TY - JOUR
T1 - Harnessing Behavioral Economics Principles to Promote Better Surgeon Accountability for Operating Room Cost
T2 - A Prospective Study
AU - Offodile, Anaeze C.
AU - Sen, Aditi P.
AU - Holtsmith, Shelby
AU - Escalante, Jon
AU - Park, Anne
AU - Terrell, John
AU - Bassett, Roland
AU - Perrier, Nancy D.
N1 - Funding Information:
Support: Analyses for this work were supported in part by the Cancer Center Support Grant (NCI Grant P30 CA016672).
Publisher Copyright:
© 2020 American College of Surgeons
PY - 2020/4
Y1 - 2020/4
N2 - Background: Operating room (OR) cost accounts for a significant portion of inpatient spending, but most surgeons are unaware of the costs of OR implants and supplies. We leveraged behavioral economics principles and a cost transparency tool to have an impact on discretionary OR spending (disposable supplies). Study design: We performed a single-institution, prospective study, from January to December 2018, across 3 departments: urology, thoracic, and endocrine. Two self-selected procedures per department were subjected to intraoperative supply cost (ISC) feedback via a custom dashboard and monthly email reports. Behavioral economics principles like choice overload, social ranking, and threshold effects were leveraged during study design. The primary outcome of percentage change in the department-level mean ISC, as determined via an interrupted time-series mixed effects model, was compared between the intervention year (2018) and “pre-baseline” (2016) and “baseline” (2017) years. Results: A total of 2,853 procedures and 26 surgeons comprised our analytical sample. Costs decreased in 5 of the 6 procedures in 2018. On average, there was a significant monthly decrease in costs of approximately 0.5% over the study period (p = 0.0004). Post-intervention, there was a nonsignificant additional decrease of 0.6% in monthly cost (p = 0.0648). Overall cost significantly decreased by 20% due to the intervention (p < 0.0001). Similar results were noted on sensitivity analysis. There were no significant changes in the incidence of postoperative complication due to our intervention. Conclusions: Deployment of a cost feedback tool using behavioral economics principles resulted in a significant decrease in OR spending without negatively affecting complication rate.
AB - Background: Operating room (OR) cost accounts for a significant portion of inpatient spending, but most surgeons are unaware of the costs of OR implants and supplies. We leveraged behavioral economics principles and a cost transparency tool to have an impact on discretionary OR spending (disposable supplies). Study design: We performed a single-institution, prospective study, from January to December 2018, across 3 departments: urology, thoracic, and endocrine. Two self-selected procedures per department were subjected to intraoperative supply cost (ISC) feedback via a custom dashboard and monthly email reports. Behavioral economics principles like choice overload, social ranking, and threshold effects were leveraged during study design. The primary outcome of percentage change in the department-level mean ISC, as determined via an interrupted time-series mixed effects model, was compared between the intervention year (2018) and “pre-baseline” (2016) and “baseline” (2017) years. Results: A total of 2,853 procedures and 26 surgeons comprised our analytical sample. Costs decreased in 5 of the 6 procedures in 2018. On average, there was a significant monthly decrease in costs of approximately 0.5% over the study period (p = 0.0004). Post-intervention, there was a nonsignificant additional decrease of 0.6% in monthly cost (p = 0.0648). Overall cost significantly decreased by 20% due to the intervention (p < 0.0001). Similar results were noted on sensitivity analysis. There were no significant changes in the incidence of postoperative complication due to our intervention. Conclusions: Deployment of a cost feedback tool using behavioral economics principles resulted in a significant decrease in OR spending without negatively affecting complication rate.
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U2 - 10.1016/j.jamcollsurg.2019.12.013
DO - 10.1016/j.jamcollsurg.2019.12.013
M3 - Article
C2 - 31954814
AN - SCOPUS:85080089124
SN - 1072-7515
VL - 230
SP - 585
EP - 593
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 4
ER -