TREATMENT AND CASE RELATED BUDGETING DEMA ND ECONOMIC MANAGEMENT - SHORT-OPERATIONS DAY - A WAY TO SOLVE THE PROBLEM

Background: Implementation of case related budgeting (similar to diagn osis related groups) has forced hospitals into more cost efficient man agement particularly with respect to surgery. Efforts to increase effi ciency are concentrated on the labor intensive organization of the sur gical ward. Operations of short duration are a major focal point. An a nalysis of the organizational structure of our hospital showed that si gnificant improvement in operating theater management and utilization can be achieved in order to improve efficiency. A new pilot project wa s tested for economic efficiency. Methods: On eleven specified surgery days (129 patients) only short operations with a duration of less tha n 20 min were allowed (tonsillectomy, adenectomy, etc.). On each day 1 5 operations were performed in one operating room with two anesthesiol ogy teams and one surgery team. This type of ''short-operation day'' w as compared with a ''regular'' surgery day with two operating rooms, t wo anesthesiology teams, and two surgery teams. Efficiency, complicati on rates, economic outcome, and patient satisfaction were assessed. Re sults: Due to reduction of staff and a more efficient organization, we were able to reduce the costs for staff and the operating theater mai ntenance from DM 378,20 to DM 243,90 for each operation. Additionally, only one operating room was required instead of two. Complication rat es (postoperative bleeding) were lower than before and patient accepta nce and satisfaction was remarkable. Conclusions: Economic efficiency of short operations could be increased by organizational restricturing . The quality of the operations and the patients' satisfaction did not decrease.