Time-driven activity-based cost of outpatient total hip and knee arthroplasty in different set-ups

Figures & data

Table 1. Cost per minute in US$for various staff members involved

Staff members	CPM
(Hvidovre)	US$
Orthopedic surgeon	2.00
Anesthesiologist	1.33
Orthopedic resident	1.20
Nurse (ward)	0.85
Nurse (anesthesia)	0.94
Nurse (scrub, OR)	0.84
Nurse assistant	0.75
Physiotherapist	0.88
Cleaning	0.75
Radiologist	2.00
Secretary	0.75
Laboratory technician	0.85
Porter	0.64

Table 2. Time (minutes) and corresponding TDABC (US$) used on preoperative preparation before operations in ambulatory surgery department (ASD) and central operation ward (COP) and post-discharge follow-up

Perioperative activities	ASD		COP
	time	TDABC	time	TDABC
	(min)	(US$)	(min)	(US$)
Preop. visit 1:
Surgeon	20	40	20	40
Total	20	40	20	40
Preop. visit 2:
Resident	30	36	30	36
Nurse	30	26	30	26
Lab technician	10	9	10	9
Anesthetist	20	27	10	13
Physiotherapist	15	13	X	0
Total	105	110	80	83
Preop. visit 3 (patient seminar, n = 30):
Surgeon	X		30	60
Anesthetist nurse	X		15	14
Physiotherapist	X		15	13
Nurse assistant	X		90	68
Total	0		150	155
Day of surgery:
Total	671	746	701	777
Follow-up (nurse):
Nurse	30	26	30	26
Total	30	26	30	26
Follow-up (surgeon):
Surgeon	10	20	10	20
Total	10	20	10	20
Total	836	942	846	951

Table 3. Time (minutes) and corresponding TDABC (US$) used on various procedures in 3 operations (TKA = total knee arthroplasty, THAh = total hip arthroplasty hybrid, THAu = total hip arthroplasty uncemented) in ambulatory surgery department (ASD) and central operation ward (COP) during day of surgery

	ASD1	ASD2	ASD3	time	TDABC	COP1	COP2	COP3	time	TDABC
	TKA	THAh	THAu	mean	US$	TKA	THAh	THAu	mean	US$
Anesthetist:
Anesthesia procedure	13	11	8			15	8	16
Total	13	11	8	11	15	15	8	16	13	17
Anesthetist nurse:
Anesthesia prep. (+ iv lines)	15	13	8			35	35	10
Anesthesia procedure	13	11	9			15	10	10
Surgery	35	57	45			43	48	39
Postoperative tasks	5	5	5			5	5	9
Total	68	86	67	74	70	98	98	68	88	83
Surgeon:
Preparation outside OR	8	10	10			10	10	10
Preparation inside OR	28	20	22			35	25	27
Scrubbing	5	5	5			5	5	5
Surgery	35	57	45			43	48	39
Postop. radiographs	8	6	7			X	X	X
Documentation	10	10	11			5	5	5
Rounds	15	12	14			15	15	15
Total	109	120	114	114	228	113	108	101	107	214
Surgical assistant:
Preparing prostheses, bed	15	20	16			20	10	10
Preparing op table/positioning	15	13	15			23	15	13
Scrubbing	5	5	5			5	5	5
Surgery	35	57	45			43	48	39
Postop. radiographs	8	6	7			X	X	X
Taking patient to recovery room	10	8	10			13	15	15
Total	88	109	98	98	118	104	93	82	93	112
Scrub nurse:
Preparation OR	15	15	15			10	15	15
Scrubbing	5	5	5			5	10	5
Prep. instruments	9	10	15			10	20	7
Anesthesia procedure	13	11	12			15	8	16
Sterilization, draping	17	16	16			13	20	10
Surgery	35	57	45			43	48	39
Cleaning instruments	16	10	15			13	10	10
Total	114	124	123	120	101	109	131	102	114	96
Floor nurse:
Preparation OR	11	15	15			10	15	12
Prep. instruments	17	15	20			20	10	7
Anesthesia procedure	13	11	13			15	8	16
Sterilization, draping	17	15	15			13	20	10
Surgery	35	57	45			43	48	39
Postop. radiographs	8	8	8			X	X	X
Cleaning	10	10	15			7	5	10
Total	111	131	131	124	104	108	106	94	103	87
Radiologist:
Postop radiographs	X	X	X			10	10	10
Total	0	0	0	0	0	10	10	10	10	20
Ward nurse:
Prep. of patient	5	5	5			22	15	10
Various incl. documentation	90	92	92			102	100	80
Total	95	97	97	96	82	124	115	90	110	94
Physiotherapist:
Mobilization	30	35	35			60	60	70
Total	30	35	35	33	29	60	60	70	63	55
Total staff minutes	628	713	673	671	746	741	729	633	701	777

Figure: Flowchart of various procedures before, during, and after outpatient TJA in a central operation ward (left) and an ambulatory surgery department (right)