The effect of a drug and supply cost feedback system on the use of intraoperative resources by anesthesiologists
We performed a randomized, prospective study to evaluate the use of a written feedback system in reducing the intraoperative costs of drugs and supplies used by anesthesiologists. Over 6 mo, 27 anesthesiology residents were randomized to feedback and control groups for their rotations in neurosurgical anesthesia. We recorded the cost of drugs and supplies for three procedures: carotid endarterectomy, lumbar decompression, and cervical decompression. For each study case, members of the feedback group received a written cost analysis showing their performance relative to the departmental average. Members of the feedback group had significantly lower costs for carotid endarterectomies ($79.98 ± $15.20 vs $97.59 ± $21.53) and for lumbar decompressions ($56.72 ± $16.49 vs $76.05 ± $20.11). The source of savings included lower use rates for propofol and etomidate and for patient warming devices. Analysis of data from recovery areas revealed a trend toward lower patient temperature in lumbar procedures performed by the feedback group. Three months after the feedback period, we collected a follow-up data set in the absence of feedback. This revealed a significant rebound in overall cost by the feedback group for both carotid endarterectomies and lumbar surgery. Implications: This is the first randomized, prospective evaluation of a cost management system in anesthesia. Using resident anesthesiologists, we showed that the written feedback of individualized performance data can be used to lower the overall cost of intraoperative drugs and supplies used for an anesthetic in the absence of mandated clinical guidelines.