Analysis of Strategies to Decrease Postanesthesia Care Unit Costs

Background The goal of this study was to identify interventions that anesthesiologists can make to decrease total costs of a postanesthesia care unit (PACU). Methods Data were collected retrospectively from patients who underwent ambulatory surgery at our tertiary care center. Results Supplies and medications accounted for only 2% of PACU charges. Personnel costs, which depend on the peak number of patients in the PACU, accounted for almost all PACU costs. If nausea and vomiting could have been eliminated in each patient who suffered this complication, without causing sedation, the total time to discharge for all patients would have been decreased by less than 4.8% (95% confidence interval < 7.3%). Arrival rates to and times to discharge from the PACU followed triangular and log-normal distributions, respectively. Computer simulations, using published times to discharge for drugs with "faster recovery," such as propofol, showed that the use of these drugs would only decrease PACU costs if operating rooms were consistently scheduled to run later each day. Such earlier discharge also might be beneficial if used at night, but only if the PACU could close after a single patient leaves. However, reasonably achievable decreases in the times to discharge for all patients undergoing general anesthesia are unlikely to substantively decrease PACU costs. In contrast, arranging an operating room schedule to optimize admission rates would greatly affect the number of PACU nurses needed. Conclusions Anesthesiologists have little control over PACU economics via choice of anesthetic drugs. The major determinant of PACU costs is the distribution of admissions.

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Abstract 14747: Dwindling Trends of Cardiology Admissions Amidst Covid-19 Pandemic in a Tertiary Care Center of Pakistan

Circulation ◽

10.1161/circ.142.suppl_3.14747 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jamshed Ali ◽

Osman Faheem ◽

Pirbhat Shams ◽

ghufran adnan ◽

Maria Khan

Keyword(s):

Care Center ◽

Tertiary Care ◽

Electronic Record ◽

Medical Attention ◽

Care Hospital ◽

Record System ◽

Admission Rates ◽

Cardiovascular Morbidity And Mortality ◽

Number Of Patients ◽

The Impact

Introduction: Social containment measures have been adopted globally to control COVID-19 outbreak. Reduction in hospital visits and inpatient admission rates have become cause for concern. Through this study we aimed to analyze the impact of SARS-CoV-2 virus Outbreak on cardiology inpatient admissions at a tertiary care hospital in Pakistan. Hypothesis: COVID-19 pandemic has resulted in significant decline in cardiology admissions. Methods: We conducted a retrospective study at our center. Admission log was accessed via electronic record system. Comparison was made for same months of 2019 and 2020 with regard to cardiology inpatient admissions. Results: A total of 239 patients were admitted to cardiology services in 2019 period and 106 in 2020 period with resultant reduction of 55.6%. Number of patients admitted to the coronary care unit were 179 and 78 respectively where as the numbers declined to 28 from 60 for cardiac step down. Reduction for admission numbered to 52.4% for males and 38.89% for females. 9.3% patients left against medical advice in 2019 and 3.4% in 2020. Conclusions: Our study concludes that numbers of cardiology admissions have dwindled. Possible explanation for this can be implementation of social containment and fear of acquiring infection. This has raised a question of whether a significant number of cardiovascular morbidity and mortality has occurred without seeking medical attention and has went unrecorded during the pandemic. This calls for stringent diagnostic measures in future to diagnose previously unrecorded burden.

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Surgical ICU Underutilization Does not Significantly Discourage Discharge

Health Services Management Research ◽

10.1177/095148489600900403 ◽

1996 ◽

Vol 9 (4) ◽

pp. 238-242 ◽

Cited By ~ 3

Author(s):

F. Dexter ◽

K. Pearson ◽

D. L. Griffiths ◽

P. Jebson

Keyword(s):

Discharge Rate ◽

Care Center ◽

Tertiary Care ◽

Case Series ◽

Patient Discharge ◽

Poor Quality ◽

Excess Capacity ◽

Admission Rates ◽

Discharge Rates ◽

Number Of Patients

An SICU must have sufficient capacity to handle peak weekly demand to prevent re-admission and/or poor quality of care. Excess capacity may, however, encourage unnecessary SICU utilization. The goal of this study was to assess the influence of availability of SICU beds on patient discharge and re-admission rates. The case series included 1,492 days, 36,816 patient days, 8,821 discharges, and 186 re-admissions within 3 days from a 24-bed multidisciplinary SICU at a tertiary care center. Census was defined to equal the total number of patients in the SICU each day. We found low census levels were not associated with significantly lower discharge rates. Decreasing the census from 19–24 to 13–18 patients per day decreased discharge rates from 31% to 30%. Odds ratio that a decrease in census by five from 24 decreased discharge rate equaled 1.01 (95% confidence interval 0.96 to 1.06). We conclude that when hospital managers choose an appropriate SICU capacity they need not be concerned that intermittent excess capacity will prompt physicians to significantly decrease their discharge rates.

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Paradigm Shift in Clinical Practice of Sexual Health in Men During COVID-19 Pandemic

Journal of Psychosexual Health ◽

10.1177/26318318211032386 ◽

2021 ◽

pp. 263183182110323

Author(s):

Aditya Prakash Sharma ◽

Japleen Kaur ◽

Ravimohan S. Mavuduru ◽

Shrawan K. Singh

Keyword(s):

Health Care ◽

Sexual Health ◽

Surgical Procedures ◽

Care Center ◽

Tertiary Care ◽

Health Care Seeking ◽

Care Seeking ◽

Health Seeking ◽

Number Of Patients ◽

The Impact

Sexual health-care seeking behavior and practices have been affected during COVID-19 pandemic. The impact of COVID-19 on this subspecialty is far reaching. This study aimed to assess the impact of COVID-19 on health-care seeking practice pertaining to sexual health in men in our tertiary care center and review the relevant literature regarding impact of COVID-19 on sexual health seeking practice and challenges faced. Outpatient data was analyzed from January 2019 to April 2021. Patients awaiting surgical procedures due to COVID were documented. A narrative synthesis of literature based on systematic search using the keywords sexual health, sexual health seeking, sexual health practice, andrology, and COVID with operators “AND” and “OR” was carried out in three search engines PubMed, Scopus, and Embase. The study outcomes were obtained by comparing data of outpatient attendance and compiling the reviewed literature. The mean attendance fell significantly from 95.11±11.17 to 17.25±13.70 persons (P <.0001) per outpatient clinic, March 2020 being the reference point. Teleconsultation has taken over physical consultation. In 98/949 cases, teleconsult could not be provided despite registration. Over 25 patients were waiting for surgical procedures pertaining to andrology due to shut down of elective services. Similar trends have been reported from other countries. Number of patients seeking consultation for sexual health problems has dramatically decreased during COVID-19 era. Establishment of data safe teleconsultation facility and its widespread advertisement is needed to encourage patients to seek consult.

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Combined Peritoneal Dialysis and Hemodialysis: Our Experience Compared to Others

Peritoneal Dialysis International ◽

10.1177/089686080302300211 ◽

2003 ◽

Vol 23 (2) ◽

pp. 157-161 ◽

Cited By ~ 18

Author(s):

Mamta Agarwal ◽

Patricia Clinard ◽

John M. Burkart

Keyword(s):

Peritoneal Dialysis ◽

Control Volume ◽

Combined Therapy ◽

Care Center ◽

Combined Treatment ◽

Tertiary Care ◽

Clinical Reason ◽

Combined Modality ◽

Number Of Patients ◽

Solute Clearance

Objective To determine the clinical experience of using combined-modality [simultaneous hemodialysis (HD) and peritoneal dialysis (PD)] treatment in patients with end-stage renal disease. Design We reviewed data on 4 patients from our center that were treated with “combined-mode therapy.” We then conducted a retrospective survey by sending questionnaires to nephrologists in the US and Canada by mail and by posting the survey on the Internet. Data queried included number of patients on combined modality, solute clearances, albumin levels pre and post combined therapy, reasons for using combined therapy, duration and success of combined therapy, and reimbursement issues. Setting and Participants Ours is a tertiary-care center. Patients that were not doing well on PD alone were put on combined modality of treatment between 1992 and 1998. Main Outcome Measures Clinical improvement in the indication for which the participant was started on combined modality. Results In response to the survey, data on 27 patients were collected. These data were combined with data on 4 patients from our unit that had previously been treated with combined HD and PD. Most patients were reported to have more than one clinical reason for changing from PD to combined therapy. The main clinical reason for offering combined treatments was inadequate solute clearance (34%), followed by ultrafiltration problems (16%) and neuropathy (11%). Mean duration of time followed on combined treatment was 8.5 ± 0.12 months. Most patients tolerated combined treatment well and were reported to show improvement in the clinical reasons for which they needed the combined modality. Dual access and reimbursement issues were not a problem. There was no single method used for calculating total (HD, PD, and residual renal) solute clearance. No universal total solute clearance goal was reported. Conclusion Hemodialysis and PD are not mutually exclusive. They can be used in combination to achieve targeted solute clearances, to improve certain clinical conditions, and to control volume and blood pressure in a subset of patients. Further evaluation is needed to better establish the long-term outcomes of using combined modality. Total solute clearance goals and methods for determining total solute clearance need to be standardized.

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Epidemiological analysis of hip fractures at a tertiary care center: a retrospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20182402 ◽

2018 ◽

Vol 4 (4) ◽

pp. 568

Author(s):

Madharam Bishnoi ◽

Tabish Tahir Kirmani ◽

Najmul Huda ◽

Gaurav Chahal ◽

Sandeep Bishnoi

Keyword(s):

Health Care ◽

Retrospective Study ◽

Hip Fractures ◽

Care Center ◽

Tertiary Care ◽

Uttar Pradesh ◽

The Elderly ◽

Tertiary Care Center ◽

Epidemiological Analysis ◽

Number Of Patients

Background: Hip fractures are a leading cause of morbidity and mortality in the elderly population posing significant burden on health care resources. The purpose of this study is to determine the epidemiological analysis of hip fractures at a tertiary care center.Methods: This was a retrospective study done on patients with hip fractures admitted during the period 2015-2017 in Moradabad district of Uttar Pradesh. Case files and radiographs of patients were reviewed for age, gender, nature of trauma, associated comorbidities, type of fracture and presence of osteoporosis.Results: During the 2015-2017 period, 2214 patients with hip fractures were admitted, out of which 1180 were males and rest females. The mean age of patients was 56.8 years with 41.6% belonging to age group 60-75 years. In elderly patients, a low energy simple fall accounted for >85% of fractures with presence of significant osteoporosis (Singh’s index grade 3). The in hospital mortality was 2.1%. Hip fracture characteristics included intertrochanteric 57.81%, femoral neck 30.26% and sub trochanteric 11.93%. Smoking and medical comorbidities were present in a significant number of patients.Conclusions: With increased longevity, hip fractures are an increasing health care problem. Various preventive measures for osteoporosis and falls will decline the prevalence of these fractures.

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Metabolic syndrome in alopecia areata: an observational study at a tertiary care center

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20213338 ◽

2021 ◽

Vol 7 (5) ◽

pp. 647

Author(s):

Subrata Kumar Das ◽

Saptadipa Das

Keyword(s):

Metabolic Syndrome ◽

Observational Study ◽

Alopecia Areata ◽

Care Center ◽

Tertiary Care ◽

Age Group ◽

Tertiary Care Center ◽

Cross Sectional ◽

Laboratory Parameters ◽

Number Of Patients

Background: The aim was to evaluate the parameters of metabolic syndrome (MS) in patients of alopecia areata and to investigate the possibility of an existing relationship between MS and alopecia areata (AA).Methods: This cross-sectional observational study included 50 patients with AA who attended OPD of department of dermatology at a tertiary care center during a period of 1 year. Clinical and laboratory parameters were noted in each patient.Results: This study included 50 patients with AA (33 males and 17 females). In the present study maximum number of patients belonged to the age group 20-30 years with 23 patients, followed by 30-40 years with 17 patients. Most of the study subjects, 17 were college students and number of employees were 15. Out of 50 patients 44 had patch(es) and 2 patient had alopecia totalis. In this study out of 50 patients, 38 had mild AA, 7 had AA and 5 patients had severe AA. No significant derangement of clinical and laboratory parameters of MS observed in patients of AA.Conclusions: In the present study we did not observe any significant derangement of clinical and laboratory parameters of MS in patients of alopecia areata.

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Research Utilization in Critical Care: An Exemplar

AACN Advanced Critical Care ◽

10.4037/15597768-1994-2004 ◽

1994 ◽

Vol 5 (2) ◽

pp. 124-132

Author(s):

Marita G. Titler ◽

Linda Moss ◽

Jane Greiner ◽

Michele Alpen ◽

Gerry Jones ◽

...

Keyword(s):

Critical Care ◽

Pain Management ◽

Research Utilization ◽

Care Center ◽

Tertiary Care ◽

Practice Change ◽

Research Committee ◽

Staff Members ◽

Number Of Patients ◽

Management Protocol

The authors describe the process and outcome of implementing a research-based pain management protocol in four adult critical care units at a large, Midwestern tertiary care center. The project was initiated and directed by members of the divisional research committee. Strategies used to change practice included determining if pain management was a problem via quality assessment monitors, surveying nurses regarding their knowledge and attitude toward pain management, educating staff members about the research base for the practice change, using change champions in each unit, and developing a core group of nurses in each unit to facilitate the change. Outcomes of this research utilization project include a 41% decline in the number of patients in pain, a 44% decline in pain intensity, and improvement in nurses knowledge about pain

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Facts about the General Medical Care of Adults with Congenital Heart Defects: Experience of a Tertiary Care Center

Journal of Clinical Medicine ◽

10.3390/jcm9061943 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1943

Author(s):

Lavinia Seidel ◽

Kathrin Nebel ◽

Stephan Achenbach ◽

Ulrike Bauer ◽

Peter Ewert ◽

...

Keyword(s):

Heart Disease ◽

Medical Care ◽

Primary Care Physicians ◽

Congenital Heart ◽

Heart Defects ◽

Care Center ◽

Tertiary Care ◽

Care Practice ◽

Cross Sectional ◽

Almost All

Background: Due to the increase in survival rates for congenital heart disease (CHD) in the last decades, over 90% of patients today reach adulthood. Currently, there are more than 300,000 adults with CHD (ACHD) living in Germany. They have an increased need for specialized medical care, since almost all ACHD have chronic heart disease and suffer from specific chronic symptoms, risks, and sequelae. Primary care physicians (PCPs) play a crucial role in referring patients to ACHD specialists or specialized institutions. This cross-sectional study is intended to clarify the real-world care of ACHD from the PCP’s perspective. Methods: This analysis, initiated by the German Heart Centre Munich, was based on a 27-item questionnaire on actual ACHD health care practice in Germany from the PCP’s perspective. Results: In total, 767 questionnaires were considered valid for inclusion. The majority of the PCPs were general practitioners (95.9%), and 84.1% had cared for ACHD during the past year. A majority (69.2%) of the PCPs had cared for patients with simple CHD, while 50.6% and 33.4% had cared for patients with moderate and severe CHD, respectively, in all age groups. PCPs treated almost all typical residual symptoms and sequelae, and advised patients regarding difficult questions, including exercise capacity, pregnancy, genetics, and insurance matters. However, 33.8% of the PCPs did not even know about the existence of certified ACHD specialists or centers. Only 23.9% involved an ACHD-specialized physician in their treatment. In cases of severe cardiac issues, 70.8% of the PCPs referred patients to ACHD-certified centers. Although 52.5% of the PCPs were not sufficiently informed about existing structures, 64.2% rated the current care situation as either “very good” or “good”. Only 26.3% (n = 190) of the responding physicians were aware of patient organizations for ACHD. Conclusions: The present study showed that the majority of PCPs are not informed about the ACHD care structures available in Germany. The need for specialized ACHD follow-up care is largely underestimated, with an urgent need for optimization to reduce morbidity and mortality. For the future, solutions must be developed to integrate PCPs more intensively into the ACHD care network.

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Trends in Digital Replantation: 10 Years of Experience at a Large Canadian Tertiary Care Center

Plastic Surgery ◽

10.1177/2292550320925914 ◽

2020 ◽

pp. 229255032092591

Author(s):

Ogi Solaja ◽

Helene Retrouvey ◽

Heather Baltzer

Keyword(s):

Care Center ◽

Tertiary Care ◽

Temporal Trends ◽

Workplace Safety ◽

Injury Characteristics ◽

Number Of Patients ◽

Significant Downward Trend ◽

Revascularization Procedures ◽

American Authors ◽

Digital Replantation

Background: Since 1965, the practice of digital replantation has seen great technical strides and become commonplace worldwide. However, some American authors have recently reported declining rates of replantation. We set out to characterize the patient population and describe treatment patterns from 2005 to 2016 at a large Canadian regional replantation center. Methods: A retrospective cohort of all patients undergoing digital replantation and revascularization from 2005 to 2016 was identified. Data were collected on demographics, injuries, procedures, and outcomes. Descriptive statistics were performed, followed by a comparison of two 5-year periods to evaluate temporal trends. Results: A total of 234 patients were treated with 146 replantation and 204 revascularization procedures. Patients were largely male, healthy, and worked as manual labourers. Overall, the failure rate of individual repairs was 28.7%. Over time, there was a trend toward more crush or avulsion and multidigit injuries, and surgeries performed after 2011 were significantly longer. There was a significant downward trend in the number of patients treated at our center each year. Additionally, there was a statistically significant decrease in the proportion of replanted to revised digits in multidigit cases. Discussion: Our observation of declining replantation rates is in line with recent American observations. The reason for this is not obvious but may represent a change in injury characteristics or surgeon attitudes. Conclusion: We suspect that these changes represent a change in workplace safety and injury characteristics, but further studies are needed to assess patient and surgeon treatment decisions.

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Clinical Characteristics and Management of the Hydatid Cyst of the Liver: A Study from a Tertiary Care Center in Nepal

Journal of Parasitology Research ◽

10.1155/2020/8867744 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Utsav Joshi ◽

Roshan Subedi ◽

Amar Jayswal ◽

Vishakha Agrawal

Keyword(s):

Hydatid Cyst ◽

Imaging Finding ◽

Care Center ◽

Descriptive Analysis ◽

Tertiary Care ◽

Clinical Manifestations ◽

Public Health Problem ◽

Imaging Studies ◽

Abdominal Ultrasonography ◽

Number Of Patients

A hydatid cyst of the liver is a significant yet neglected public health problem in Nepal. The present study was carried out to evaluate the demographic characteristics, clinical presentations, and management of the patients of the hydatid cyst of the liver in the setting of a developing country. It was a retrospective, descriptive analysis of 53 patients admitted in the department of surgery with the diagnosis of hydatid cyst of the liver based on clinical manifestations, imaging studies, or serology between 2016 and 2019. The median age of the patients was 36 years, with the age group of 25-45 years being the most commonly affected (23, 43.4%). 58.5% of the patients were female. Abdominal pain (49, 92.5%) and a palpable liver (17, 32.1%) were the most common complaint and physical finding in our study population, respectively. Abdominal ultrasonography and computed tomography scan were the major imaging studies used to establish a diagnosis. A unilocular and anechoic cystic lesion was the most frequent imaging finding. The right lobe of the liver harbored the cysts in the maximum number of patients. Surgery was the preferred modality of treatment (23, 43.4%), with pericystectomy being the most common form of surgical intervention. The hydatid cyst of the liver is a common cause of morbidity in Nepal. Clinical evaluation supplemented by imaging studies is required for diagnosis, and surgery remains the treatment of choice in most cases. To explain the epidemiological pattern of the disease, multicentric studies involving a larger sample of patients should be conducted.

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