Abstract：
OBJECTIVES:Healthcare reform policies are emphasizing value-based healthcare delivery. We hypothesize that time-driven activity-based costing (TDABC) can be used to appraise healthcare interventions in pediatric appendicitis. METHODS:Triage-based standing delegation orders, surgical advanced practice providers, and a same-day discharge protocol were implemented to target deficiencies identified in our initial TDABC model. Post-intervention process maps for a hospital episode were created using electronic time stamp data for simple appendicitis cases during February to March 2016. Total personnel and consumable costs were determined using TDABC methodology. RESULTS:The post-intervention TDABC model featured 6 phases of care, 33 processes, and 19 personnel types. Our interventions reduced duration and costs in the emergency department (-41min, -$23) and pre-operative floor (-57min, -$18). While post-anesthesia care unit duration and costs increased (+224min, +$41), the same-day discharge protocol eliminated post-operative floor costs (-$306). Our model incorporating all three interventions reduced total direct costs by 11% ($2753.39 to $2447.68) and duration of hospitalization by 51% (1984min to 966min). CONCLUSION:Time-driven activity-based costing can dynamically model changes in our healthcare delivery as a result of process improvement interventions. It is an effective tool to continuously assess the impact of these interventions on the value of appendicitis care. LEVEL OF EVIDENCE:II, Type of study: Economic Analysis.
journal_name
J Pediatr Surgjournal_title
Journal of pediatric surgeryauthors
Yu YR,Abbas PI,Smith CM,Carberry KE,Ren H,Patel B,Nuchtern JG,Lopez MEdoi
10.1016/j.jpedsurg.2017.03.032subject
Has Abstractpub_date
2017-06-01 00:00:00pages
1045-1049issue
6eissn
0022-3468issn
1531-5037pii
S0022-3468(17)30181-1journal_volume
52pub_type
杂志文章abstract：PURPOSE:Forme fruste choledochal cyst (FFCC) is a choledochal cyst that has minimal or no dilatation of the extrahepatic bile duct (EHBD) and is associated with pancreaticobiliary malunion (PBMU). The authors reviewed the long-term outcome of their patients with FFCC. METHODS:Inpatient and outpatient records of 281 pa...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/j.jpedsurg.2003.08.026
更新日期：2003-12-01 00:00:00
abstract：PURPOSE:The purpose of this study was to describe morphological classification of congenital buried penis (BP) and present a versatile surgical approach for correction. MATERIALS AND METHODS:Sixty-one patients referred with BP were classified into 3 grades according to morphological findings: Grade 1-29 patients with ...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/j.jpedsurg.2013.09.066
更新日期：2014-02-01 00:00:00
abstract：METHODS:From 1983 to 1996, 31 children with caustic esophageal strictures were seen at Bambino Gesù Children's Hospital; they were all treated conservatively except for two cases complicated by tracheoesophageal fistula. The remaining 29 patients were divided into three groups depending on the treatment, which was modi...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/s0022-3468(98)90361-x
更新日期：1998-01-01 00:00:00
abstract：:Varicella (chickenpox) affects approximately 90,000 children each year. Although most cases resolve, some develop necrotizing soft tissue infections secondary to group A streptococcus and staphylococcus. Delay in diagnosis is common. At the time of initial presentation, the need for surgical intervention is not always...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/s0022-3468(96)90103-7
更新日期：1996-08-01 00:00:00
abstract：:A choledochopancreatic end-to-side ductal anastomosis was successfully performed in 40 puppies as an experimental animal model of choledochopancreatic elongated common channel disorders. Follow-up periods were up to 1 year after surgery. Fusiform dilatation was developed in all puppies. The dilatation was completed wi...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/s0022-3468(84)80439-x
更新日期：1984-04-01 00:00:00
abstract：:Aberrant migration of thymic tissue occurs with ectopic thymus in the mediastinum, base of the skull, tracheal bifurcation, and cervical region. A recent review of the literature showed a total of 76 reported cases of aberrant thymus or thymic cysts in patients who presented with primary neck masses. We report three a...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章,评审
doi：10.1016/0022-3468(90)90764-z
更新日期：1990-11-01 00:00:00
abstract：BACKGROUND/PURPOSE:Gastroesophageal reflux is common in children with severe neurological impairment. Fundoplication may produce symptomatic improvement but has a high failure rate. Esophagogastric dissociation (EGD) is an alternative procedure for treatment of gastroesophageal reflux. The aim of this study is to evalu...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/j.jpedsurg.2005.03.004
更新日期：2005-06-01 00:00:00
abstract：BACKGROUND/PURPOSE:Vascular anomalies are a diverse set of lesions with distinct clinical behaviors, whose biomolecular characteristics are largely undefined. Common hemangiomas proliferate during the first year of life, then involute at a variable pace over several years. Other vascular tumors may involute much more q...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/j.jpedsurg.2003.11.043
更新日期：2004-03-01 00:00:00
abstract：:Congenital lumbar hernia is rare in infancy and childhood, and its association with the lumbocostovertebral syndrome is even more unusual. Only 20 cases have been reported in the English literature. We present the case of a child with multiple costovertebral anomalies, undescended testis, and lateral abdominal wall he...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/j.jpedsurg.2007.08.065
更新日期：2008-01-01 00:00:00
abstract：:This article reviews of the current evidence-based treatment standards for children with Wilms tumor. In this article, a summary of recently completed clinical trials by the Children's Oncology Group is provided, the current diagnostic evaluation and surgical standards are discussed, and the surgical impact on current...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章,评审
doi：10.1016/j.jpedsurg.2018.09.005
更新日期：2019-03-01 00:00:00
abstract：BACKGROUND:No consensus exists among surgeons regarding the optimal treatment of complicated acute appendicitis in children (CAA). Existing studies present heterogeneity of data and only few studies analyzed free perforated appendicitis (FPA) separately from appendicular abscess (AAb) and appendicular phlegmon (AP). M...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章,meta分析
doi：10.1016/j.jpedsurg.2019.01.065
更新日期：2019-11-01 00:00:00
abstract：BACKGROUND:Investigation of the value of scrotal Doppler ultrasound (DUS) in the diagnosis of acute scrotum and its impact on the treatment strategy was undertaken. METHOD:Seventy-nine children (mean age, 9.2 years) with acute scrotum were prospectively studied. The protocol included history, clinical examination, scr...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/j.jpedsurg.2006.04.026
更新日期：2006-08-01 00:00:00
abstract：:The development of hydrops fetalis and maternal mirror syndrome in the setting of fetal sacrococcygeal teratoma (SCT) carries a grave prognosis. Fetal surgery is not typically offered for hydropic fetuses beyond 26 weeks of gestational age. Few options exist for these families, and they are typically counseled to cont...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/j.jpedsurg.2008.04.010
更新日期：2008-08-01 00:00:00
abstract：:Intestinal obstruction in a 2-year-old girl with a histologically proven diagnosis of retroperitoneal yolk sac carcinoma developed after the second course of anticancer chemotherapy. Nonoperative treatment was not effective. Because the patient had fallen into a state of chemotherapy-induced myelosuppression, surgery ...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/s0022-3468(98)90494-8
更新日期：1998-10-01 00:00:00
abstract：:A 13-year-old girl with multiple genitourinary malformations, incomplete bladder exstrophy, urethral duplication with single bladder, septate vagina, and total urinary incontinence is presented. Prior to admission she had undergone surgery for teratoma and calculi of the bladder and partial fecal incontinence. A conti...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/0022-3468(90)90534-g
更新日期：1990-12-01 00:00:00
abstract：:Zenker's Diverticulum (ZD) is a false diverticulum located in the posterior esophagus between the cricopharyngeus and inferior constrictor. Few cases have been reported in the pediatric population. Congenital esophageal diverticulum is commonly associated with additional esophageal anatomical deformities or iatrogenic...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章,评审
doi：10.1016/j.jpedsurg.2012.12.037
更新日期：2013-03-01 00:00:00
abstract：BACKGROUND/PURPOSE:Significant oesophageal eosinophilia is associated with oesophagitis and gastroesophageal reflux (GER). Eosinophilic oesophagitis is a rare disease that causes thickening of the oesophageal wall, narrowing of the oesophageal lumen, and severe motor disturbance. METHODS AND RESULTS:Two 12 yr-old pati...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1053/jpsu.2002.30256
更新日期：2002-02-01 00:00:00
abstract：BACKGROUND:The management of giant omphaloceles (GO) can be quite difficult when there is absence of abdominal domain. Coverage with delayed closure has been described. We present a technique to create an adequate peritoneal domain. METHODS:This is a retrospective review of our experience using an intraperitoneal tiss...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/j.jpedsurg.2005.12.013
更新日期：2006-04-01 00:00:00
abstract：:The plan for cervical lymph node biopsy should include special maneuvers for recognition of patients with lymphadenitis due to atypical mycobacteria, since these children need extensive operations. The diagnosis should be suspected in children less than 3 yr old with lymphadenopathy present for several months and no e...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/s0022-3468(82)80116-4
更新日期：1982-10-01 00:00:00
abstract：PURPOSE:The purpose of this study was to compare the incidence and type of technical complications seen in a concurrent series of pyloromyotomies done open and laparoscopically. METHODS:The medical records of all patients who underwent pyloromyotomy for congenital hypertrophic pyloric stenosis over a 66-month period w...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/j.jpedsurg.2003.11.047
更新日期：2004-03-01 00:00:00
abstract：BACKGROUND:Rhomboid excision with Limberg flap (RELF) repair has been shown to be effective in the management of pilonidal disease (PD) in adults. Wide excision allows complete removal of diseased tissue, and the rotational flap allows tensionless coverage as well as helps flatten the natal crease, which is believed to...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/j.jpedsurg.2008.11.033
更新日期：2009-08-01 00:00:00
abstract：BACKGROUND:The American College of Surgeons Committee on Trauma (ACS-COT) view over- and undertriage rates based on trauma team activation (TTA) criteria as surrogate markers for quality trauma patient care. Undertriage occurs when classifying patients as not needing a TTA when they do. Over-triage occurs when a TTA is...
journal_title：Journal of pediatric surgery
pub_type： 临床试验,杂志文章
doi：10.1016/j.jpedsurg.2016.04.010
更新日期：2016-09-01 00:00:00
abstract：:From September 1, 1984 to March 1, 1988, 201 patients were evaluated for liver transplantation. Ninety-one orthotopic liver transplants were performed on 80 children ranging in age from 3 months to 15 years. The average waiting time for a transplant was 5 months, with children less than 10 kg in weight waiting a dispr...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/s0022-3468(89)80306-9
更新日期：1989-01-01 00:00:00
abstract：BACKGROUND:A 12-year-old girl presenting with intermittent epigastric pains and diarrhea was referred to our clinic. Diagnostic workup revealed nonfunctional bilateral adrenal pheochromocytomas as well as a neuroendocrine tumor of the pancreatic head. This is the first report on the combination of a neuroendocrine panc...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/j.jpedsurg.2007.02.029
更新日期：2007-07-01 00:00:00
abstract：:There are compelling physiologic arguments for correcting certain malformations before birth. Although fetal surgery has been successful in sheep and lower animals, it has proven difficult in primates because the gravid uterus is exquisitely sensitive to induction of preterm labor and abortion. Because the feasibility...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/s0022-3468(82)80193-0
更新日期：1982-04-01 00:00:00
abstract：BACKGROUND/PURPOSE:In 1996, the glial cell line-derived neurotrophic factor (GDNF) was identified as one of the ligands of the RET transmembrane receptor. In the same year, GDNF mutations were found in association with RET protooncogene mutations in Hirschsprung patients. Mutations in GDNF per se are thought neither ne...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/s0022-3468(98)90371-2
更新日期：1998-01-01 00:00:00
abstract：:Hepatic (cirrhosis) accounts for a higher percentage of portal hypertension than extrahepatic portal vein obstruction. Some patients with extrahepatic portal hypertension (portal vein obstruction) have a more favorable clinical status. Nonoperative management (balloon tamponade, vasopressin) will usually succeed in co...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/s0022-3468(82)80111-5
更新日期：1982-10-01 00:00:00
abstract：INTRODUCTION:Non-central nervous system (non-CNS) rhabdoid tumors tend to present at a young age and have an extremely aggressive course, with dismal overall survival rates. Inactivation of the tumor suppressor gene SMARCB1 has been shown in rhabdoid tumors regardless of anatomic location, suggesting a common genetic b...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/j.jpedsurg.2016.08.017
更新日期：2017-03-01 00:00:00
abstract：BACKGROUND/PURPOSE:Asphyxiating thoracic dystrophy (ATD) can occur years after a Ravitch-type repair of pectus excavatum, resulting in debilitating alteration in pulmonary function (PFT). An operation was devised to attempt repair of this deformity. METHODS:After institutional review board approval, the records of 10 ...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/j.jpedsurg.2004.09.039
更新日期：2005-01-01 00:00:00
abstract：PURPOSE:Heterotaxy syndrome is associated with intestinal abnormalities. We sought to define the gastrointestinal anatomy and determine both the risk of volvulus and benefit of screening upper gastrointestinal fluoroscopy (UGI) in these patients. METHODS:Medical records from 2003 until 2011 at Children's Hospital Los ...
journal_title：Journal of pediatric surgery
pub_type： 杂志文章
doi：10.1016/j.jpedsurg.2012.10.033
更新日期：2013-01-01 00:00:00
