This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (13) Citing Articles via Google Scholar Google Scholar Articles by Schuster, M. Articles by am Esch, J. S. Search for Related Content PubMed PubMed Citation Articles by Schuster, M. Articles by am Esch, J. S.

---

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH

Reduction of Anesthesia Process Times After the Introduction of an Internal Transfer Pricing System for Anesthesia Services

Martin Schuster, MD, MA^*, Thomas Standl, MD^*, Hajo Reissmann, MD^*, Ludwig Kuntz, PhD, and Jochen Schulte am Esch, MD^*

*Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; and Department of Health Care Management, University of Cologne, Cologne, Germany

Address correspondence and reprint requests to Martin Schuster, MD, Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. Address e-mail to m.schuster{at}uke.uni-hamburg.de.

To improve operating room workflow, an internal transfer pricing system (ITPS) for anesthesia services was introduced in our hospital in 2001. The basic principle of the ITPS is that the department of anesthesia receives reimbursement only for the surgically controlled time, not for anesthesia-controlled time (ACT). A reduction in anesthesia process times is therefore beneficial for the anesthesia department. In this study, we analyzed the ACT (with its parts: preparation before induction, induction, extubation, and recovery room transfer) for 3 yr before and 3 yr after the introduction of the ITPS in 55,776 cases. Furthermore, the anesthesia cases were subsegmented into 10 different anesthesia techniques, and the process times were studied. The average total ACT was reduced from 40.4 ± 23.5 min in 1998 to 34.3 ± 21.7 min in 2003. The main effect came from reductions in anesthesia preparation time and recovery room transfer time, whereas induction and extubation time changed little. A significant reduction in average ACT was seen in 7 of 10 analyzed anesthesia techniques, ranging from 4 to 18 min. We conclude that transfer pricing of anesthesia services based on the surgically controlled time can be a successful approach to reduce anesthesia process times.

This article has been cited by other articles:

				D. Masursky, F. Dexter, M. P. Garver, and N. A. Nussmeier Incentive Payments to Academic Anesthesiologists for Late Afternoon Work Did Not Influence Turnover Times Anesth. Analg., May 1, 2009; 108(5): 1622 - 1626. [Abstract] [Full Text] [PDF]

				M. Schuster, T. Kotjan, M. Fiege, and A. E. Goetz Influence of resident training on anaesthesia induction times Br. J. Anaesth., November 1, 2008; 101(5): 640 - 647. [Abstract] [Full Text] [PDF]