Abstract
OBJECTIVE: Despite cochlear implants' (CIs) effectiveness, only a small minority of eligible US adults receive them, with significant socioeconomic disparities in access. Understanding time and cost requirements for CI care delivery is essential for improving access and supporting clinical teams. This study quantifies personnel time and costs for preoperative and postoperative CI care to identify opportunities for workflow optimization and enhanced audiologist support.
STUDY DESIGN: Multi-institutional time-driven activity-based costing (TDABC) analysis.
SETTING: Academic tertiary neurotology cochlear implant centers.
METHODS: TDABC analysis of CI programs at 2 tertiary centers (University of California San Francisco and Massachusetts Eye and Ear) was conducted in 2023 to 2024. Direct observation captured time requirements for standard CI care pathways: 2 preoperative audiology evaluations, 1 preoperative otolaryngology consultation, 1 postoperative surgical follow-up, and 2 postoperative audiology visits (activation and programming). Personnel costs were calculated using national salary data.
RESULTS: The complete preoperative and postoperative care pathway required 397.5 minutes (6.6 hours) of direct clinician time, costing $316.65 in personnel expenses. Audiology services comprised 80% ($254.45) of total costs requiring 361 minutes. Preoperative audiology evaluations alone consumed 2.6 hours. Individual visit times ranged widely: preoperative otology consultations (8-66 minutes), first audiology evaluations (26-112 minutes), and CI activation visits (74-124 minutes).
CONCLUSION: Audiologists invest nearly 6 hours of direct patient care per CI recipient in the perioperative period, representing 80% of personnel costs. Wide time variations suggest opportunities for standardization. Supporting audiologists through administrative assistance, streamlined documentation, and optimized scheduling could improve both clinician satisfaction and patient access.