ABSTRACT
Purpose: Surgical procedure packs are commonly used in ophthalmological surgeries, but quantitative evidence demonstrating the time efficiency and economic impact of their use is limited. Evaluating the time and cost of surgical pack use is particularly important for publicly funded healthcare systems with tight budgets and/or an emphasis on value-based care. This study sought to estimate the economic impact of comprehensive surgical pack use in cataract and vitreoretinal (retina) surgeries across operating room (OR), materials management, and accounting departments in Canada. Methods: A budget impact model developed for the United States (US) from a self-reported cross-sectional study was adapted for Canada. The US study obtained data via an online survey and timing exercises of surgical procedures. The model was adapted using relevant Canadian-specific labor and cost inputs. Use of generic commodity packs (no proprietary equipment-specific supplies) was compared to full utilization of Custom-Pak®, a comprehensive pack (disposables plus equipment-specific supplies) in cataract and retina surgeries at the facility and aggregate group (provincewide) levels. Results: Switching from generic to comprehensive pack use in all 2500 cataract procedures at a community hospital saves 287 labor hours per year, primarily in the materials management department. Surgery preparation (OR) hours saved allow for an additional 196 potential procedures annually. Most of the Canadian Dollar (CAD) $39,815 annual cost savings are realized for the OR. Aggregating across 50,000 cataract surgeries at the provincial level yields savings of 5608 hours and 3916 additional procedures, translating to hidden cost reductions of CAD$790,632 annually. Implementing full Custom-Pak use at the facility level in 1000 retina cases saves $10,650 annually; provincewide, 127 potential additional procedures can be gained. Conclusion: Comprehensive Custom-Pak use improves efficiency in cataract and retina surgeries saving substantial time and cost in Canadian hospitals, potentially allowing more patients to have these procedures, and reducing wait times.
ABSTRACT
There is little evidence available in the research literature as to how to undertake an implementation process that ensures electronic medical record (EMR)/electronic health record (EHR) implementation success (i.e. high levels of clinician adoption). The research literature has documented the presence of a direct relationship between how systems are implemented and their level of adoption by clinicians after implementation. In order to develop recommendations for systems implementation to enhance the level of clinician adoption and to ensure EHR/EMR success, researchers need to analyze implementation failures (i.e. where there has been a low level of adoption among clinicians) and successes (i.e. where there has been a high level of clinician adoption). This paper examines EMR/EHR system implementation in the context of adoption success, by conducting a scoping review of the EMR/EHR case study literature. The paper attempts to answer the following: "How does the published, case study research literature provide insights into the success and/or failure of EMR/EHR implementations?" Case studies can provide insights that allow researchers to identify best practice approaches to EMR/EHR implementations that may turn the tide towards reducing the number failed EMR/EHR implementation projects.
