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A “zero tolerance for overtime” increases surgical per case costs

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Abstract

Purpose

One technique which some hospitals have used in an attempt to control Operating Room costs is a “zero tolerance for overtime” policy. We used a case cost analysis to determine if this policy was always cost effective.

Method

A case cost analysis was designed based on a “test case” which would start late in the day. The case would last for three hours of which 1 1/2 hr would be during regular hours, and 1 1/2 hr would incur overtime. Costs were analysed using a “patient pays,” “society pays,” and “hospital pays” analysis. Costs were based on figures determined from the SMBD-Jewish General Hospital budget, Québec Health Insurance fees, and Government of Canada statistics.

Results

Regardless of who pays, in this case scenario it was more cost effective to proceed than to postpone surgery. Costs of proceeding with the surgery in the “patient pays,” “society pays,” and “hospital pays” models were $1,832.00, $1,227.40, and $1,215.00 respectively. The costs of postponing the surgery in the same three models were $1,937.00, $1,336.80, and $1,436.00.

Conclusion

A “zero tolerance for overtime” policy may be too rigid to be consistently cost effective.

Résumé

Objectif

À la salle d’opération, certains hôpitaux appliquent la règie de la tolérance zéro vis-à-vis le temps supplémentaire dans le but de diminuer les coûts. Nous avons analyse les frais d’une intervention pour déterminer si cette politique était toujours efficace par rapport au coût.

Méthodes

Une analyse des frais occasionnes par une intervention a été élaborée autour d’une intervention type qui commencerait tard dans la journée. Elle durerait au moins trois heures dont la moitié pendant les heures régulières et l’autre en dehors de celles-ci. Une analyse basée sur la source du paiement, patient, collectivité, hôpital, a servi à déterminer les coûts. Les valeurs utilisées provenaient des chiffres fournis par l’Hôpital Juif SMBD de Montréal, les honoraires de la Régie d’Assurance Maladie du Québec et Statistiques Canada.

Résultats

Les coûts de l’intervention selon la source du paiement, patient, collectivité et hôpital, se chiffraient respectivement à 1,832,00$, 1,227,40$ et 1,215,00$. Basés sur ces mêmes modèles, les coûts du report de l’intervention s’élevaient a 1,937,00$, 1,336,80$ et 1,436,00$.

Conclusion

La règie de la tolérance zéro vis-à-vis le temps supplémental semble trop rigide pour garantir un bon rapport efficacité/coût.

References

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Author information

Correspondence to Michael J. Tessler.

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Tessler, M.J., Kleiman, S.J. & Huberman, M.M. A “zero tolerance for overtime” increases surgical per case costs. Can J Anaesth 44, 1036 (1997). https://doi.org/10.1007/BF03019223

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Keywords

  • Labour Cost
  • Post Anaesthesia Care Unit
  • Frais
  • Zero Tolerance
  • Canada Statistic