1. Cost of Oral Contrast in ED Patients with Non-traumatic Abdominal Pain
Final Report
April 17th, 2018
Emily Herbstman, Trevor Hoffman, Alexis Flake, Ben Sweeney
Team 5
. . .
Dr. Prasad Shankar, Assistant Professor of Radiology
Dr. Matthew Davenport, Associate Professor of Radiology and Urology
Ms. Allie Mukavitz, Industrial Engineering Fellow
Mr. Jonathan Lee, Industrial Engineer
Dr. Mark Van Oyen, IOE 481 Professor
18W5-final-presentation

2. Introduction and Background
IV contrast vs oral contrast
Readi-Cat and Gastrografin
Policy change on June 1st, 2017
Exceptions: BMI under 25, recent abdominal surgery, pre-existing inflammatory bowel disease
Oral contrast takes hours and has an impact on ED workflow
Scan with oral contrast shows anatomy of abdomen

3. Key Issues Increased time of patient in a bed
Delays in Emergency Department Workflow

4. Goals and Objectives
Design a process map of oral contrast administration
Find the average time range necessary for ED staff to complete oral contrast administration
Calculate the labor, materials, and time costs incurred from the oral contrast administration process

5. Project Scope Patients receiving CT scans outside of the ED
Non-traumatic abdominal pain patients receiving CT scans in the ED
Patients receiving oral contrast
Time from when the CT scan is ordered to when patient leaves for scan
Cost of labor, cost of material, time, occupancy
Patients receiving CT scans outside of the ED
Patients receiving no form of contrast
Any diagnosis, follow-ups, or additional testing

6. Approach Literature Review Time Studies Informal Interviews1
Literature Review
Time Studies 2
Approach 3
Informal Interviews 4
Cost Calculation 5
Retrospective Data Analysis

7. Literature Review
Significant time difference between oral contrast and IV patients
Mean time for oral contrast procedure of minutes and no diagnostic compromise for appendicitis patients who did not receive oral contrast
Oral contrast not required to establish diagnosis for patients in ED with non-traumatic abdominal pain
Time-Driven Activity-Based-Costing (TDABC) to calculate labor costs

8. Time Studies February 5th - March 30th
Identified steps for process map
100 hours of observation
Found average times for each process step

9. Informal Interviews Low volume of oral contrast patients
Strengthened sense of processes
Time estimates

10. Labor Costing TDABC formula
Salary Data from Bureau of Labor Statistics
Staff utilization, salary, and benefits considered

11. Material Costing Readi-Cat: 10 distributors $3.32 per patient
Gastrogafin:
7 distributors
$13.70 per patient

12. Occupancy Costing
Drinking times for Readi-Cat and Gastrografin take 57, 93 minutes, respectively
Real & opportunity costs associated with time spent in a bed
A literature search was conducted determining a cost range of $.10/minute-$1.41/min for time spent in ED bed
Used $.21/min from radiologists expert opinion

13. Retrospective Data Analysis

14. Findings: Time Studies
Contrast Preparation
Dose 1 Administration
Dose 1 Progress Check
Dose 2 Administration
Dose 2 Progress Check
3:41*
2:48
2:39
2:24
2:45
* Add 90 seconds to contrast preparation for Gastrografin

15. Findings: Per Patient Costs
Contrast Type
Labor Cost
Material Cost
Occupancy Cost
Total Cost
Readi-Cat
$12.01
$3.41
$12.03
$27.45
Gastrografin
$13.73
$16.05
$19.58
$49.36

16. Findings: Total ED Cost Savings
Total cost of $150,570 over the year
~$94,000 attributed to Readi-Cat (3,391 patients)
~$57,000 attributed gastrografin (1,150)
Using BMI, IBD, Surgery criteria, 2,648 patients would no longer receive contrast.
$86,814 in cost reduction when removing these patients → annual ED savings

17. Findings: Process

18. Design Methods: Process Map
Different Roles
Different Contrast
Types
Step Granularity
Process Timeline

19. Design Methods: Cost Model
Data Collection Method
Sources of Cost Data

20. Design Requirements Process Map Cost Model Process Map Cost Model
Clear, neat, and within scope
Able to be easily incorporated into a paper for publication
Cost Model
Accurate representation of true cost
Process Map
Cost Model
Accurate representation of true cost
Clear, neat, and within scope
Able to be easily incorporated into a paper for publication

21. Design Constraints Data Collection Process Map Cost Model
ED policy on who receives contrast
Oral contrast administration is a long, rare process
Process Map
Project Scope
Cost Model
Only one year of retrospective data
Nurse/patient interaction times are limited to observation data

22. Design Standards National Michigan Best Practices HIPAA
ATSM E1699: Standard Practice for Performing VE/VA of Projects, Products, and Processes
Institutional costing data cannot be published
PEERRS Training
Standard value stream mapping symbols
TDABC

23. Recommendations 1 Validation of policy change 2
Method for evaluating future policy changes

24. Expected Impact Potential future policy changes
Incentive for similar policies in other emergency departments across the country

25. Questions?