Title : A time-driven activity-based costing method to estimate the cost of personal protective equipment use in the emergency department during the COVID-19 pandemic
Abstract:
Background: During the COVID-19 pandemic, personal protective equipment (PPE), including masks, gloves, gowns, and eye protection, became an essential safeguard for healthcare workers and patients. This study aimed to estimate the cost of PPE utilization in an emergency department (ED) from the perspective of the Ministry of Health within a universal healthcare system.
Methods: We used a time-driven activity-based costing (TDABC) approach to determine the cost of a PPE bundle in the ED setting. In TDABC, the longer the duration of a care activity, the higher its associated cost. Observational data were collected for the 2021–2022 fiscal year from the CHUL ED, an academic hospital in Québec City, Canada, serving approximately 80,000 patient visits annually. The analysis included the time required for staff to perform donning and doffing protocols, the cost of disposable PPE items, and related overhead expenses. Donning and doffing durations were recorded in real-world conditions using time-motion software (UMT+, Laubrass), while financial data were retrieved from the hospital’s accounting department. All costs are reported in 2021 Canadian dollars (CAD).
Results: The mean time (95% confidence interval [CI]) for PPE donning and doffing was 2.2 minutes (2.1–2.3). The overall mean cost (95% CI) of a single PPE bundle in the ED was $14.45 (12.40–16.49). Since costs per minute differ by staff role, the PPE cost per bundle was estimated at $12.96 (10.89–15.03) for nursing assistants, $13.96 (11.91–16.00) for nurses, and $22.08 (20.00–24.16) for emergency physicians. For physicians, labor costs associated with donning and doffing PPE accounted for 49% of the total cost, compared to less than 20% for other roles. During the pandemic, expenses for enhanced protective equipment (e.g., respirators, face shields, fluid-resistant gowns, long gloves) were over seven times higher than those for standard PPE. In 2021, the total expenditure on PPE in the CHUL ED was estimated at $2.2 million (equivalent to €1.56 million), representing 8.5% of the department's $26 million annual budget.
Conclusion: This study highlights the substantial financial burden of PPE usage on healthcare systems and underscores the need for efficient resource allocation. Optimizing resource management is essential not only during routine operations but also in preparation for future public health emergencies.
