Results: Between 2005 and 2009, 1544 out of 19 141 (8.07 %) elective surgical cases were cancelled within the three surgical specialties (general surgery, gynecology and urology); urology had the highest average rate of 9.53%. Non-oncological cases represented a higher percentage of cancelled cases (15%, p < 0.001) and overall rates varied significantly over time in urology compared to the other surgical specialties. Potentially modifiable, processrelated causes were by far the most common reason for cancellation (58.5%) and "standby" cases were a common cause of overall cancellation rates. Patient interviews confirmed the emotional and financial impact of cancellation; there was no overwhelming concern that clinical outcomes were negatively affected. Conclusions: This contemporary exploration of cancelled urological cases is consistent with previous reports, although variable over time and dependent on definitions used. Potentially modifiable, process-related factors appear to be most frequently associated with cancellation, although more thorough and detailed documentation is required to further mitigate inefficient OR use. We suggest that all OR cancellations should be considered to be adverse incidents to be monitored by institutions in a systematic fashion.

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“…Consequently, many patients are not evaluated by an attending anesthesiologist at all prior to surgery. It has been estimated that greater than 50% of patients do not visit a preadmission testing center, even though these have been showed to be efficient and costeffective [1][2][3][4][5][6][7][8][9]. Preoperative testing for surgery is estimated to account for approximately $30 billion in health care costs annually in the US and a majority of these tests may be unnecessary [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Reference Guidelines Improve Residents? Ability to Order Appropriate Preoperative Tests in Standardized Case Scenarios

Katz¹

2013

J Anesth Clin Res

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Background: Preoperative testing for surgery is estimated to cost $30 billion annually. The goal of this study was to determine the relative influence of access to a guideline reference for preoperative test ordering appropriateness by resident physicians in simulated case scenarios.Methods: At a single teaching hospital, 80 PGY (Post Medical School Graduation Year) 2-5 residents from anesthesiology, surgery, internal medicine, and obstetrics/gynecology were recruited to review simulated case scenarios. Participants within each specialty were randomized with half receiving supplemental ASA preoperative testing guidelines during completion of the questionnaire. Participants indicated which preoperative tests they believed appropriate for each scenario. Correct responses were set by an expert panel and results were reported as relative probabilities and 95% CI.Results: 66 surveys were analyzed. In the entire cohort, the group receiving supplemental guidelines achieved a greater percentage of correct answers (x=84.2%) compared to the group without guidelines (x=78.6%) (relprob =1.07 [CI 1.01-1.12], p=0.011). Correct answers improved to 1.07 [1.01-1.12] with a guideline across specialties and experience levels. Without a guideline, correct answer rates were greater for anesthesia vs surgery residents (1.19 [1.08, 1.31]) and anesthesia vs internal medicine residents (1.16 [1.04, 1.31]). With guidelines, these differences were maintained. Without a guideline, significant differences were noted between PGY 3 vs PGY 2 residents (1.12 [1.03, 1.23]) and PGY 4 vs PGY 2 residents (1.11 [1.03, 1.20]), but these differences were not present with guidelines. Surgery residents did not improve with the guideline. Conclusions:In a set of simulated clinical scenarios, reference to ASA-adapted guidelines improved test ordering by the majority of resident physicians. While anesthesia residents performed better than others independent of the guideline, the guideline negated the effect of experience in non-anesthesia trainees. Given the financial burden of inappropriate preoperative test ordering, further validation of the benefits of guideline implementation is warranted.

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Economic Benefits Attributed to Opening a Preoperative Evaluation Clinic for Outpatients

Cited by 53 publications

References 14 publications

Capital budgeting decisions using the discounted cash flow method

Capital budgeting decisions using the discounted cash flow method

Day of surgery cancellation rates in urology: identification of modifiable factors

Reference Guidelines Improve Residents? Ability to Order Appropriate Preoperative Tests in Standardized Case Scenarios

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