Post-surgery length of stay using multi-criteria decision-making tool

Sandra C. Buttigieg, Dorothy Gauci, Frank Bezzina, Prasanta K. Dey

Research output: Contribution to journalArticle

Abstract

Purpose
Length of stay (LOS) in hospital after surgery varies for each patient depending on surgeon’s decision that considers criticality of the surgery, patient’s conditions before and after surgery, expected time to recovery and experience of the surgeon involved. Decision on patients’ LOS at hospital post-surgery affects overall healthcare performance as it affects both cost and quality of care. The purpose of this paper is to develop a model for deriving the most appropriate LOS after surgical interventions.

Design/methodology/approach
The study adopts an action research involving multiple stakeholders (surgeon, patients/patients’ relatives, hospital management and other medics). First, a conceptual model is developed using literature and experts’ opinion. Second, the model is applied in three surgical interventions in a public hospital in Malta to demonstrate the effectiveness of the model. Third, the policy alternatives developed are compared to a selection of current international standards for each surgical intervention. The proposed model analyses three LOS threshold policies for three procedures using efficiency and responsiveness criteria. The entire analysis is carried out using 325 randomly selected patient files along with structured interactions with more than 50 stakeholders (surgeon, patients/patients’ relatives, hospital management and other medics). A multiple criteria decision-making method is deployed for model building and data analysis. The method involves combining the analytic hierarchy process (AHP) for verbal subjective judgements on prioritizing the four predictors of surgical LOS—medical, financial, social and risk, with pairwise comparisons of the sub-criteria under each criterion in line with the concerned interventions—the objective data of which are obtained from the patients’ files.

Findings
The proposed model was successfully applied to decide on the best policy alternative for LOS for the three interventions. The best policy alternatives compared well to current international benchmarks.

Research limitations/implications
The proposed method needs to be tested for other interventions across various healthcare settings.

Practical implications
Multi-criteria decision-making tools enable resource optimization and overall improvement of patient care through the application of a scientific management technique that involves all relevant stakeholders while utilizing both subjective judgements as well as objective data.

Originality/value
Traditionally, the duration of post-surgery LOS is mainly based on the surgeons’ clinical but also arbitrary decisions, with, as a result, having insufficiently explicable variations in LOS amongst peers for similar interventions. According to the authors’ knowledge, this is the first attempt to derive post-surgery LOS using the AHP, a multiple criteria decision-making method.
Original languageEnglish
Pages (from-to)514-531
JournalJournal of Health Organization and Management
Volume32
Issue number4
Early online date1 Jul 2018
DOIs
Publication statusE-pub ahead of print - 1 Jul 2018

Fingerprint

Length of Stay
Decision Making
Malta
Delivery of Health Care
Surgery
Multicriteria decision-making
Length of stay
Benchmarking
Quality of Health Care
Health Services Research
Public Hospitals
Expert Testimony
Patient Care
Surgeons
Costs and Cost Analysis
Research

Bibliographical note

© Emerald Publishing Limited 2018
Published by Emerald Publishing Limited
Licensed re-use rights only

Cite this

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title = "Post-surgery length of stay using multi-criteria decision-making tool",
abstract = "PurposeLength of stay (LOS) in hospital after surgery varies for each patient depending on surgeon’s decision that considers criticality of the surgery, patient’s conditions before and after surgery, expected time to recovery and experience of the surgeon involved. Decision on patients’ LOS at hospital post-surgery affects overall healthcare performance as it affects both cost and quality of care. The purpose of this paper is to develop a model for deriving the most appropriate LOS after surgical interventions.Design/methodology/approachThe study adopts an action research involving multiple stakeholders (surgeon, patients/patients’ relatives, hospital management and other medics). First, a conceptual model is developed using literature and experts’ opinion. Second, the model is applied in three surgical interventions in a public hospital in Malta to demonstrate the effectiveness of the model. Third, the policy alternatives developed are compared to a selection of current international standards for each surgical intervention. The proposed model analyses three LOS threshold policies for three procedures using efficiency and responsiveness criteria. The entire analysis is carried out using 325 randomly selected patient files along with structured interactions with more than 50 stakeholders (surgeon, patients/patients’ relatives, hospital management and other medics). A multiple criteria decision-making method is deployed for model building and data analysis. The method involves combining the analytic hierarchy process (AHP) for verbal subjective judgements on prioritizing the four predictors of surgical LOS—medical, financial, social and risk, with pairwise comparisons of the sub-criteria under each criterion in line with the concerned interventions—the objective data of which are obtained from the patients’ files.FindingsThe proposed model was successfully applied to decide on the best policy alternative for LOS for the three interventions. The best policy alternatives compared well to current international benchmarks.Research limitations/implicationsThe proposed method needs to be tested for other interventions across various healthcare settings.Practical implicationsMulti-criteria decision-making tools enable resource optimization and overall improvement of patient care through the application of a scientific management technique that involves all relevant stakeholders while utilizing both subjective judgements as well as objective data.Originality/valueTraditionally, the duration of post-surgery LOS is mainly based on the surgeons’ clinical but also arbitrary decisions, with, as a result, having insufficiently explicable variations in LOS amongst peers for similar interventions. According to the authors’ knowledge, this is the first attempt to derive post-surgery LOS using the AHP, a multiple criteria decision-making method.",
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Post-surgery length of stay using multi-criteria decision-making tool. / Buttigieg, Sandra C.; Gauci, Dorothy; Bezzina, Frank; Dey, Prasanta K.

In: Journal of Health Organization and Management, Vol. 32, No. 4, 01.07.2018, p. 514-531.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Post-surgery length of stay using multi-criteria decision-making tool

AU - Buttigieg, Sandra C.

AU - Gauci, Dorothy

AU - Bezzina, Frank

AU - Dey, Prasanta K.

N1 - © Emerald Publishing Limited 2018 Published by Emerald Publishing Limited Licensed re-use rights only

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N2 - PurposeLength of stay (LOS) in hospital after surgery varies for each patient depending on surgeon’s decision that considers criticality of the surgery, patient’s conditions before and after surgery, expected time to recovery and experience of the surgeon involved. Decision on patients’ LOS at hospital post-surgery affects overall healthcare performance as it affects both cost and quality of care. The purpose of this paper is to develop a model for deriving the most appropriate LOS after surgical interventions.Design/methodology/approachThe study adopts an action research involving multiple stakeholders (surgeon, patients/patients’ relatives, hospital management and other medics). First, a conceptual model is developed using literature and experts’ opinion. Second, the model is applied in three surgical interventions in a public hospital in Malta to demonstrate the effectiveness of the model. Third, the policy alternatives developed are compared to a selection of current international standards for each surgical intervention. The proposed model analyses three LOS threshold policies for three procedures using efficiency and responsiveness criteria. The entire analysis is carried out using 325 randomly selected patient files along with structured interactions with more than 50 stakeholders (surgeon, patients/patients’ relatives, hospital management and other medics). A multiple criteria decision-making method is deployed for model building and data analysis. The method involves combining the analytic hierarchy process (AHP) for verbal subjective judgements on prioritizing the four predictors of surgical LOS—medical, financial, social and risk, with pairwise comparisons of the sub-criteria under each criterion in line with the concerned interventions—the objective data of which are obtained from the patients’ files.FindingsThe proposed model was successfully applied to decide on the best policy alternative for LOS for the three interventions. The best policy alternatives compared well to current international benchmarks.Research limitations/implicationsThe proposed method needs to be tested for other interventions across various healthcare settings.Practical implicationsMulti-criteria decision-making tools enable resource optimization and overall improvement of patient care through the application of a scientific management technique that involves all relevant stakeholders while utilizing both subjective judgements as well as objective data.Originality/valueTraditionally, the duration of post-surgery LOS is mainly based on the surgeons’ clinical but also arbitrary decisions, with, as a result, having insufficiently explicable variations in LOS amongst peers for similar interventions. According to the authors’ knowledge, this is the first attempt to derive post-surgery LOS using the AHP, a multiple criteria decision-making method.

AB - PurposeLength of stay (LOS) in hospital after surgery varies for each patient depending on surgeon’s decision that considers criticality of the surgery, patient’s conditions before and after surgery, expected time to recovery and experience of the surgeon involved. Decision on patients’ LOS at hospital post-surgery affects overall healthcare performance as it affects both cost and quality of care. The purpose of this paper is to develop a model for deriving the most appropriate LOS after surgical interventions.Design/methodology/approachThe study adopts an action research involving multiple stakeholders (surgeon, patients/patients’ relatives, hospital management and other medics). First, a conceptual model is developed using literature and experts’ opinion. Second, the model is applied in three surgical interventions in a public hospital in Malta to demonstrate the effectiveness of the model. Third, the policy alternatives developed are compared to a selection of current international standards for each surgical intervention. The proposed model analyses three LOS threshold policies for three procedures using efficiency and responsiveness criteria. The entire analysis is carried out using 325 randomly selected patient files along with structured interactions with more than 50 stakeholders (surgeon, patients/patients’ relatives, hospital management and other medics). A multiple criteria decision-making method is deployed for model building and data analysis. The method involves combining the analytic hierarchy process (AHP) for verbal subjective judgements on prioritizing the four predictors of surgical LOS—medical, financial, social and risk, with pairwise comparisons of the sub-criteria under each criterion in line with the concerned interventions—the objective data of which are obtained from the patients’ files.FindingsThe proposed model was successfully applied to decide on the best policy alternative for LOS for the three interventions. The best policy alternatives compared well to current international benchmarks.Research limitations/implicationsThe proposed method needs to be tested for other interventions across various healthcare settings.Practical implicationsMulti-criteria decision-making tools enable resource optimization and overall improvement of patient care through the application of a scientific management technique that involves all relevant stakeholders while utilizing both subjective judgements as well as objective data.Originality/valueTraditionally, the duration of post-surgery LOS is mainly based on the surgeons’ clinical but also arbitrary decisions, with, as a result, having insufficiently explicable variations in LOS amongst peers for similar interventions. According to the authors’ knowledge, this is the first attempt to derive post-surgery LOS using the AHP, a multiple criteria decision-making method.

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