Streamlining variability in hospital charges for standard thyroidectomy: Developing a strategy to decrease waste

Morris, Lilah F.; Arenas, M.; Cerný, J; Berger, Joel S.; Borror, Connie M.; Ong, M. C. C.; Cayo, Ashley K.; Graham, Paul H.; Grubbs, Elizabeth G.; Lee, Jeffrey E.; Perrier, Nancy D.

doi:10.1016/j.surg.2014.08.068

Cited by 33 publications

(22 citation statements)

References 15 publications

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“…[6] As a result, there is no consensus in the literature regarding the potential benefi t of RAI for intermediate-risk patients. As outlined by the ATA, the decision to treat is therefore based on clinical judgment, with particular weight placed on patient's age, histology, tumour size, and lymph node metastases status in combination with other potential risk factors, such as the presence of tumour multifocality and vascular invasion.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, aend tail whole body scan ( WBS) can be done after postoperative RAI; the results of this scan may identify previously undiagnosed disease, and may change the initial staging and facilitate early recurrence detection that is based on serum thyroglobulin (Tg) measurement and/or WBS. [6,7] Although I-131 is widely used, RAI therapy is not without adverse consequences. RAI can impact quality of life due to side effects such as acute or chronic xerostomia, acute or chronic sialoadentitis, and dental caries.…”

Section: Introductionmentioning

confidence: 99%

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Is postoperative radioactive iodine associated with a survival advantage among…

Hamed

2017

Forum of Clinical Oncology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is postoperative radioactive iodine associated with a survival advantage among…

Hamed

2017

Forum of Clinical Oncology

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“…In fact, the DRG system should be considered an iso-resource, all-inclusive model. In this perspective, the goal should be the implementation of "low cost" cases as much as possible with the aim of spreading the costs of the more expensive procedures in a wide range of different situations (37). Different strategic measures can be called into question: systematic assessments for improving the efficiency and, at the same time, for reducing the waste of unnecessary tools; implementation of case-selected clinical pathways.…”

Section: Discussionmentioning

confidence: 99%

Comparison of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis

Melfa¹,

Raspanti²,

Attard³

et al. 2016

Gchir

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Primary hyperparathyroidism (PHPT) is the third most frequent disease among the endocrine disorders, with a prevalence of 1-3% in western countries. Moreover, it is the commonest cause of hypercalcemia (1-4). Nowadays, the PHPT is diagnosed increasingly due to the improvement of biochemical test; it allowed the precocious diagnosis and the identification of asymptomatic patients (5, 6). Conventional bilateral neck exploration remains the reference surgical technique, although the hyperproduction of the parathyroid hormone (PTH) is due to a single hyperfunctioning gland (most frequently a parathyroid adenoma) in a high percentage (70-95%) of cases. It could allow to perform a minimally invasive "focused" approach if the preoperative diagnosis of localization is not doubtful, especially in the presence of two concordant imaging procedures, such as ultrasounds (US) and 99mTc-Sestamibi Scintigraphy (MIBI) (2, 7-11). This focused approach can be performed under general as well as local anaesthesia and it is widely accepted for the sporadic, non-hereditary, uni-focal form (4). The goal of a minimally invasive approach can also be reached with the minimally invasive video-assisted parathyroidectomy (MIVAP), which is an adaptation of the mini-incision cervical procedures to the video-assisted gasless techniques (9,12,13

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“…The most widely used technique in STR studies based on EA was the CL, followed by focus groups (FG), OBS and standardization (STD). FG were an important means to motivate multidisciplinary groups to analyze ST rationalization through observation of actual instrument usage, reviewing preference cards, creating educational programs to minimize waste and assessing team motivation after implementation [15,21,[50][51][52]. The indicator utilization rate was used by several authors (e.g.…”

Section: Charting the Datamentioning

confidence: 99%

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

Santos

Fogliatto

Zani

et al. 2020

Preprint

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Background Surgical Tray Rationalization (STR) consists of a systematic reduction in the quantity 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 aiming at identifying and mapping available evidence on the topic of 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 directions for future research, which are presented as nine research questions associated with the four generic steps proposed in the STR roadmap.

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Streamlining variability in hospital charges for standard thyroidectomy: Developing a strategy to decrease waste

Cited by 33 publications

References 15 publications

Is postoperative radioactive iodine associated with a survival advantage among…

Is postoperative radioactive iodine associated with a survival advantage among…

Comparison of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis

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

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