Joint replacement hospitals benefit financially from the anesthesia room

Regional anesthesia is increasingly used in total joint arthroplasty (TJA). It has demonstrated efficiency improvements by allowing patients to be treated in tandem in a dedicated block room (BR). However, there is no detailed measurement of these benefits for hospital operations. For one study, researchers sought to use detailed operational modeling to estimate the financial impact of creating a BR.

A discrete-event simulation model of the daily flow of patients in the operating room for TJA surgeries in a medium-sized hospital was created. Two situations were tested: without and with BR. Staffing requirements, daily hours and labor expenditures were used to compare the scenarios. The number of operating rooms and cases varied from two to six, with each operating room performing three to five cases. These results were incorporated into a discounted cash flow (CF) model. The discounted outputs of the CF model were CF, net present value, internal rate of return, and return on investment.

The average time saved by integrating a BR was 68 minutes per day (range: 30 to 80 minutes per day), decreasing the time of closure of the operating room by one hour. Additional labor costs/day of nurse overtime pay ranged from $2,025 to $10,125 without BR and from $1,595 to $9,045 with BR, resulting in profit gain/ day from $360 to $1,605. The annual cost of capital was $54,363, the net present value was $213,082, the internal rate of return was 12%, and the return on invested capital was 43.61%.

The analysis showed that a BR is more lucrative than no BR for a hospital performing the TJA through a bundled care or private payer remuneration model in all situations. Even after taking into account the initial financial investment, a BR turned out to be a net financial benefit. In addition, work indicated the possibility of combining discrete event simulation with financial analysis to evaluate alternative care operational models, such as specialized trauma rooms and swing rooms, to increase the hospital efficiency.


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