scholarly journals 348 Virtual Patient Assessment for Hand Fracture Management: A Departmental Analysis of Financial and Clinical Implications

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
N Roberts ◽  
J Totty ◽  
R Pinder
Keyword(s):  
Clinical Performance ◽  
Quality Care ◽  
Cost Savings ◽  
Virtual Patient ◽  
British Society ◽  
Patient Assessment ◽  
Pilot Model ◽  
Hand Fractures ◽  
Fracture Management ◽  
Short Period

Abstract Introduction The COVID-19 pandemic demanded reduced face-to-face (FTF) contact. Our department integrated virtual assessment into the incoming referral pathway to enable continuation of high-quality care. This study aimed to assess any potential efficiency benefit of this change in service whilst ensuring no compromise to clinical outcomes. Method A prospective analysis was undertaken of all hand fractures referred virtually during a seven-week period starting at the initiation of national lockdown. Cost analysis using NHS reference costs, inflated to 2019/20 prices, was performed. Clinical performance was assessed using the British Society for Surgery for the Hand (BSSH) Standards for Open and Closed Hand Fractures. Results Seventy-six hand fractures were referred; FTF attendance was avoided in 35 cases, with an estimated per-patient cost saving of £179.16. Of the 33 patients who attended FTF, 13 achieved same day non-operative treatment; 20 underwent operative intervention with 95% compliance to BSSH standards. No complications occurred. Conclusions Our pilot model demonstrates potentially significant cost savings of £6270 over a relatively short period, as well as clinical non-inferiority. This supports sustained integration of virtual patient assessment in the ‘new normal’. Further work across all disciplines is needed to define acceptable limits of telemedicine and new avenues for potential benefit.

scholarly journals A laboratorian’s perspective on evaluation and implementation of new laboratory tests

1997 ◽  
Vol 43 (9) ◽  
pp. 1771-1780 ◽  
Author(s):  
Dennis J O’Kane ◽  
Thomas A Ebert ◽  
Brenda J Hallaway ◽  
Steven G Roberts ◽  
Abul K M J Bhuiyan ◽  
...  
Keyword(s):  
Laboratory Tests ◽  
Clinical Performance ◽  
Cost Savings ◽  
Cost Effective ◽  
Assay Development ◽  
Development Projects ◽  
Clinical Testing ◽  
Delivery Of Healthcare ◽  
Future Value ◽  
Clinical Questions

Abstract New assay development should be directed toward answering fundamental clinical questions. Caveats that must be considered before initiating assay development projects are: New assays should allow the clinician to interact with and treat a patient more effectively, thereby improving medical outcome; and new assays should facilitate recapture of system resources, enabling cost savings or reinvestment of resources. Defining the clinical questions and consideration of the caveats permit a means of prioritizing assay development activities. Laboratorians are faced with evaluating several types of development activities that lead to assay implementation in routine clinical testing. Assays can be prioritized for up-grading to newer cost-effective technologies, provided the changes maintain or improve analytical and clinical performance. Predicting which research assay will have future value is difficult when clinical performance is not fully validated. However, such assay development has the greatest potential for changing the delivery of healthcare by a clinician.

scholarly journals Engaging and developing front-line clinical nurses to drive care excellence: Evaluating the Chief Nurse Excellence in Care Junior Fellowship initiative

2018 ◽  
Vol 23 (8) ◽  
pp. 678-689 ◽  
Author(s):  
Louise Bramley ◽  
Joseph C Manning ◽  
Joanne Cooper
Keyword(s):  
Staff Development ◽  
Case Studies ◽  
Positive Impact ◽  
Quality Care ◽  
Cost Savings ◽  
Outcome Evaluation ◽  
Preliminary Evaluation ◽  
Front Line ◽  
Improvement Project ◽  
Clinical Nurses

Background Global challenges in the development of a highly skilled and motivated nursing workforce jeopardise the delivery of high-quality care. Flexible and innovative workforce solutions are required to overcome these challenges. Aims To describe the implementation and present the preliminary evaluation of the ‘Chief Nurse Excellence in Care Junior' bespoke Fellowship initiative designed to develop the foundational clinical and academic skills of front-line junior clinical staff. Methods This initiative was developed and piloted at a large, inner-city, acute NHS trust. The initiative involved two main components: a bespoke development programme and an improvement project that was supported by clinical and academic mentors. The initiative was evaluated using structured feedback, case studies and data on dissemination activities. Results Six front-line nurses completed the first cohort of the initiative that commenced in spring 2016. Results showed a positive impact on professional development relating to the acquisition of new knowledge and skills. Case studies of projects had a demonstrable impact on patient experiences, outcomes and cost savings. Wider organisational and NHS impact was demonstrated through multiple dissemination activities. Conclusion This preliminary evaluation provides evidence that this initiative is a sustainable, clinically driven career development opportunity at a foundational level that has a demonstrable positive impact on care and staff development. Further work is underway to carry out a longitudinal structure, process and outcome evaluation with particular focus on impact.

scholarly journals A Clinical Process Change and Educational Intervention to Reduce the Use of Unnecessary Preoperative Tests

2014 ◽  
Vol 6 (4) ◽  
pp. 733-737 ◽  
Author(s):  
Sarah E. Richards ◽  
Jason F. Shiffermiller ◽  
Adam D. Wells ◽  
Sara M. May ◽  
Subhankar Chakraborty ◽  
...  
Keyword(s):  
Educational Intervention ◽  
Medical Center ◽  
Quality Care ◽  
Diagnostic Testing ◽  
Cost Savings ◽  
Process Change ◽  
Appropriate Use ◽  
Preoperative Testing ◽  
Clinical Process ◽  
The Mean

Abstract Background Internal medicine residents receive limited training on how to be good stewards of health care dollars while preserving high-quality care. Intervention We implemented a clinical process change and an educational intervention focused on the appropriate use of preoperative diagnostic testing by residents at a Veterans Administration (VA) medical center. Methods The clinical process change consisted of reducing routine ordering of preoperative tests in the absence of specific indications. Residents received a short didactic session, which included algorithms for determining the appropriate use of perioperative diagnostic testing. One outcome was the average cost savings on preoperative testing for a continuous cohort of patients referred for elective knee or hip surgery. Resident knowledge and confidence prior to and after the intervention was measured by pre- and posttest. Results The mean cost of preoperative testing decreased from $74 to $28 per patient after the dual intervention (P < .001). The bulk of cost savings came from elimination of unnecessary blood and urine tests, as well as reduced numbers of electrocardiograms and chest radiographs. Among residents who completed the pretest and posttest, the mean score on the pretest was 54%, compared with 80% on the posttest (P  =  .027). Following the educational intervention, 70% of residents stated they felt “very comfortable” ordering appropriate preoperative testing (P  =  .006). Conclusions This initiative required few resources, and it simultaneously improved the educational experience for residents and reduced costs. Other institutions may be able to adopt or adapt this intervention to reduce unnecessary diagnostic expenditures.

Can a Patient-Centered Medical Home Lead to Better Patient Outcomes? The Quality Implications of Geisinger’s ProvenHealth Navigator

2011 ◽  
Vol 27 (3) ◽  
pp. 210-216 ◽  
Author(s):  
Daniel D. Maeng ◽  
Thomas R. Graf ◽  
Duane E. Davis ◽  
Janet Tomcavage ◽  
Frederick J. Bloom
Keyword(s):  
Patient Outcomes ◽  
Medical Home ◽  
Care Delivery ◽  
Quality Care ◽  
Patient Centered Medical Home ◽  
Patient Centered ◽  
Care Delivery Model ◽  
Short Period ◽  
Patients With Diabetes ◽  
Stage Renal Disease

One of the primary goals of the patient-centered medical home (PCMH) is to provide higher quality care that leads to better patient outcomes. Currently, there is only limited evidence regarding the ability of PCMHs to achieve this goal. This article demonstrates the effect of PCMHs in improving certain clinical outcomes, as shown by the ProvenHealth Navigator (PHN), an advanced PCMH model developed and implemented by Geisinger Health System. In this study, the authors examined the claims data from Geisinger Health Plan between 2005 and 2009 and estimated the effect of PHN on reducing amputation rates among patients with diabetes, end-stage renal disease, myocardial infarction, and stroke. The results show that, despite its relatively short period of existence, PHN has led to significant improvements in certain outcomes, further illustrating its potential as a care delivery model to be adopted on a wider scale.

An Optical Method for Immediate Evaluation of Microfoam Stability in Foam Sclerotherapy

2021 ◽  
Vol 34 (3) ◽  
pp. 128-134
Author(s):  
Taoping Bai ◽  
Wentao Jiang ◽  
Lin Liang ◽  
Yalan Li ◽  
Yubo Fan
Keyword(s):  
Half Life ◽  
Optical Method ◽  
Clinical Performance ◽  
Foam Stability ◽  
Life Time ◽  
Optical Methods ◽  
Foam Sclerotherapy ◽  
Drainage Rate ◽  
Short Period ◽  
The Stability

<b><i>Objectives:</i></b> The objective of our study was to develop an optical method that instantly evaluates the stability of sclerosing foam, which would enable early predictions of the clinical performance of the foam and reduce the occurrence of clinical side effects. <b><i>Methods:</i></b> Based on the principle of light scattering, we developed a method to optically test foam stability and verified it experimentally using sodium morrhuate (2 mL; 0.05 g/mL) and carbon dioxide. A self-made foam preparation instrument was used to achieve a preparation speed of 275 mm/s. The liquid-gas ratios were considered as 1:3, 1:4, and 1:5. Curves of illuminance with respect to the drainage rate and decay time were obtained. By fitting the curve, the relationship between foam half-life time (FHT) and foam decay was obtained. Thus, foam stability was evaluated using the initial illuminance value; the foam transfer time was approximately 3 s. <b><i>Results:</i></b> The experimental FHT varies between 205 and 232 s. Illuminance is exponentially related to drainage rate and linearly related with time. FHT can be expressed by the initial illuminance and illuminance curve fitting coefficients. The half-life of the foam decreases as the initial illuminance value increases, for the same sclerosing drug. The suitability of foam stability is determined by the position of the initial value in the chart. <b><i>Conclusion:</i></b> Optical methods are feasible for evaluating foam stability over a short period of time. Clinically predicting the stability of freshly prepared foam can reduce number of incidences of further complications. This will promote the development of foam sclerotherapy and provide a basic understanding of the internal mechanical properties of foam.

Hand Fractures

2017 ◽  
Author(s):  
Issei Komatsu ◽  
Thomas B Hughes Jr
Keyword(s):  
Treatment Options ◽  
Fracture Pattern ◽  
Angular Deformity ◽  
Mechanism Of Injury ◽  
Hand Fractures ◽  
Fracture Management ◽  
Skin Integrity ◽  
Research Findings ◽  
Operative Fixation ◽  
Phalangeal Fractures

Fractures of the metacarpals and phalanges are common. Clinical evaluation, including eliciting the mechanism of injury, physical examination observing skin integrity, neurovascular status, rotational and angular deformity, and arc of motion and stability in each joint, and review of dedicated radiographs are needed to guide successful fracture management. Most of these fractures can be successfully managed by nonoperative techniques. However, operative fixation is indicated in certain fractures. In this review, we discuss the most representative hand fractures and their management. We also highlight various surgical treatment options, with recent clinical research findings for each fracture pattern. This review contains 10 figures, 2 tables and 54 references Key words: metacarpal fractures, phalangeal fractures, thumb fractures  

Computing Body Segment Trajectories in the Hybrid III Dummy Using Linear Accelerometer Data

1994 ◽  
Vol 116 (1) ◽  
pp. 37-43 ◽  
Author(s):  
Rex T. Shea ◽  
David C. Viano
Keyword(s):  
High Speed ◽  
Angular Displacement ◽  
Angular Acceleration ◽  
Cost Savings ◽  
Accelerometer Data ◽  
Short Period ◽  
Planar Trajectory ◽  
Hybrid Iii ◽  
High Speed Film ◽  
New Generation

An analytical method was developed and tested using several mini-sled and Hyge sled tests to calculate the planar trajectory of a Hybrid III dummy head. Aimed at expediting the Hybrid III test analyses, it may provide an opportunity for cost savings through reduced hardware and manpower on film analyses. Transformation from the moving coordinate to the laboratory coordinate is based on the angular positions integrated from the derived angular accelerations. Gravitational correction of the linear accelerometers was found to be insignificant. The computed head trajectories were compared to the ones obtained from the high speed film images. Accuracy of the calculated head trajectory relies heavily on the accuracy of the computed angular acceleration. Strain-gaged accelerometers are not dependable at all times during an impact and an ill-behaved signal for a very short period may create a significant drift in computed displacement due to double integrations. Accuracy of the currently available accelerometers is not high enough for an angular displacement calculation. A new generation of accelerometers with higher accuracy, or an angular velocity sensor may provide more accurate angular displacement for trajectory analyses. The redundancy of the in-line accelerations helps improve the isolation of erroneous outputs and improve accuracy of the procedure.

Telehealth for oncology genetic counseling: An Idaho experience.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 288-288
Author(s):  
Jennifer N. Eichmeyer ◽  
Dan Sayam Zuckerman ◽  
Thomas M. Beck ◽  
Nicolas Camilo ◽  
Kevin Mark ◽  
...  
Keyword(s):  
Genetic Counseling ◽  
Quality Care ◽  
Tertiary Care ◽  
Cost Savings ◽  
Small Scale ◽  
Care Hospital ◽  
Elapsed Time ◽  
Rural Settings ◽  
Web Camera ◽  
Satisfaction Measures

288 Background: Access to qualified genetics specialists continues to be a barrier for patients in rural settings. Our institution aimed to develop a proof-of-concept telehealth program that supports the vision of transforming the way healthcare is delivered specific to Idaho. Methods: Based on a needs assessment with 40 direct caregivers the program was designed to eliminate inconsistency and variation through the system and expand the specialty care footprint from the tertiary care hospital. To gain traction, specific areas (genetic counseling and nutritional counseling) were identified that could move forward with telehealth. This small-scale implementation could be rapidly executed using few system resources while providing feedback for future refinement and expansion. Technology needs included, Microsoft Lync, a HD web camera, USB speaker/microphone, dual monitors, and a document camera to be added to workstations for the provider. A transportable cart with computer and dual monitor workstation was assembled for the outreach site with the same technology components. The metrics chosen to track the benefits of this service included: provider travel time and costs, elapsed time from referral to first scheduled appointment, comparison of patient volumes, and patient satisfaction. Satisfaction measures were collected by written questionnaires and interviews with the patient. Results: During a 3-month period 23 genetic counseling appointments were conducted by telehealth. This resulted in a savings of $1050.63 in mileage and travel wages and 13.5 travel hours. Wait times for appointments dropped from 23 days to 16 days, and appointment volumes increased from 6/month to 8/month. Access to services increased from 8 hours per month to 16 variable hours per month with the availability of immediate needs appointments. Patient scores (N=12) demonstrated “Excellent” ratings (5/5) in the following: 83% satisfaction using the telehealth cart, 83% likelihood to use telehealth again, and 92% recommend telehealth to a friend. Conclusions: Improved convenience, access, and cost savings while providing high quality care were maintained using telehealth. Expansion of the program to another outreach site has already been approved by leadership.

Effect of palliative care on aggressiveness of end-of-life care in patients with advanced colon cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 168-168
Author(s):  
Jessica Ann Reifer Hildebrand ◽  
Renuka Bhan
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advanced Cancer ◽  
Medical Center ◽  
Quality Care ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Course Of Illness ◽  
Significant Difference ◽  
Aggressive Care

168 Background: Recent studies have observed that starting Palliative Care (PC) soon after diagnosis for patients with advanced cancer improves quality of life, end of life (EOL) care, and possibly survival. Consequently, it has been recommended that combined standard oncology care and PC should be considered early in the course of illness for patients with advanced cancer. It has been posited that patients enrolled in early PC receive less aggressive care at the EOL and consequently spend fewer healthcare dollars. We sought to compare the aggressiveness of care received by those enrolled in early PC to those enrolled in late PC. Methods: A retrospective chart review of patients diagnosed with stage III or IIII colorectal cancer (CRC) at New Hanover Regional Medical Center between 2009 through 2011 was performed. Patients who were enrolled in PC within 30 days of diagnosis were compared to those enrolled later. Aggressiveness of care given during the last 30 days of life was assessed by: hospitalizations, ED visits, days spent in the ICU, chemotherapy received in the last 14 days of life, and death in the hospital. Results: 186 patients were identified for the study, and 89 met inclusion criteria. We found no significant difference in the aggressiveness of care received by those enrolled in early PC (46.7%) versus later PC (47.8%) (p = 1.00). In fact, almost half of all patients with advanced cancer received some form of aggressive care within the last 30 days of life. While those enrolled in late PC more frequently received chemotherapy, were admitted to the ICU, and died in the hospital, the differences were not statistically significant. Whether or not these differences account for cost savings in the early PC group has yet to be determined. Conclusions: Our study found that patients were just as likely to receive aggressive care at the EOL regardless of whether or not they were enrolled in early PC. This finding was unexpected given the goals and philosophy of PC groups. While early PC has been recommended as a quality care measure, patient and physician factors may limit its effectiveness. For example, patients, while receptive to certain aspects of PC, still desire a cure. Similarly, physicians feel compelled to treat patients aggressively.

Development of an infusion nurse staffing model for outpatient chemotherapy centers.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 103-103
Author(s):  
Georgina T. Rodgers
Keyword(s):  
Patient Safety ◽  
Health System ◽  
Quality Care ◽  
Cost Savings ◽  
Patient Volume ◽  
Care Needs ◽  
Outpatient Chemotherapy ◽  
Staffing Model ◽  
Ambulatory Oncology ◽  
Nursing Roles

103 Background: Nursing roles and responsibilities within ambulatory oncology infusion suites across our health system are not clearly defined and it is not understood what the appropriate staffing ratio should be per site. It is not clear if employees are working to the highest level of their licensure or skill, and if the appropriate activities are performed by the correct department. A standard staffing model to provide efficiency of clinical services and patient safety does not exist, and nursing roles are variable between the sites. Similar patient populations are being treated at each site and the variability of the roles introduces unnecessary costs to the system as a whole. The purpose of this project was to define roles of the infusion nurse to insure performance to the highest level of licensure, create efficiencies within the clinical setting, potentially reduce RN staffing requirements, achieve a cost savings, and develop a target nurse to patient ratio while maintaining quality care. Methods: Daily patient volume and hours of operation were compiled for each outpatient site and three methodologies were used to determine nurse to patient ratio. We utilized an acuity based ratio tool, hours per unit (HPU) method using billed charges for technical procedures and finally a simple 1:6 ratio based upon patient volume. Each methodology showed similar results and a final target ratio of 1:6 was chosen. Results: A staffing template was created to predict the number of RN’s necessary for treatment and an analysis of infusion sites was also completed to observe workflows and determine potential staffing adjustments. Our pilot site was initially staffed with 14 RN FTE’s and analysis showed many non-clinical, non-nursing duties were being performed by RN’s. Through process improvement we have created clear role delineation and the site currently functions with 5 RN FTE’s. We have maximized the efficiency of the nursing team, reduced costs, and there has been no decline or compromise in quality or patient safety. Conclusions: The implications of establishing this standard for infusion nursing has allowed us to duplicate the methodology across the health system and achieve a level of staffing that matches well with patient care needs.

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