Applying Cost Accounting to Operating Room Staffing in Otolaryngology: Time-Driven Activity-Based Costing and Outpatient Adenotonsillectomy

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(1) To describe the application of a detailed cost-accounting method (time-driven activity-cased costing) to operating room personnel costs, avoiding the proxy use of hospital and provider charges. (2) To model potential cost efficiencies using different staffing models with the case study of outpatient adenotonsillectomy.

Study Design

Prospective cost analysis case study.


Tertiary pediatric hospital.

Subject and Methods

All otolaryngology providers and otolaryngology operating room staff at our institution.


Time-driven activity-based costing demonstrated precise per-case and per-minute calculation of personnel costs. We identified several areas of unused personnel capacity in a basic staffing model. Per-case personnel costs decreased by 23.2% by allowing a surgeon to run 2 operating rooms, despite doubling all other staff. Further cost reductions up to a total of 26.4% were predicted with additional staffing rearrangements.


Time-driven activity-based costing allows detailed understanding of not only personnel costs but also how personnel time is used. This in turn allows testing of alternative staffing models to decrease unused personnel capacity and increase efficiency.

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