Case Studies in the Netherlands

Reduction of inpatient bed use in cardiology angioplasty patients

Our benchmark analysis and discussions with cardiologists show that care for patients undergoing angioplasty can be more efficient. The hospital cardiologists do not do angioplasty themselves; that happens in another hospital. Before the patients leave for the other hospital, they sleep overnight in the first hospital. Then they leave for the other hospital for angioplasty; they also sleep there for another night, and then they go back to the first hospital for clinical (after) treatment.

After consultation, an improvement plan is drawn up: from now on, patients who undergo angioplasty will no longer spend the night in the first hospital. This reduction of inpatient bed use in cardiology angioplasty patients resulted in a 15% cost savings on angioplasty patients and 2% savings on total cardiology volume.

Gall bladder surgery can be done more often through outpatient treatment

The benchmark analysis shows that a hospital performs gallbladder surgery in a clinical setting (inpatient treatment) in 50 percent of the cases, while in other hospitals this is done on average in 30 percent of the cases. The remaining gall bladder surgeries take place through outpatient treatment. Even after corrections for the type of patients (for example comorbidity or an average higher age) the difference is clearly present. Together with the doctors of the hospital – the autonomy remains with them after all – we look at where this difference comes from. In this case, the hospital decides to try and reduce clinical gallbladder surgeries. And successfully so!

Significantly improved outcomes for Moh’s patients

A hospital removes basal cell carcinoma, a malignant spot on the skin, through what appears to be a more expensive treatment: Moh’s surgery. The spot is removed as precisely as possible, without losing too much healthy skin. The removed tissue is examined  during surgery, while the patient waits. If the edges of the wound are free from cancer cells, the specialist will suture the wound. This treatment has many benefits for the patient: less damage to the skin and the certainty that all cancer cells have been removed.

Assessing Mohs-surgery, we found that the actual cost was not more expensive when taking full cycle of care into account (e.g. readmissions and treatment by plastic surgeon). Outcomes for patients were significantly improved; no waiting time for result, higher cure rate (~95%) and virtually eliminated need for plastic surgery.

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