ESPU Congress 2018 - Abstract Book

120 29 th 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. BODAR  1 , Arun K. SRINIVASAN MD  1 , Apurva S. SHAH MD, MBA  2 , Trudy KAWAL MD  1 , Meaghan LUTTS MBA  3 and Aseem R. SHUKLA MD  1 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 EPIC TM 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.