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2010 Annual Meeting Abstracts

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Surgical Vampires and Rising Healthcare Expenditure: the cost of daily phlebotomy
*Elizabeth Stuebing, MD
Alpert School of Medicine at Brown University

Objective
Phlebotomy is a substantial proportion of hospital expenditure and much of it is unwarranted. Most physicians are unaware of the charge to the patient for any particular test. We hypothesized that simply knowing the charge of daily phlebotomy for general surgical patients would affect practice patterns.

Design
This is an observational study. Patient lists for 3 general surgical services were studied for number of chemistries and complete blood counts ordered per patient per day on floor level-of-care patients. These numbers were monitored before and after the intervention, and the difference in practice pattern observed.

Setting
Data was collected at a large teaching hospital from noncritical inpatients on 3 different general surgical services. The daily census for theses services was printed once a day and the number of chemistries and complete blood counts was counted.

Patients or Other Participants
All patients on a general surgery service who were not in an intensive care unit were included. Consent was waived, as this was an observational study, and it was IRB approved.

Intervention(s)
Background data was collected for 2 weeks prior to the intervention. Then every week at an educational conference, a brief announcement was given stating the total amount charged to patients for daily phlebotomy for that week as well as dollars charged per patient per day. This was done for 12 weeks.

Main Outcome Measure(s)
The main outcome measure was dollars charged per patient per day on chemistries and complete blood counts only. This was measured over the 12 week period of intervention.

Results
The dollars charged per patient per day started at a baseline of and decreased over the study period to . This was a significant change, P=0.002. Over 11 weeks of intervention, this resulted in a savings of ,000 in amount charged to patients.

Conclusions
Physicians being made aware of the cost of patient care can make a difference in practice patterns. Simply being informed of the charge for daily phlebotomy can reduce the overuse of bloodwork by up to 27%. This results in significant savings for the hospital.


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