ESPU Congress 2018 - Abstract Book

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120 29th CONGRESS OF THE ESPU
09:25–09:28
S14-7 (PP)
USING TIME-DRIVEN ACTIVITY-BASED COSTING
TO IDENTIFY OPPORTUNITIES FOR PROCESS EFFICIENCY
AND COST OPTIMIZATION FOR THE ROBOT-ASSISTED
LAPAROSCOPIC PYELOPLASTY
Yves J.L. BODAR1 , Arun K. SRINIVASAN MD1 , Apurva S. SHAH MD, MBA2 , Trudy
KAWAL MD1, Meaghan LUTTS MBA3 and Aseem R. SHUKLA MD1
1) Children's Hospital of Philadelphia, Urology, Philadelphia, USA - 2) Children's Hospital of Philadelphia, Orthopaedic
Surgery, Philadelphia, USA - 3) Children's Hospital of Philadelphia, Finance, Philadelphia, USA
PURPOSE
Robot-Assisted Laparoscopic Pyeloplasty (RALP) is a commonly performed procedure in children,
but as an emerging technology, a standard methodology to assess costs and opportunities for
work flow optimization lacks elucidation. We hypothesized that time-driven activity-based costing
(TDABC) yields granular data points to determine the true costs of a procedure, and can be utilized
to maximize cost and time-flow efficiency.
MATERIAL AND METHODS
The RALP care pathway was defined as a single day process from patient arrival to the pre-operative
suite to discharge from the post-anesthesia care unit (PACU). Process maps were created with
an interdisciplinary team to survey RALP activities. Retrospective time stamps from EPICTM were
analyzed for fiscal year 2016 (FY16) RALP cases. Prospective stop watch timing was performed for
13 RALP cases to validate retrospective data. Maintenance and disposable costs were calculated,
amortized and categorized. Personnel costs for each phase of care were measured using TDABC.
Per-minute capacity costs were calculated using FY16 financial data, and multiplied by the time
stamps.
RESULTS
A total of 25 RALP cases were analyzed from FY16, and TDABC calculation determined a cost
of $11906.67 including overhead and indirect robot costs. Current robot usage is 22 % of total
available capacity, and per case costs could be reduced by 15 % if total capacity is utilized. Cost
categories with the most variance were pre-operative services (115 min, 27.5 SD), robotic console
(142 min, 30.7 SD) and PACU times (145 min, 101.1SD). Robotic console time and operating room
turnover/preparation comprised the costliest categories by TDABC calculation.
CONCLUSIONS
TDABC offers a novel approach to cost accounting of the RALP that most accurately measures
resource utilization. TDABC also identifies high-cost/high variability loci in the RALP process map
that will be targeted for process/quality improvement that is ongoing at our institution.