International Journal of Clinical Science and Medical Research

Background: Cost management is a core responsibility of nursing administrators, who must allocate limited resources for maximum benefit. Time-driven activity-based costing (TDABC) identifies the true cost of each nursing activity from the time and resources it consumes, yet activity-level cost evidence for older patients undergoing hip fracture surgery in Thailand is scarce. Objective: To analyze the time-driven activity-based cost of nursing care for elderly patients undergoing hip fracture surgery in a tertiary hospital. Methods: This descriptive study used retrospective and prospective data collection in the female orthopedic ward of a tertiary hospital. Two samples were purposively selected: the cost reports of 24 nursing personnel and of 30 patients aged 60 years or older who underwent hip fracture surgery. Three instruments were used: unit-cost data recording forms, a nursing activity dictionary, and a nursing activity cost and time recording form (content validity index = 1.0; inter-observer reliability = 0.97). Labor, material, and capital costs, plus allocated utility costs, were calculated for five main nursing activities, with labor and capital costs assigned as cost per minute multiplied by observed activity time, and analyzed using descriptive statistics. Results: The total nursing activity cost was USD 14,743.56 (USD 1 = 31.20 baht; mean USD 491.45 per patient). Surgical preparation nursing had the highest cost (USD 5,643.99; 38.28%), followed by postoperative nursing (USD 4,849.59; 32.89%). By cost component, materials accounted for the largest share (USD 8,797.05; 59.67%), followed by capital (32.21%) and labor (6.90%). Conclusion: Nursing care for elderly hip fracture surgery patients is material-intensive, and cost is concentrated in the surgical preparation and postoperative phases. Activity-level cost data can help nurse administrators identify and control high-cost activities and remove redundant ones without compromising the quality of care.

Time-driven activity-based costing, Nursing activity cost, Hip fracture surgery, Older adults, Nursing administration

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