The Role of DOSA-Principle for German Hospitals

Introduction: Inpatient admission on the day of surgery – in jargon “Day of Surgery Admission” (DOSA) is an in many countries widely introduced care principle. There it is already implemented in the treatment standards and combined with fixed target rates. Advantages like higher patient sa-tisfaction, reduction of nosocomial infections or higher cost effectiveness have been proved by earlier studies. German hospitals focus primarily on the punctual start of surgical procedures, op-timization of transition times between two surgeries or surgical management. Some of them are already working with the DOSA principle. The study analyzes the current implementation rate of DOSA in Germany and the hidden financial potential of a consistent implementation. Case Presentation: Underlying data include the routinely compiled inpatient documentation of German hospitals as well as the results of the annual quality reports and the hospital benchmark of IGES Institute. The study analyzes if and if so, to which extend the DOSA principle is already im-plemented in German inpatient care for the surgical procedure of cholecystectomy. Based on the assumption that a DOSA rate of 85% for eligible patients is feasible financial savings are then es-timated for the case that preoperative inpatient days could be reduced by one day per case (for non-DOSA cases). The results are then translated into an estimation for the whole inpatient sector and sorted by major diagnostic categories (only for procedures with operative codes relevant for grouping in the contract for ambulatory surgeries). Conclusion: In 2013 the preoperative inpatient period for cholecystectomy procedures averaged at 2.1 days per case. The DOSA-rate for those surgeries was at 47.6 percent. That translates into a DOSA potential of approx. 46,000 occupancy days or 126 hospital beds (reduction by one preoperative inpatient day per case). The financial impact of a consistent implementation results in 11.9 million Euro of savings solely for gall bladder surgeries (260.54 Euro per case). In case the number of preoperative inpatient days is reduced to zero for eligible cases the savings would increase up 25.1 million Euro (547.13 Euro per case) or approx. 265 hospital beds. Considering not only cholecystectomy but a nearly complete set of DOSA relevant procedures the analysis for those surgeries results in a DOSA potential of 510,774 cases per year and 138 million Euro in savings. The scale of the calculated figures in this projection evoked by consistent implementation of the DOSA principle is of significant relevance to individual hospitals, as well as the entire inpatient service provision in Germany.