SP10.1.4 COVID as a driver of innovation: getting the right patient to the right place at the right time. A novel Registrar-led approach to minimising unnecessary footfall in the Surgical Assessment Unit of a District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Emma L. Court ◽  
Nicola A. Lennon ◽  
Anas Zarka ◽  
Megan Pryor ◽  
Susan Lawrence ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Cost Savings ◽  
Cost Effective ◽  
District General Hospital ◽  
Service Development ◽  
Telephone Triage ◽  
Assessment Unit ◽  
Outcome Comparison ◽  
Impact Patient Care ◽  
The Right

Abstract Aim To give shielding Registrars opportunities to innovate and lead service development through telephone triage of Surgical Assessment Unit (SAU) referrals from General Practitioners and Nurse Practitioners. Prior to the COVID pandemic, referrals were taken by Nurse Coordinators. Increasing call volumes put pressure on the department and disrupted clinical duties. Furthermore, referrers often expressed difficulties in contacting SAU staff. Methods During the study, referral calls were diverted for triage by the hospital switchboard. Three outcomes were offered: Clinical advice, ‘Hot Clinic’ (HC) appointment or urgent SAU review. Prospective referral data (15/6-31/7/2020) and retrospective non-triage data (15/6-1/7/2019) were gathered. Triage effects were measured by outcome comparison with non-triage data and the associated financial implications calculated. Stakeholder feedback questionnaires were distributed. Results Non-triage data showed 56% of patients reviewed in SAU were sent home and 44% admitted, compared to 23.6% and 28.1% of referrals during the 2020 study period. Furthermore, 28.4% of admissions were avoided by triage. Only 3.1% of triaged patients presented to Emergency Department within 7 days of the triage conversation. Almost half of these had been reviewed in SAU following triage and discharged the same day. HC availability was limited during the triage study. In view of reduced admissions and overall cost savings of £8330.62/week, expanding these clinics may prove cost neutral. Triage was universally popular with stakeholders. Data will inform future development of Urgent and Emergency Care at our hospital. Conclusions Traditional ways of working should be challenged. Novel approaches can be cost effective & positively impact patient care.

Abdominal ultrasound scans for diagnostic imaging of the liver

2019 ◽  
Vol 17 (Sup6) ◽  
pp. S30-S35
Author(s):  
Gerri Mortimore ◽  
JP Mayes
Keyword(s):  
Nurse Practitioners ◽  
Cost Effective ◽  
Abdominal Ultrasound ◽  
Liver Function Tests ◽  
Background Information ◽  
Sound Waves ◽  
Clinical Background ◽  
Line Imaging ◽  
The Right ◽  
Available Information

Ultrasound is a common first-line imaging investigation that uses sound waves to produce an image (sonogram) of the internal organs. It is easy, quick and cost-effective to perform and safe, non-invasive and generally painless for the patient. Abdominal ultrasound in particular visualises the hepatobiliary system. It is used to investigate abdominal pain, abnormal liver function tests, distension and jaundice, as well as to screen for hepatocellular carcinoma and abdominal aortic aneurysm. Ultrasound requests should include relevant clinical background information to ensure the patient receives the right test and help the sonographer rule out differential diagnoses. Before the test, patients should be given all available information and asked to fast for 6–8 hours, although clear fluids are permitted. The scan usually procedure takes 15–30 minutes but may be extended depending on pathology identified. The sonogram displays the comparative echogenicity of the liver and adjacent organs in real time. Increased echogenicity, a coarse echotexture and a saw-tooth liver edge are indicative of liver pathology. Ultrasound can also allow the assessment of the portal venous system to exclude portal vein thrombus or elevated portal velocities. Advanced clinical nurse practitioners can order ultrasounds in line with local hospital trust guidance, which may include Ionising Radiation Medical Exposure Regulations (IRMER) training.

15K Multistage Fracturing Completion System Addresses Operational Challenges, Improves Production Performance and Cost Savings in Openhole Environments

2021 ◽  
Author(s):  
Rasim Serdar Rodoplu ◽  
Adegbenga O. Sobowale ◽  
Jon E. Hanson ◽  
Beau R. Wright
Keyword(s):  
New Technology ◽  
Cost Savings ◽  
Cost Effective ◽  
Production Performance ◽  
High Rate ◽  
Field Development ◽  
Additional Equipment ◽  
Effective Manner ◽  
Open Hole ◽  
The Right

Abstract Multistage fracturing (MSF) ball drop completion systems have been utilized around the globe for effectively treating formations completed as open hole and cemented. Multiple, high-rate hydraulic fracturing stages are pumped through these completions while gaining efficiency during pumping operations. A challenge within the industry was developing systems that are capable of higher pressures (greater than 10k psi) while still being able to be deployed in challenging openhole environments with minimum equipment and intervention requirements. This paper will discuss the planning, deployment and fracturing execution operations of an improved version of one of these systems. To be able to effectively utilize any MSF completion system; formation properties, deployment environment, lateral length, openhole size, liner size, and tubing movements during fracturing should be thoroughly analyzed and equally considered. To create a reliable system, another important consideration is how the system will be deployed; a long string to surface, or will it be deployed as part of a liner hanger system? In the case of the latter, it should be compatible with the liner hanger system by accommodating multiple balls to set and release the hanger system and actuate the openhole packers. In tight formation environments, where treating pressure differentials reaches as high as 15,000 psi during fracturing operations, openhole packers that are capable of holding these pressures in challenging openhole conditions are needed. Not only the packers but also the remaining completion system components need to be capable of withstanding, including burst, collapse, and ball-to-ball seat differential while simultaneously accommodating the pressure with cooling and ballooning induced tubing movement caused by these high pressure treatments. Improving such a robust design with innovative solutions, such as dissolvable frac balls that can handle 15,000 psi differential, optimizes the overall process. The completion design, deployment, and subsequent fracturing operations on a well showcases how effective consideration of components operates as a system can create a reliable MSF system. It also demonstrates how close collaboration between reservoir management, production engineering, completion experts, and vendor results in a coordination of efforts that eliminates operational hazards, thus ensuring smooth operations. The successful deployment of an openhole MSF completion system that can handle 15,000 psi with dissolving frac balls and eliminating openhole anchors helped pave the way to deal with tighter formations in an efficient and cost-effective manner. With the help of this new technology, the well planners were able to address operational challenges that would have otherwise required additional equipment or would have limited deployment capabilities. The engineering approach and design to develop this completion system and utilization in the right candidate confirmed the benefit of the novel completion for field development options.

Mineral/microfibrillated cellulose composite materials: High performance products, applications, and product forms

TAPPI Journal ◽  
2018 ◽  
Vol 17 (09) ◽  
pp. 507-515 ◽  
Author(s):  
David Skuse ◽  
Mark Windebank ◽  
Tafadzwa Motsi ◽  
Guillaume Tellier
Keyword(s):  
Composite Materials ◽  
High Performance ◽  
Aqueous Suspension ◽  
Production Capacity ◽  
Cost Savings ◽  
Cost Effective ◽  
New Materials ◽  
Wet Strength ◽  
Product Forms ◽  
Cellulose Composite

When pulp and minerals are co-processed in aqueous suspension, the mineral acts as a grinding aid, facilitating the cost-effective production of fibrils. Furthermore, this processing allows the utilization of robust industrial milling equipment. There are 40000 dry metric tons of mineral/microfbrillated (MFC) cellulose composite production capacity in operation across three continents. These mineral/MFC products have been cleared by the FDA for use as a dry and wet strength agent in coated and uncoated food contact paper and paperboard applications. We have previously reported that use of these mineral/MFC composite materials in fiber-based applications allows generally improved wet and dry mechanical properties with concomitant opportunities for cost savings, property improvements, or grade developments and that the materials can be prepared using a range of fibers and minerals. Here, we: (1) report the development of new products that offer improved performance, (2) compare the performance of these new materials with that of a range of other nanocellulosic material types, (3) illustrate the performance of these new materials in reinforcement (paper and board) and viscosification applications, and (4) discuss product form requirements for different applications.

Pound Wise and Penny Foolish? Weight Loss and The Dynamics of Health Care Spending

2011 ◽  
Vol 14 (2) ◽  
Author(s):  
Thomas G Koch
Keyword(s):  
Weight Loss ◽  
Cost Savings ◽  
Cost Effective ◽  
Economic Consequences ◽  
Health Care Spending ◽  
Order Of Magnitude ◽  
Dynamic Measures ◽  
The Cost ◽  
The Impact ◽  
The Relationship

Current estimates of obesity costs ignore the impact of future weight loss and gain, and may either over or underestimate economic consequences of weight loss. In light of this, I construct static and dynamic measures of medical costs associated with body mass index (BMI), to be balanced against the cost of one-time interventions. This study finds that ignoring the implications of weight loss and gain over time overstates the medical-cost savings of such interventions by an order of magnitude. When the relationship between spending and age is allowed to vary, weight-loss attempts appear to be cost-effective starting and ending with middle age. Some interventions recently proven to decrease weight may also be cost-effective.

Cost Avoidance and Clinical Benefits Derived from a Pharmacy-Managed Anemia Program

2000 ◽  
Vol 35 (2) ◽  
pp. 169-175 ◽  
Author(s):  
Robert A. Quercia ◽  
Ronald Abrahams ◽  
C. Michael White ◽  
John D'Avella ◽  
Mary Campbell
Keyword(s):  
Cost Savings ◽  
Cost Effective ◽  
Hemodialysis Patients ◽  
Cost Avoidance ◽  
Number Of Patients ◽  
Epoetin Alpha ◽  
Clinical Benefits ◽  
Unit Dose ◽  
One Year ◽  
Alpha Therapy

A pharmacy-managed anemia program included distribution and clinical components, with the goal of making epoetin alpha therapy for hemodialysis patients more cost-effective. The Pharmacy Department prepared epoetin alpha doses for patients in unit-dose syringes, utilizing and documenting vial overfill. Pharmacists dosed epoetin alpha and iron (oral and intravenous) per protocol for new and established patients. Baseline data were obtained in 1994, one year prior to implementation of the program, and were re-evaluated in 1995 and 1998. Cost avoidance from utilization of epoetin alpha vial overfill in 1995 and 1998 was $83,560 and $91,148 respectively. In 1995 and 1998, cost avoidance from pharmacy management of anemia was $191,159 and $203,985 respectively. The total cost avoidance from 1995 through 1998 was estimated at $1,018,638. The number of patients with hematocrits under 31% decreased from 32% in 1994 to 21% and 14% in 1995 and 1998 respectively. We conclude that a pharmacy-managed anemia program for hemodialysis patients results in significant cost savings and better achievement of target hematocrits.

The Future of Plasma-Based Surface Engineering Techniques in Tribology (Keynote)

2005 ◽  
Author(s):  
Allan Matthews ◽  
Adrian Leyland
Keyword(s):  
Surface Engineering ◽  
Performance Enhancement ◽  
Bulk Material ◽  
Cost Savings ◽  
Cost Effective ◽  
Ceramic Coatings ◽  
Performance Improvements ◽  
Treatment Techniques ◽  
Wide Range ◽  
Macro Scale

Over the past twenty years or so, there have been major steps forward both in the understanding of tribological mechanisms and in the development of new coating and treatment techniques to better “engineer” surfaces to achieve reductions in wear and friction. Particularly in the coatings tribology field, improved techniques and theories which enable us to study and understand the mechanisms occurring at the “nano”, “micro” and “macro” scale have allowed considerable progress to be made in (for example) understanding contact mechanisms and the influence of “third bodies” [1–5]. Over the same period, we have seen the emergence of the discipline which we now call “Surface Engineering”, by which, ideally, a bulk material (the ‘substrate’) and a coating are combined in a way that provides a cost-effective performance enhancement of which neither would be capable without the presence of the other. It is probably fair to say that the emergence and recognition of Surface Engineering as a field in its own right has been driven largely by the availability of “plasma”-based coating and treatment processes, which can provide surface properties which were previously unachievable. In particular, plasma-assisted (PA) physical vapour deposition (PVD) techniques, allowing wear-resistant ceramic thin films such as titanium nitride (TiN) to be deposited on a wide range of industrial tooling, gave a step-change in industrial productivity and manufactured product quality, and caught the attention of engineers due to the remarkable cost savings and performance improvements obtained. Subsequently, so-called 2nd- and 3rd-generation ceramic coatings (with multilayered or nanocomposite structures) have recently been developed [6–9], to further extend tool performance — the objective typically being to increase coating hardness further, or extend hardness capabilities to higher temperatures.

scholarly journals Is an integrated model of school eye health delivery more cost-effective than a vertical model? An implementation research in Zanzibar

2021 ◽  
Vol 6 (1) ◽  
pp. e000561
Author(s):  
Ving Fai Chan ◽  
Fatma Omar ◽  
Elodie Yard ◽  
Eden Mashayo ◽  
Damaris Mulewa ◽  
...  
Keyword(s):  
Implementation Research ◽  
Cost Savings ◽  
Cost Effective ◽  
Integrated Model ◽  
Health Screening ◽  
High Coverage ◽  
Health Delivery ◽  
Screening Cost ◽  
Eye Health ◽  
The Cost

ObjectiveTo review and compare the cost-effectiveness of the integrated model (IM) and vertical model (VM) of school eye health programme in Zanzibar.Methods and analysisThis 6-month implementation research was conducted in four districts in Zanzibar. Nine and ten schools were recruited into the IM and VM, respectively. In the VM, teachers conducted eye health screening and education only while these eye health components were added to the existing school feeding programme (IM). The number of children aged 6–13 years old screened and identified was collected monthly. A review of project account records was conducted with 19 key informants. The actual costs were calculated for each cost categories, and costs per child screened and cost per child identified were compared between the two models.ResultsScreening coverage was 96% and 90% in the IM and VM with 297 children (69.5%) from the IM and 130 children (30.5%) from VM failed eye health screening. The 6-month eye health screening cost for VM and IM was US$6 728 and US$7 355. The cost per child screened for IM and VM was US$1.23 and US$1.31, and the cost per child identified was US$24.76 and US$51.75, respectively.ConclusionBoth models achieved high coverage of eye health screening with the IM being a more cost-effective school eye health delivery screening compared with VM with great opportunities for cost savings.

scholarly journals 1003 A Case of Tunnel-Vision in Upper Renal Tract Imaging: The Invisible Gorilla

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Swamad ◽  
M K Quraishi ◽  
S Ahmed
Keyword(s):  
Renal Mass ◽  
Left Kidney ◽  
Interesting Case ◽  
Ct Scans ◽  
Renal Ultrasound ◽  
Ultrasound Scan ◽  
Surgical Team ◽  
Tunnel Vision ◽  
Impact Patient Care ◽  
The Right

Abstract We present an interesting case of a 70-year-old female who presented with haematuria on the suspected cancer pathway. Renal ultrasound showed a vascular renal mass on her right kidney measuring 8x7cm with an unremarkable left kidney. She underwent a laparoscopic radical nephrectomy following confirmation of an 8cm renal mass in the right kidney on the contrasted staging CT scan with a repeat review at the multidisciplinary meeting. Post-operatively a subsequent review of the pre-operative CT and ultrasound scan, showed an incidental large left(contralateral) upper quadrant retroperitoneal fatty mass sized 15x10cm, displacing the stomach and spleen. Further investigation in the form of an MRI Abdomen excluded features of a liposarcoma, resulting in the diagnosis of a large retroperitoneal lipoma. This case highlights the significance of selective attention in imaging interpretation. We believe this to be a prime example of the level of meticulousness required as fat-rich tissues have low attenuation on CT-scans, which can be easily missed out. A cautious multi-clinician interpretation of scans should be performed to avoid missing potentially sinister pathology which would impact patient care dramatically. This case has led to more thorough review of future pre-operative imaging by the operating surgical team.

scholarly journals Economic Development Based on a Mathematical Model: An Optimal Solution Method for the Fuel Supply of International Road Transport Activity

Energies ◽  
2021 ◽  
Vol 14 (10) ◽  
pp. 2963
Author(s):  
Melinda Timea Fülöp ◽  
Miklós Gubán ◽  
György Kovács ◽  
Mihály Avornicului
Keyword(s):  
Decision Making ◽  
Ad Hoc ◽  
Market Competition ◽  
Optimal Solution ◽  
Cost Savings ◽  
Cost Effective ◽  
Optimization Method ◽  
Optimal Decision ◽  
Environmental Damage ◽  
Fuel Cost

Due to globalization and increased market competition, forwarding companies must focus on the optimization of their international transport activities and on cost reduction. The minimization of the amount and cost of fuel results in increased competition and profitability of the companies as well as the reduction of environmental damage. Nowadays, these aspects are particularly important. This research aims to develop a new optimization method for road freight transport costs in order to reduce the fuel costs and determine optimal fueling stations and to calculate the optimal quantity of fuel to refill. The mathematical method developed in this research has two phases. In the first phase the optimal, most cost-effective fuel station is determined based on the potential fuel stations. The specific fuel prices differ per fuel station, and the stations are located at different distances from the main transport way. The method developed in this study supports drivers’ decision-making regarding whether to refuel at a farther but cheaper fuel station or at a nearer but more expensive fuel station based on the more economical choice. Thereafter, it is necessary to determine the optimal fuel volume, i.e., the exact volume required including a safe amount to cover stochastic incidents (e.g., road closures). This aspect of the optimization method supports drivers’ optimal decision-making regarding optimal fuel stations and how much fuel to obtain in order to reduce the fuel cost. Therefore, the application of this new method instead of the recently applied ad-hoc individual decision-making of the drivers results in significant fuel cost savings. A case study confirmed the efficiency of the proposed method.

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