THUR 021 Transforming acute neurology: a 4 year study

2018 ◽  
Vol 89 (10) ◽  
pp. A4.1-A4
Author(s):  
Nitkunan Arani ◽  
Macdonald Bridget ◽  
Bhoodoo Ajay ◽  
Southam Medina ◽  
Smyth Caitlyn ◽  
...  
Keyword(s):  
Average Length ◽  
Early Discharge ◽  
Primary Diagnosis ◽  
Triage Nurse ◽  
Medical Admission ◽  
Specialist Nurse ◽  
Average Length Of Stay ◽  
Novel Approach ◽  
Group A ◽  
The Cost

We present a novel approach to acute neurological care. The key is an acute neurology triage nurse, based in the medical admission unit as well as an epilepsy specialist nurse seeing every patient referred with fits on the day of admission, a designated acute neurology consultant and acute neurophysiology and neuroradiology links. We have designated this group, a hyperacute neurology team (HANT).This study compares all admissions in 2014, the year before the team was established with 2015–2017. The total number of referrals has increased from 720 in 2014 to 1248 in 2017. The percent of patients seen on the day of referral has risen from 59% in 2014 to 92% in 2017.Average length of stay for patients with a primary diagnosis of epilepsy has gone down from 4.1 days in 2014 to 3.4 in 2017. Multiple admissions for epilepsy has reduced from 28 in 2014 to 21 in 2017. Patients suitable for early discharge are seen in consultant or nurse «outpatient hot clinics» or nurse telephone clinics.The cost of establishing this service has been relatively small (£106,000) and the service benefits enormous. We feel this model is worthy of wider debate.

scholarly journals Proposal of resources optimization in the hospital treatment of heart failure by an increased utilization of cardiac rehabilitation

2016 ◽  
Vol 66 (4) ◽  
Author(s):  
Tommaso Diaco ◽  
Geremia Milanesi ◽  
Daniela Zaniboni ◽  
Massimo Gritti ◽  
Gianna Zavatteri ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Average Length ◽  
Mean Value ◽  
Hospital Treatment ◽  
Utilization Rate ◽  
Average Length Of Stay ◽  
Use Of Resources ◽  
Acute Patient ◽  
The Cost ◽  
Acute Patients

weight on social cost. An improved resources utilization could promote a reduction of the new hospitalization and a of medical costs. Working hypotesis: To analyze a model of increased utilization of our Cardiac Rehabilitation (CR) Unit, aiming at improving the cost/profit ratio through a better use of resources and a better assignment of care. With a reduction of average length of stay in the Operative Units for acute patients, we could promote a demand of post-acute hospitalization of 950.7 days of hospitalization that could be assigned to Cardiologic Rehabilitation Unit. Results: With the transfer of patients the utilization rate of CR would increase to 97%. With a mean period in bed of 15.3 days we could hospitalize 62 additional patients and the total margin of contribution would became positive: 69.817 euro. The break even analysis applied to costs and returns of the Unit shows a further indication to increase the hospitalization number in CR Unit with patients transfered from acute patient units. Under the same costs the recovery of efficiency leads to a reduction of variable costs. In the same time there is an increase of returns due to an increase of mean value for case and an increase of services. Conclusion: The increase in the efficiency in the utilization of CR Unit leads to an increase of the Hospital efficiency. The transfer of patients from acute units to CR Unit would allow an increased hospitalization rate for acute patients without requiring additional resources.

Early Discharge Does Not Increase Readmission Rates After Minimally Invasive Anatomic Lung Resection

2019 ◽  
Vol 14 (3) ◽  
pp. 218-226
Author(s):  
Guillaume S. Chevrollier ◽  
Amanda K. Nemecz ◽  
Courtney Devin ◽  
Kendrick V. Go ◽  
Misung Yi ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Enhanced Recovery ◽  
Average Length ◽  
Lung Resection ◽  
Multivariable Analysis ◽  
Early Discharge ◽  
Enhanced Recovery Pathway ◽  
Average Length Of Stay ◽  
Anatomic Lung Resection

Objective Enhanced recovery pathways reduce length of stay and costs following lung resection. However, many fear that early discharge may lead to increased hospital readmissions. In this study, we aimed to determine whether early discharge was associated with increased readmission following anatomic lung resection. Methods Using the lung resection database approved by our institutional review board, we identified all patients undergoing minimally invasive lobectomy and segmentectomy between January 2010 and March 2017 at our institution, where an enhanced recovery pathway is well established. Thirty-day readmissions were compared between patients with short- and average length of stay, defined as 1 to 2 days and 3 to 5 days, respectively. Multivariable logistic regression analysis of patients matched by propensity scores was performed to determine odds of 30-day readmission for each group. Significance was set at P < 0.05. Results A total of 296 patients met inclusion criteria. Unadjusted analysis revealed a 3-fold increased rate of readmission in the group with average length of stay (9%, n = 12) versus the group with short length of stay (3%, n = 5; P < 0.01). At baseline, patients with average length of stay had increased rates of preoperative chemotherapy (13%, n = 18 vs. 4%, n = 6; P < 0.01) and radiation (12%, n = 16 vs. 3%, n = 5). Patients with average length of stay also had higher rates of lobectomy (95%, n = 127 vs. 86%, n = 140; P = 0.02) and postoperative complications (31%, n = 41 vs. 4%, n = 7; P < 0.01). On multivariable analysis, patients with average length of stay had a 2.3-fold greater odds of readmission, which was not statistically significant (OR = 2.33; 95% CI, 0.60 to 9.02; P = 0.22). Conclusions Early discharge following minimally invasive anatomic lung resection does not increase the risk of hospital readmission in patients treated within an enhanced recovery pathway.

A Single-Institution's Experience With the CMS Noncervical Spine Fusion Bundle Payments

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Abraham Schlauderaff ◽  
Neel T Patel ◽  
G Timothy Reiter
Keyword(s):  
Healthcare Costs ◽  
Chart Review ◽  
Average Length ◽  
Skilled Nursing Facility ◽  
Retrospective Chart Review ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Average Length Of Stay ◽  
Cost Metrics ◽  
The Cost

Abstract INTRODUCTION To reign in escalating healthcare costs, multiple cost-containment methodologies have been proposed. CMS has recently initiated bundle payments for certain DRGs during a 90 d global period. These include DRG codes 459 and 460: spinal fusion except cervical with and without major complications or comorbidity, respectively. METHODS The investigators reviewed patients who have been included in the CMS dataset for the aforementioned CMS trial. The data were utilized to analyze our performance in both quality and estimated cost metrics. Data not included in the CMS dataset were obtained via a retrospective chart review. RESULTS A total of 29 patients were included (25 with DRG 460 and 4 with DRG 459). Currently, there are no complete episodes, and final net episode payments are not known. Mean age was 68.9 (SD 9.7) yr. There were 17 males and 12 females. A total of 25 cases were elective and 4 were traumatic. Average length of stay (LOS) was 6 d (2-16 d) with a mean estimated cost of $30,631 (SD $6332). Six patients went to an inpatient rehab for a mean of 14 d (6-21 d) at a mean estimated cost of $28,089 (SD $7372). Two patients went to a skilled nursing facility for 8 and 23 d at a mean estimated cost of $21,906 (5091 and 38,721). Only 1 traumatic case went to rehab/SNF (25%) compared to 7 elective cases (32%). The estimated net episode payment (ENEP) for discharge to home was $36,726 versus that for discharge to facility of $73,100. CONCLUSION From these preliminary data, we conclude that being discharged to Rehab/SNF approximately doubled the ENEP. Of interest, being admitted as a trauma did not increase the risk of being discharged to Rehab/SNF. As patient data mature, we will be able to analyze the cost and expense relationship to obtain a variance to target in our population.

scholarly journals Comparison of three antimicrobial strategies in diabetic foot infections post-amputation

2019 ◽  
Vol 6 ◽  
pp. 204993611986454
Author(s):  
Samarth P. Shah ◽  
Ana Negrete ◽  
Timothy Self ◽  
Jaclyn Bergeron ◽  
Jennifer D. Twilla
Keyword(s):  
Patient Outcomes ◽  
Diabetic Foot ◽  
Hospital Admissions ◽  
Average Length ◽  
Primary Diagnosis ◽  
Antimicrobial Treatment ◽  
Optimal Route ◽  
Average Length Of Stay ◽  
Diabetic Foot Infections ◽  
Selection Of

Background: The 2012 Infectious Disease Society of America (IDSA) guidelines recommend antimicrobial treatment of diabetic foot infections (DFIs) post-amputation, but the optimal route and duration are poorly defined. Objective: The objective of this study was to determine whether the selection of a specific antimicrobial treatment modality affected hospital and patient outcomes. Methods: This was a retrospective review of hospital admissions of adults admitted to ourhealthcare system with a primary diagnosis of DFIs post-amputation. The groups were separated into patients who received intravenous antimicrobials (IV), oral antimicrobials (PO), or no antimicrobials (NA). Outcomes included average length of stay among others. Results: Of the 200 patients screened, 120 patients were included (IV n = 72; PO n = 20; NA n = 28). No statistically significant differences were identified in average LOS (IV = 9.97 ± 5.85, PO = 8.83 ± 7.37, NA = 9.33 ± 5.91 days; p = 0.73). However, post-operative (post-op) LOS was significantly shorter in the PO group (PO = 3.43 ± 2.56, IV = 7.34 ± 5.95, NA = 5.81 ± 4.18 days; p = 0.0001). Conclusion: The results of our study indicate that a PO antimicrobial treatment strategy post amputation for DFIs has the potential to decrease post-op LOS without increasing the risk of readmission. Based on the results of our study, we feel consideration should be given to transition to oral antimicrobials soon after amputation to facilitate discharge and decrease the utilization of intravenous antimicrobials.

Physician data review to reduce cost per case and ALOS.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 268-268
Author(s):  
Susan Schreiner ◽  
Theresa Franco
Keyword(s):  
Average Length ◽  
Communication Strategy ◽  
Net Income ◽  
Average Length Of Stay ◽  
Cancer Services ◽  
Reduction Methods ◽  
Critical Feedback ◽  
Reducing Costs ◽  
The Cost ◽  
Time Frames

268 Background: Reducing costs in health care is critical due to declining reimbursement. Physicians are often unaware of how their practices affect the cost of patient care and may have difficulty in making changes. The leadership of the Cancer Service Line believed a more targeted approach in sharing data would improve physician understanding and engagement to assist in greater standardization and cost reduction. Methods: An education and communication strategy was developed that involves the leadership of each specialty section of oncology. A dashboard was created with metrics such as clinic visits, surgical volume, cost per case, average length of stay, and net income. The data is presented in monthly, quarterly and annual time frames with trends to highlight progress and identify areas for improvement. Monthly meetings are conducted with key stakeholders to obtain critical feedback. Results: Consistent data has increased physician understanding of clinical businesses the business is doing and has prompted them to optimize clinical schedules and improve operational efficiencies. Outpatient and inpatient data regarding cost per case, ancillary costs, pharmaceutical usage, blood product utilization, and drug exchanges has driven practice changes. The ALOS is at almost an entire day below benchmarks and direct cost per case is at budgeted target. Standardization has occurred in the use of blood products and there has been an intentional shift of some interventions to the outpatient arena. Conclusions: The implementation of a robust education and communication strategy have resulted in active engagement and participation of physicians, significant practice changes in cancer care and heightened understanding of the relationship of practice to cost. A dashboard that trends relevant metrics shared at regular intervals with key providers impact the cost of cancer services without affecting the quality.

The Cost of Hospital Stay for Operable Breast Cancer

1992 ◽  
Vol 78 (6) ◽  
pp. 359-362 ◽  
Author(s):  
Stefano Capri ◽  
Edoardo Majno ◽  
Maurizio Mauri
Keyword(s):  
Breast Cancer ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Average Length ◽  
Operable Breast Cancer ◽  
Cost Component ◽  
Homogeneous Groups ◽  
Total Cost ◽  
Average Length Of Stay ◽  
The Cost

The cost of the first hospital stay for operable breast cancer was deducted by analysing a random sample of 100 admissions to the National Institute of Cancer during the period January-December 1989. The aims of the study were: (1) to describe and calculate the cost component of the stay; (2) to analyse whether any procedure, service rended or stage of the pathology might explain differences in the total costs of the stay; and (3) to acquire a better knowledge of the organizational aspects to be improved. With an average length of stay of 14.1 days, the overall total cost observed was 4.9 million lira (US $ 3.800, 1989 US dollars). A significant correlation between total cost and duration of stay was found (R2 = 0.982), while no or very little correlation was found between cost and the anatomical extent of disease (TNM stage) and different cost items (laboratory, imaging tests, operating room, etc.). Two homogeneous groups of cases were found: patients with quadrantectomy and patients with mastectomy. The cost of the latter was 40% greater than that of the former (P < 0.001) with a length of stay 52% longer (p < 0.001). This study does not concern the costs immediately following the stay, which namely are higher for the quadrantectomy because the radiotherapy outpatient procedures. Attention should be paid to reducing the length of stay, keeping waiting time for organizational procedures to a minimum during the stay.

Hospital Admissions for Obsessive-Compulsive Disorder in NSW, 1997 to 2010

2011 ◽  
Vol 19 (6) ◽  
pp. 502-506 ◽  
Author(s):  
Vlasios Brakoulias ◽  
Grant Sara
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Outpatient Treatment ◽  
Hospital Admissions ◽  
Average Length ◽  
Admission Rate ◽  
Primary Diagnosis ◽  
Secondary Diagnosis ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Average Length Of Stay

Objectives: To assess the characteristics of admissions to NSW hospitals with a diagnosis of obsessive-compulsive disorder (OCD). Method: Assessment of administrative data from all NSW hospital admissions from 1997 to 2010. Results: The average admission rate for a primary diagnosis of OCD was 1.5 per 100 000 population. This rate increased over the period assessed. OCD was much more common as a secondary diagnosis (6.1 per 100 000 population), often occurring with affective disorders in adults and other anxiety disorders in children. Adults admitted with OCD had an average length of stay of 24 days. Conclusions: Although hospital admissions of patients with OCD are uncommon, the high rates of comorbidity and increasing rates of admission alert us to the significance of screening patients for OCD and being able to offer outpatient treatment.

Emergency department presentation with colorectal cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15094-e15094
Author(s):  
Yasmin A. Zerhouni ◽  
Nelya Melnitchouk ◽  
Eric Schneider ◽  
Aparajita Singh
Keyword(s):  
Colorectal Cancer ◽  
Emergency Department ◽  
Average Length ◽  
Primary Diagnosis ◽  
Surgical Patients ◽  
Average Length Of Stay ◽  
The Us ◽  
Ed Visits ◽  
Index Hospital ◽  
Emergent Surgery

e15094 Background: Despite screening protocols shown to reduce mortality, colorectal cancer (CRC) remains the 2nd leading cause of cancer death in the US. CRC patients who have emergent surgery have worse outcomes than those treated electively. We examined presentation and index hospital outcomes for emergency department (ED) patients with a primary diagnosis of CRC. Methods: The 2013 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample was queried and all patients with a primary ICD-9-CM diagnosis of CRC were identified. Descriptive analyses were weighted to the level of the US population. Results: Among 134,869,015 ED visits, approximately 44,717 patients received a primary diagnosis of CRC. Patients with CRC were older (68 vs. 40 years, p < 0.001) and more likely to be male (50.4% vs. 44.3%, p < 0.001) than those presenting for other reasons. Among CRC patients, 88.6% were older than 50 years with males younger than females (66 vs. 70y, p < 0.001) and 90.4% were insured. 88.6% were admitted of whom 44% underwent oncologic resection. Females were more likely to undergo resection (47% vs.42%, p = < 0.001) and to be older at time of surgery (71 vs. 68, p = < 0.001). Average length of stay was 12.5 days for surgical vs. 6.6 days for non-surgical patients (p < 0.001). After admission, 68.0% of those admitted vs. 64.7% of patients who had surgery were discharged home. 6.9% of admitted CRC patients and 4.7% of surgical patients died in-hospital. Average total charges were $124,846 for patients undergoing resection vs. $53,542 for inpatients who did not undergo surgery (p < 0.001). Conclusions: Most patients presenting to the ED for CRC are admitted and many require surgical intervention. Because nearly 90% were 50 or older and insured, further research is warranted to determine if increased screening among eligible patients might reduce the numbers of ED presentations and emergent surgical procedures for CRC.

scholarly journals Differences in the cost of admitted patient care for Indigenous people and people from remote locations

2013 ◽  
Vol 37 (1) ◽  
pp. 26 ◽  
Author(s):  
Rosalyn Malyon ◽  
Yuejen Zhao ◽  
Brett Oates
Keyword(s):  
Indigenous People ◽  
Average Length ◽  
Diagnosis Related Groups ◽  
Multivariate Regression Analysis ◽  
Public Hospitals ◽  
Payment Systems ◽  
Remote Areas ◽  
Remote Locations ◽  
Average Length Of Stay ◽  
The Cost

The introduction of activity-based funding (ABF) means that Australian Refined Diagnosis Related Groups and their relative costs will become the basis for reimbursing public hospitals for admitted patient services. This study sought to investigate the variation in admitted patient costs for Indigenous people and people from remote areas that cannot be explained by variation in the clinical mix of cases, and to interpret this variation within an ABF framework. The study used a dataset of discharges from public hospitals of Northern Territory residents between July 2007 and June 2009. Multivariate regression analysis was used to estimate the variation in average costs, using the logarithm of patient cost as the dependent variable and Major Diagnostic Categories (MDCs), hospitals and population subgroups (Indigenous v. non-Indigenous; urban v. remote) as independent variables. Although much of the additional cost of Indigenous and remote patients was found to be due to differences in severity and complexity between MDCs, there were extra costs for remote Indigenous patients that were not captured by the classification system. Hospitals servicing larger than average proportions of these patients could be systematically underfunded within an ABF framework unless a price adjustment is applied. What is known about the topic? Indigenous people and people living in remote locations have a greater burden of disease and injury and are high users of hospital services. Past studies have quantified the relative cost of providing admitted patient services to these groups using survey data or the average length of stay as a proxy for cost. What does this paper add? This study provides estimates of the additional costs of providing admitted patient services to Indigenous people and people from remote areas and interprets these within an activity-based funding framework. What are the implications for practitioners? This paper provides information on the importance of recognising high cost populations in payment systems for public hospitals.

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