Improvement Report: Reduction in Cost of Coronary Artery Bypass Grafting for Low-Risk Patients

Scott & White Memorial Hospital, Clinic, and Health Plan
Temple, Texas, USA

Team

The improvement team included a Cardiothoracic Surgeon, Cardiologist, Business Development Manager, and a Director of Perioperative Services.

 
Aim
Reduce the cost of coronary artery bypass surgery by 40 percent in low-risk patients.

Measures
Cost of coronary artery bypass surgery

Changes
  • Discontinued use of a preoperative coagulation panel, Cell Saver, and Swan Ganz catheter in low-risk cases.
  • Implemented the use of short-acting anesthetic agents, which allowed immediate postoperative extubation in some patients and shorter ventilation time in others.
  • Renegotiated the cost of perfusion and operating room supplies.
  • Emphasized daily case selection with the goal of completing two cases in the same room in an eight-hour period, thus avoiding overtime.
  • Decreased minutes per case by instituting parallel processing of steps, two-stick rule for IVs, etc.


Results
Graph_costreductioninlowriskCABGpatients.gif

 

Summary of Results / Lessons Learned / Next Steps

In November 1996, the average cost of Coronary Artery Bypass Grafting (CABG) for low-risk patients was over $15,000. By August 1997, the average cost dropped by 33 percent to $10,000 per case — and remained steady at the new level.

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