165. Impact of a centralized spinal orthoses program on cost of care in the hospital setting

OBJECTIVE In an era of escalating health care costs and pressure to improve efficiency and cost of care, ambulatory surgery centers (ASCs) have emerged as lower-cost options for many surgical therapies. Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries performed, and the frequency of its performance is rapidly increasing as the aging population grows. Although ASCs offer significant cost advantages over hospital-based surgical centers, concern over the safety of outpatient ACDF has slowed its adoption. The authors intended to 1) determine the safety of the first 1000 consecutive ACDF surgeries performed in their outpatient ASC, and 2) compare the safety of these outpatient ACDFs with that of consecutive ACDFs performed during the same time period in the hospital setting. METHODS A total of 1000 consecutive patients who underwent ACDF in an ACS (outpatient ACDF) and 484 consecutive patients who underwent ACDF at Vanderbilt University Hospital (inpatient ACDF) from 2006 to 2013 were included in this retrospective study of patients' medical records. Data were collected on patient demographics, comorbidities, operative details, and perioperative and 90-day morbidity. Perioperative morbidity and hospital readmission were compared between the outpatient and inpatient ACDF groups. RESULTS Of the first 1000 outpatient ACDF cases performed in the authors' ASC, 629 (62.9%) were 1-level and 365 (36.5%) were 2-level ACDFs. Mean patient age was 49.5 ± 8.6, and 484 (48.4%) were males. All patients were observed postoperatively at the ASC postanesthesia care unit (PACU) for 4 hours before being discharged home. Eight patients (0.8%) were transferred from the surgery center to the hospital postoperatively (for pain control [n = 3], chest pain and electrocardiogram changes [n = 2], intraoperative CSF leak [n = 1], postoperative hematoma [n = 1], and profound postoperative weakness and surgical reexploration [n = 1]). No perioperative deaths occurred. The 30-day hospital readmission rate was 2.2%. All 90-day surgical morbidity was similar between outpatient and inpatient cohorts for both 1-level and 2-level ACDFs. CONCLUSIONS An analysis of 1000 consecutive patients who underwent ACDF in an outpatient setting demonstrates that surgical complications occur at a low rate (1%) and can be appropriately diagnosed and managed in a 4-hour ASC PACU window. Comparison with an inpatient ACDF surgery cohort demonstrated similar results, highlighting that ACDF can be safely performed in the outpatient ambulatory surgery setting without compromising surgical safety. In an effort to decrease costs of care, surgeons can safely perform 1- and 2-level ACDFs in an ASC environment.

Download Full-text

Cost of care of chronic non-communicable diseases in Jamaican patients: the role of obesity

Farmeconomia Health economics and therapeutic pathways ◽

10.7175/fe.v17i2.1232 ◽

2016 ◽

Vol 17 (2) ◽

pp. 81-95

Author(s):

Christine M. Fray-Aiken ◽

Rainford J. Wilks ◽

Abdullahi O. Abdulkadri ◽

Affette M. McCaw-Binns

Keyword(s):

Cost Of Illness ◽

Hospital Setting ◽

Indirect Costs ◽

Communicable Diseases ◽

Cost Of Care ◽

Total Direct Cost ◽

Non Communicable Diseases ◽

Female Patients ◽

Per Capita ◽

The Cost

OBJECTIVE: To estimate the economic cost of Chronic Non-Communicable Diseases (CNCDs) and the portion attributable to obesity among patients in Jamaica.METHODS: The cost-of-illness approach was used to estimate the cost of care in a hospital setting in Jamaica for type 2 diabetes mellitus, hypertension, coronary heart disease, stroke, gallbladder disease, breast cancer, colon cancer, osteoarthritis, and high cholesterol. Cost and service utilization data were collected from the hospital records of all patients with these diseases who visited the University Hospital of the West Indies (UHWI) during 2006. Patients were included in the study if they were between15 and 74 years of age and if female, were not pregnant during that year. Costs were categorized as direct or indirect. Direct costs included costs for prescription drugs, consultation visits (emergency and clinic visits), hospitalizations, allied health services, diagnostic and treatment procedures. Indirect costs included costs attributed to premature mortality, disability (permanent and temporary), and absenteeism. Indirect costs were discounted at 3% rate.RESULTS: The sample consisted of 554 patients (40%) males (60%) females. The economic burden of the nine diseases was estimated at US$ 5,672,618 (males 37%; females 63%) and the portion attributable to obesity amounted to US$ 1,157,173 (males 23%; females 77%). Total direct cost was estimated at US$ 3,740,377 with female patients accounting for 69.9% of this cost. Total indirect cost was estimated at US$ 1,932,241 with female patients accounting for 50.6% of this cost. The greater cost among women was not found to be statistically significant. Overall, on a per capita basis, males and females accrued similar costs-of-illness (US$ 9,451.75 vs. US$ 10,758.18).CONCLUSIONS: In a country with per capita GDP of less than US$ 5,300, a per capita annual cost of illness of US$ 10,239 for CNCDs is excessive and has detrimental implications for the health and development of Jamaica.

Download Full-text

The implementation of a virtual ward using digital solutions informing community clinicians in early supported discharge of patients with SARS-Cov2 respiratory symptoms from an acute hospital setting

10.1101/2021.03.29.21254548 ◽

2021 ◽

Author(s):

Jim Swift ◽

Alex woodward ◽

Zoe Harris ◽

O'Kelly I Noel ◽

Chris Barker ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Discharge ◽

Resource Use ◽

Respiratory Symptoms ◽

Hospital Setting ◽

Acute Hospital ◽

Cost Of Care ◽

Early Supported Discharge ◽

The Mean ◽

Acute Hospital Setting

The implementation of a virtual ward using digital solutions informing community clinicians in early supported discharge of patients with SARS-Cov2 respiratory symptoms from an acute hospital setting Swift J*, Harris Z#, Woodward A#, OKelly NI*, Barker C* and Ghosh S#! *Spirit Health Group; # Community Health Services, Leicestershire Partnership NHS Trust, ! Leicester School of Allied Health Sciences, DMU Abstract Objectives: To assess the short run successes and challenges of the implementation of a digitally supported accelerated acute hospital discharge scheme for patients admitted with Covid-19. Design: Analysis of the safety, resource use and health outcomes within the virtual service for the first 65 patients that have been discharged from a virtual respiratory ward. Setting: Community based intervention using digital technology and a multi-disciplinary team of specialist clinicians to monitor patients at home. Participants: 65 patients discharged from hospital followed until discharge from the virtual ward. Results: 24.6% of 65 patients had symptoms that were coded red (urgent response required) in CliniTouch Vie in the first day after hospital discharge falling to 7.7% on their final day on the virtual ward; p=0.049. Reductions in red days decreased significantly over time, from 33.8% of patients in their first three days to 10.8% in their final three days; all patients p=0.002. Four patients were re-admitted to hospital, all for clotting disorders. There was one death within this group, which following senior clinical review was deemed to be unrelated to infection with Covid-19. The most important gain for Glenfield hospital was in expediting the rapid discharge of patients admitted with Covid-19 into a supported environment and the freeing up of beds. On 15th January, 48% of beds were taken up with patients admitted with Covid-19 symptoms. In November 2020, immediately prior to the launch of the virtual ward, the mean length of stay for patients who did not access high dependency care or oxygen was 5.5 (+/-1.3) days. The mean length of stay in patients discharged into the virtual ward thereafter was 3.3 (+/-0.4) days; relative reduction, 40.3% (p<0.001). The cost of care provision in the virtual ward was 8,165 UK Pounds in total and 124.31 UK pounds per patient. The estimated overall savings were 68,550 UK Pounds and the mean saving per patient was estimated at 1,055 UK Pounds. Conclusions: The virtual ward appeared to assist with earlier discharges, had a low rate of clinically necessary re-admissions, the safety of patients was not compromised and whilst cost savings were not the primary objective, it seemed to also reduce overall resource use and costs.

Download Full-text

Diagnosis and Management of Depression in CRS: A Knowledge, Attitudes and Practices Survey

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1701268 ◽

2020 ◽

Author(s):

Amarbir S. Gill ◽

Joshua M. Levy ◽

Machelle Wilson ◽

E. Bradley Strong ◽

Toby O. Steele

Keyword(s):

Negative Impact ◽

Hospital Setting ◽

Cost Of Care ◽

Screening Tools ◽

Sinus Surgery ◽

Prognostic Information ◽

Attitudes And Practices ◽

Academic Settings ◽

Chi Squared ◽

The Impact

Abstract Introduction Comorbid major depressive disorder (MDD) is present in up to 25% of chronic rhinosinusitis (CRS) cases and provides prognostic information for patients undergoing endoscopic sinus surgery (ESS). Clinical visits offer an opportunity to identify at-risk patients. Objective The purpose of the present study is to evaluate practice patterns among members of the American Rhinologic Society (ARS) in screening for/diagnosing MDD. Methods A 21-question survey was distributed to 1,206 members of the ARS from May 26, 2018 to June 12, 2018. The impact of demographic factors, including hospital setting, fellowship status, and experience were assessed through chi-squared analysis. Results A total of 80 members of the ARS completed the survey, yielding a response rate of 7%. Half of the respondents worked in academic settings and 43% had completed a rhinology fellowship. Twenty percent of the participants felt comfortable diagnosing or managing MDD, while only 10% of participants screened for MDD in patients with CRS. Respondents cited a lack of training (76%) and unfamiliarity with diagnostic criteria (76%) as barriers to the routine assessment of MDD. Most respondents (95%) considered comorbid psychiatric illness to negatively impact outcomes following ESS. Fellowship-trained respondents were significantly more likely to implement screening tools in their practice (p = 0.05), and believe in the negative impact of MDD on postoperative outcomes (p = 0.007), cost of care (p = 0.04) and quality of life (p = 0.047). Conclusion Amongst ARS members, 95% of the respondents consider comorbid MDD to negatively impact patient outcomes following ESS. Regardless, a large proportion of surgeons neither screen nor feel comfortable diagnosing MDD.

Download Full-text

AB1179 EMERGENCY DEPARTMENT LENGTH OF STAY FOR PATIENTS WITH ACUTE GOUT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2682 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1880.1-1881

Author(s):

N. Mbuyi ◽

S. Reinert ◽

R. Hilliard ◽

A. Reginato ◽

D. Dalal

Keyword(s):

United States ◽

Emergency Department ◽

Length Of Stay ◽

Teaching Hospital ◽

Hospital Setting ◽

Cost Of Care ◽

Older Age ◽

Acute Gout ◽

Factors Associated ◽

Acuity Score

Background:Emergency department (ED) visits for acute gout increased by approximately 20% between 2006 and 2014 in the United States. (1) Reducing ED length of stay (LOS) can help improve health outcomes, and reduce ED crowding and cost of care for patients with gout.Objectives:The aim of our study was to assess ED LOS and to identify factors associated with prolonged ED LOS in patients with acute gout.Methods:In this retrospective analysis, we included the first ED visit of adult patients (>18years) with acute gout who presented to the 3 EDs affiliated with Lifespan Health Systems, the largest healthcare provider in Rhode Island. Our study period was 3/30/2015 to 9/30/2017.We calculated ED LOS as the time spent by patients in the ED until they were discharged. Patients presenting to the ED and subsequently admitted to the hospital were excluded given the differential effect of systems factors in these patients. We assessed the following factors’ association with being in the upper quartile of ED LOS: (a) Patient factors – demographics, comorbidities and clinical presentation of gout (number of joints involved, severity as gauged by an ED triage nurse on a scale of 1 to 5; 1 being the worst) and (b) systems factors – time of day, day of the week, and time of year at presentation to the ED, teaching versus non-teaching hospital setting, and performing an arthrocentesis. We performed univariate and multivariable analyses to identify factors associated with prolonged ED LOS in patients with acute gout.Results:A total of 355 patients (mean age 56.6 ± 16.03 years, 81.3% males) were included. The median ED LOS was 2.65 hours (1.75, 4.3 hours). A quarter of the patients spent more than 4.3 hours in the ED; the national average across all medical illnesses being 3.7 hours (2). In the univariate analysis, older age (> 65 years), comorbidities (hypertension, congestive heart failure), worse ED severity score, procedural delays, and teaching hospital setting were associated with being in the upper quartile of ED LOS. In a multivariable analysis, age >65 years, procedural delays, and worse ED acuity score continued to be associated with longer ED LOS.Conclusion:In our study settings, patients with acute gout spent a longer time in the ED than the national median of 120-150 minutes. (2) We noted that older age and higher acuity score in addition to procedural delays led to longer length of stay in the ED. The results of our study should guide future interventions to reduce ED LOS for patients with acute gout.References:[1] Mithal, A., & Singh, G. (2018). OP0185 Emergency department visits for gout: a dramatic increase in the past decade[2]Centers for Disease Control and Prevention. (2014). QuickStats: median emergency department (ED) wait and treatment times, by triage level–National Hospital Ambulatory Medical Care Survey, United States, 2010-2011. Morb Mortal Wkly Rep, 63,439. (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6319a8.htm)Disclosure of Interests:None declared

Download Full-text

Retrospective Quality Improvement Study of Insulin-Induced Hypoglycemia and Implementation of Hospital-Wide Initiatives

Journal of Diabetes Science and Technology ◽

10.1177/19322968211008513 ◽

2021 ◽

pp. 193229682110085

Author(s):

Carter Shelton ◽

Andrew P. Demidowich ◽

Mahsa Motevalli ◽

Sam Sokolinsky ◽

Periwinkle MacKay ◽

...

Keyword(s):

Quality Improvement ◽

Community Hospital ◽

Statistical Significance ◽

Hospital Setting ◽

Cost Savings ◽

Cost Of Care ◽

Potential Cost ◽

Increased Risk ◽

Reduction Strategies ◽

Risk Reduction Strategies

Background: Hospitalized patients who are receiving antihyperglycemic agents are at increased risk for hypoglycemia. Inpatient hypoglycemia may lead to increased risk for morbidity, mortality, prolonged hospitalization, and readmission within 30 days of discharge, which in turn may lead to increased costs. Hospital-wide initiatives targeting hypoglycemia are known to be beneficial; however, their impact on patient care and economic measures in community nonteaching hospitals are unknown. Methods: This retrospective quality improvement study examined the effects of hospital-wide hypoglycemia initiatives on the rates of insulin-induced hypoglycemia in a community hospital setting from January 1, 2016, until September 30, 2019. The potential cost of care savings has been calculated. Results: Among 49 315 total patient days, 2682 days had an instance of hypoglycemia (5.4%). Mean ± SD hypoglycemic patient days/month was 59.6 ± 16.0. The frequency of hypoglycemia significantly decreased from 7.5% in January 2016 to 3.9% in September 2019 ( P = .001). Patients with type 2 diabetes demonstrated a significant decrease in the frequency of hypoglycemia (7.4%-3.8%; P < .0001), while among patients with type 1 diabetes the frequency trended downwards but did not reach statistical significance (18.5%-18.0%; P = 0.08). Based on the reduction of hypoglycemia rates, the hospital had an estimated cost of care savings of $98 635 during the study period. Conclusions: In a community hospital setting, implementation of hospital-wide initiatives targeting hypoglycemia resulted in a significant and sustainable decrease in the rate of insulin-induced hypoglycemia. These high-leverage risk reduction strategies may be translated into considerable cost savings and could be implemented at other community hospitals.

Download Full-text

Effects of a Dedicated Inpatient Diabetes Management Service on Glycemic Control in a Community Hospital Setting

Journal of Diabetes Science and Technology ◽

10.1177/1932296821993198 ◽

2021 ◽

pp. 193229682199319

Author(s):

Andrew P. Demidowich ◽

Kristine Batty ◽

Teresa Love ◽

Sam Sokolinsky ◽

Lisa Grubb ◽

...

Keyword(s):

Glycemic Control ◽

Community Hospital ◽

Diabetes Management ◽

Hospital Setting ◽

The United States ◽

Cost Of Care ◽

Management Service ◽

Full Time ◽

Inpatient Diabetes ◽

Inpatient Diabetes Management

Background: Community hospitals account for over 84% of all hospitals and over 94% of hospital admissions in the United States. In academic settings, implementation of an Inpatient Diabetes Management Service (IDMS) model of care has been shown to reduce rates of hyper- and hypoglycemia, hospital length of stay (LOS), and associated hospital costs. However, few studies to date have evaluated the implementation of a dedicated IDMS in a community hospital setting. Methods: This retrospective study examined the effects of changing the model of inpatient diabetes consultations from a local, private endocrine practice to a full-time endocrine hospitalist on glycemic control, LOS, and 30-day readmission rates in a 267-bed community hospital. Results: Overall diabetes patient days for the hospital were similar pre- and post-intervention (20,191 vs 20,262); however, the volume of patients seen by IDMS increased significantly after changing models. Rates of hyperglycemia decreased both among patients seen by IDMS (53.8% to 42.5%, P < .0001) and those not consulted on by IDMS (33.2% to 29.9%; P < .0001). When examined over time, rates of hypoglycemia steadily decreased in the 24 months after dedicated IDMS initiation ( P = .02); no such time effect was seen prior to IDMS ( P = .34). LOS and 30DRR were not significantly different between IDMS models. Conclusions: Implementation of an endocrine hospitalist-based IDMS at a community hospital was associated with significantly decreased hyperglycemia, while avoiding concurrent increases in hypoglycemia. Further studies are needed to investigate whether these effects are associated with improvements in clinical outcomes, patient or staff satisfaction scores, or total cost of care.

Download Full-text

Quality Improvement Goals for Acute Kidney Injury

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.01250119 ◽

2019 ◽

Vol 14 (6) ◽

pp. 941-953 ◽

Cited By ~ 35

Author(s):

Kianoush Kashani ◽

Mitchell Howard Rosner ◽

Michael Haase ◽

Andrew J.P. Lewington ◽

Donal J. O'Donoghue ◽

...

Keyword(s):

Health Care ◽

Quality Improvement ◽

Health Care Providers ◽

Care Delivery ◽

Quality Care ◽

Hospital Setting ◽

Kidney Injury ◽

Cost Of Care ◽

Care Providers ◽

Improvement Programs

AKI is a global concern with a high incidence among patients across acute care settings. AKI is associated with significant clinical consequences and increased health care costs. Preventive measures, as well as rapid identification of AKI, have been shown to improve outcomes in small studies. Providing high-quality care for patients with AKI or those at risk of AKI occurs across a continuum that starts at the community level and continues in the emergency department, hospital setting, and after discharge from inpatient care. Improving the quality of care provided to these patients, plausibly mitigating the cost of care and improving short- and long-term outcomes, are goals that have not been universally achieved. Therefore, understanding how the management of AKI may be amenable to quality improvement programs is needed. Recognizing this gap in knowledge, the 22nd Acute Disease Quality Initiative meeting was convened to discuss the evidence, provide recommendations, and highlight future directions for AKI-related quality measures and care processes. Using a modified Delphi process, an international group of experts including physicians, a nurse practitioner, and pharmacists provided a framework for current and future quality improvement projects in the area of AKI. Where possible, best practices in the prevention, identification, and care of the patient with AKI were identified and highlighted. This article provides a summary of the key messages and recommendations of the group, with an aim to equip and encourage health care providers to establish quality care delivery for patients with AKI and to measure key quality indicators.

Download Full-text

Otorhinolaryngological Trauma in Some Private Health Facilities in Benin City

Journal of Complementary and Alternative Medical Research ◽

10.9734/jocamr/2021/v13i130216 ◽

2021 ◽

pp. 20-28

Author(s):

I. O. Akpalaba ◽

F. O. Ogisi ◽

R. O. Momoh

Keyword(s):

Tympanic Membrane ◽

Hospital Setting ◽

Tympanic Membrane Perforation ◽

Cost Of Care ◽

Treatment Modalities ◽

Suppurative Otitis Media ◽

Early Presentation ◽

Female Ratio ◽

Benin City ◽

Membrane Perforation

Background: Otorhinolaryngological trauma is common in clinical practice. The disaster caused by otorhinolaryngological trauma arises from its morbidity and mortality. This is due to increased cost of care and varying degree of physical, cosmetic and functional disfigurements. Aim: This study was conducted to determine the causes, mechanisms of trauma and outcomes of these injuries in private setting; and to profer possible preventive measures. Methods: This study was a one-year descriptive prospective study on patients with otorhinolaryngological trauma managed at three private health settings in Benin City, Nigeria. All consecutive trauma patients seen from May 2016 to April 2017 constituted the sample size. Total population sampling technique was used. Statistical analysis was performed using SPSS version 20.0. Results: A total of 31 patients were studied. Age ranged from 1 to 80 years. Median age was 35 years. Male to female ratio was 1.1:1. The commonest cause of trauma was use of cotton buds to clean the ears in 48.4% patients. This was followed by foreign bodies in the ear in 12.9% of the patients. This was not statistically significant as p>0.05. The commonest mechanism of trauma was from Tympanic membrane perforation, canal laceration and ear canal inflammation in 48.4% of patients. The ear was the most affected region in 80.6% of the patients. The greatest complain at presentation was ear discharge in 38.7% of the patients, followed by hearing loss in 35.5% patients. The commonest complication was tympanic membrane perforation noted in 48.4% of the study population followed by chronic suppurative otitis media in 35.5% of them. Majority of the subjects (87.1%) were treated as outpatients. Only 12.9% of the subjects required admission to the ward. The most common treatment modalities used were ‘keeping the ear dry’ protocol, ear toileting and daily ear dressing in 80.6%, 41.9% and 38.7% of the patients respectively. The median length of hospital stay for in-patients was 7 days (range 3 to 11 days). There was no mortality. Majority of the patients (77.4%) had full recovery. Tympanic membrane perforation was persistent in 22.6% of the patients. Conclusion: Otorhinolaryngological trauma constitutes a significant cause of morbidity in private hospital setting. Majority of these trauma are both preventable and treatable through public enlightenment programmes and early presentation to Otorhinolaryngologists respectively.

Download Full-text

LINC-23. PRE-OPERATIVE AND POST-OPERATIVE INTERVENTIONS REDUCE RATES OF VENTRICULITIS IN PEDIATRIC BRAIN TUMOR PATIENTS: A PILOT STUDY

Neuro-Oncology ◽

10.1093/neuonc/noaa222.457 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii382-iii383

Author(s):

Laura Melissa Stephanie Diamante - San ◽

Marciel Pedro ◽

Ana Patricia Alcasabas ◽

Marissa Lukban ◽

Kathleen Khu ◽

...

Keyword(s):

Brain Tumor ◽

Length Of Stay ◽

Wound Care ◽

Tumor Resection ◽

Hospital Setting ◽

Pediatric Brain Tumor ◽

Cost Of Care ◽

Clinical Practices ◽

Care Protocol ◽

Pediatric Brain

Abstract BACKGROUND The Philippine General Hospital, a public national referral center, sees 60–80 pediatric brain tumor cases per year. Historically, the rate of post-operative ventriculitis has been high, resulting in treatment delays and poor outcomes. Starting in July 2019, as a means to decrease infections, patients were provided standardized bathing and wound care kits and caregivers were trained to follow a bathing and wound care protocol. METHODS This quality improvement study included patients younger than 18 years who underwent craniotomy at PGH were enrolled. The type of surgery, length of surgery, existence of post-operative CNS infection, length of stay and total cost of care was collected. The outcome of these interventions are analyzed 6 months after implementation. RESULTS Thirty-two 32 patients were included, with mean age of 7 years (1–16). The surgeries performed were: tumor resection (n=20), ventriculo-peritoneal shunt insertion (VPS) (n=3), endoscopic third ventriculostomy (n=3), resection with tube ventriculostomy (n=3), Ommaya reservoir placement (n=2), and resection with shunt (n=1). Median surgery time was 4 hours (1–10). Three patients (9.4%) developed ventriculitis. No surgical site infections occurred. Compared to historical controls, a lower rate of infections was noted (9.4% vs. 15.5%, runchart analysis). Patients without post-operative infections had a shorter length of stay (median 14 vs 48 days, p<0.05) and a lower cost of care (median $1098 vs. $2425 USD, p<0.05). CONCLUSION Implementation of simple hygiene interventions effectively lowered post-operative CNS infections and hospital costs in a public hospital setting. Incorporation of these into standard clinical practices is urgently needed.

Download Full-text