Solo Hand Surgery

Unassisted hand surgery is being undertaken by necessity for both elective and emergency cases, due to hospital resource restrictions. The authors outline the principles of local anesthesia, surgeon-controlled tourniquet techniques, and a number of new instruments which allow a surgeon to work in comfort and safety, unassisted. The traditional surgical instruments designed for the days when trained surgical assistants were available to hold them are no longer suitable. We are entering a new era of surgical design with safer instruments that can complement our skills rather than challenge them. There are significant cost savings and efficiency when hand procedures are undertaken in the emergency and outpatient clinic settings.

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Abstract #806812: Endocrinology E-Consults Improve Patient Access to Care While Providing Significant Cost Savings

Endocrine Practice ◽

10.1016/s1530-891x(20)39740-8 ◽

2020 ◽

Vol 26 ◽

pp. 192-193

Author(s):

Krystel Feghali

Keyword(s):

Access To Care ◽

Cost Savings ◽

Patient Access ◽

Significant Cost ◽

Improve Patient

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Gamma-Irradiated Cornea in Combat-related Ocular Trauma

Military Medicine ◽

10.1093/milmed/usaa479 ◽

2020 ◽

Author(s):

Brian M Davis ◽

Carson Clabeaux ◽

Anton Vlasov ◽

Paul Houghtaling

Keyword(s):

Ocular Trauma ◽

Cost Savings ◽

Corneal Tissue ◽

Significant Cost ◽

Visual Rehabilitation ◽

Military Health ◽

Corneal Injury ◽

Gamma Irradiated ◽

The Military ◽

Penetrating Ocular Trauma

ABSTRACT Corneal injury is a known risk for deployed troops worldwide. To the authors’ knowledge, there has been no reported use of gamma-irradiated corneas in the setting of severe corneal trauma. Our report highlights the case of a 36-year-old active duty solider who sustained bilateral penetrating ocular trauma from a nearby ordnance explosion. We propose that ocular surgeons should consider utilizing gamma-irradiated corneas in (1) a situation where the corneal tissue is so damaged that it would be challenging to accomplish an adequate repair while providing the opportunity for future visual rehabilitation and (2) remote and/or deployed environments where storage of fresh donor tissue is limited. The long shelf life of gamma-irradiated corneas reduces the need for specialized storage equipment and the need for continuous resupply, both potentially leading to significant cost savings for the Military Health System.

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Effect of Time Interval Between Tumescent Local Anesthesia Infiltration and Start of Surgery on Operative Field Visibility in Hand Surgery Without Tourniquet

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2015.03.034 ◽

2015 ◽

Vol 40 (8) ◽

pp. 1606-1609 ◽

Cited By ~ 9

Author(s):

Muhammad Mustehsan Bashir ◽

Rehan Qayyum ◽

Muhammad Hammad Saleem ◽

Kashif Siddique ◽

Farid Ahmad Khan

Keyword(s):

Local Anesthesia ◽

Hand Surgery ◽

Time Interval ◽

Operative Field ◽

Tumescent Local Anesthesia ◽

Without Tourniquet

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Implementation of a Radiology Utilization Dashboard Yields Significant Cost Savings in a Large Primary Care Network

Journal of the American College of Radiology ◽

10.1016/j.jacr.2021.02.015 ◽

2021 ◽

Author(s):

Adrian Clark-Randall ◽

David J. Halpern ◽

Janice Taylor ◽

Christopher J. Roth ◽

Rajan T. Gupta ◽

...

Keyword(s):

Primary Care ◽

Cost Savings ◽

Significant Cost ◽

Care Network ◽

Large Primary

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Open Hemorrhoidectomy With Ligasure™ Under Local or Spinal Anesthesia: A Comparative Study

The American Surgeon ◽

10.1177/00031348211038590 ◽

2021 ◽

pp. 000313482110385

Author(s):

Claudio F. Feo ◽

Chiara Ninniri ◽

Cinzia Tanda ◽

Giulia Deiana ◽

Alberto Porcu

Keyword(s):

Spinal Anesthesia ◽

Operating Room ◽

Local Anesthesia ◽

Outpatient Clinic ◽

Perioperative Complications ◽

Study Groups ◽

Reoperation Rate ◽

Hyperbaric Bupivacaine ◽

Open Hemorrhoidectomy ◽

American Society

Background There is increasing evidence that many anorectal surgical procedures may be performed under local anesthesia. The aim of the present study was to evaluate the safety and efficacy of local anesthesia in the outpatient clinic vs spinal anesthesia in the operating room for open hemorrhoidectomy. Methods Sixty-two patients with grade III or IV hemorrhoids underwent open hemorrhoidectomy with LigaSure™ between 2018 and 2020. Of them, 32 procedures were performed in the operating room under spinal anesthesia with hyperbaric bupivacaine and other 30 procedures were undertaken in the outpatient clinic under local anesthesia with ropivacaine. Results There were no significant differences regarding age, gender, American Society of Anesthesiologists class, and Goligher’s grade in between groups. No significant differences were observed in postoperative pain score (P = .85), perioperative complications (P = .51), and reoperation rate (P = .96). No recurrences and no differences in patients’ satisfaction degree (P = .76) were documented at long-term follow-up in both study groups. Discussion Our results suggest that open hemorrhoidectomy with LigaSure™ performed in selected patients under local anesthesia in the outpatient clinic is a well-tolerated, safe, and effective procedure.

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The Value of Clinical Teachers for EMR Implementations and Conversions

Applied Clinical Informatics ◽

10.4338/aci-2014-09-ie-0075 ◽

2015 ◽

Vol 06 (01) ◽

pp. 75-79 ◽

Cited By ~ 9

Author(s):

J.L. Pantaleoni ◽

C.A. Longhurst ◽

L.A. Stevens

Keyword(s):

Medical Students ◽

Training Program ◽

Cost Savings ◽

Learner Satisfaction ◽

Physician Training ◽

Significant Cost ◽

Clinical Teachers ◽

Essential Aspect ◽

Satisfaction Rates ◽

High Learner

SummaryEffective physician training is an essential aspect of EMR implementation. However, it can be challenging to find instructors who can present the material in a clinically relevant manner. The authors describe a unique physician-training program, utilizing medical students as course instructors. This approach resulted in high learner satisfaction rates and provided significant cost-savings compared to alternative options.Citation: Stevens LA, Pantaleoni JL, Longhurst CA. The value of clinical teachers for EMR implementations and conversions. Appl Clin Inf 2015; 6: 75–79http://dx.doi.org/10.4338/ACI-2014-09-IE-0075

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Surgical instrumentation: the true cost of instrument trays and a potential strategy for optimization

Journal of Hospital Administration ◽

10.5430/jha.v4n6p82 ◽

2015 ◽

Vol 4 (6) ◽

pp. 82 ◽

Cited By ~ 6

Author(s):

Julie M. Mhlaba ◽

Emily W. Stockert ◽

Martin Coronel ◽

Alexander J. Langerman

Keyword(s):

United States ◽

Cost Savings ◽

Cost Effective ◽

The United States ◽

Waste Reduction ◽

Significant Cost ◽

Instrument Type ◽

Hospital Revenue ◽

Potential Strategy ◽

The Cost

Objective: Operating rooms (OR) generate a large portion of hospital revenue and waste. Consequently, improving efficiency and reducing waste is a high priority. Our objective was to quantify waste associated with opened but unused instruments from trays and to compare this with the cost of individually wrapping instruments.Methods: Data was collected from June to November of 2013 in a 550-bed hospital in the United States. We recorded the instrument usage of two commonly-used trays for ten cases each. The time to decontaminate and reassemble instrument trays and peel packs was measured, and the cost to reprocess one instrument was calculated.Results: Average utilization was 14% for the Plastic Soft Tissue Tray and 29% for the Major Laparotomy Tray. Of 98 instruments in the Plastics tray (n = 10), 0% was used in all cases observed and 59% were used in no observed cases. Of 110 instruments in the Major Tray (n = 10), 0% was used in all cases observed and 25% were used in no observed cases. Average cost to reprocess one instrument was $0.34-$0.47 in a tray and $0.81-$0.84 in a peel pack, or individually-wrapped instrument.Conclusions: We estimate that the cost of peel packing an instrument is roughly two times the cost of tray packing. Therefore, it becomes more cost effective from a processing standpoint to package an instrument in a peel pack when there is less than a 42%-56% probability of use depending on instrument type. This study demonstrates an opportunity for reorganization of instrument delivery that could result in a significant cost-savings and waste reduction.

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Progressive Collapse Approach Compared to the Traditional Temperature Screening on Structural Assessment of Offshore Structures Against Fire

Volume 3: Structures, Safety and Reliability ◽

10.1115/omae2016-54923 ◽

2016 ◽

Author(s):

Paula T. Nascimento ◽

Marco A. P. Rosas ◽

Leonardo Brandão ◽

Fernando Castanheira

Keyword(s):

Traditional Approach ◽

Progressive Collapse ◽

Screening Method ◽

Substantial Reduction ◽

Cost Savings ◽

Offshore Structures ◽

Significant Cost ◽

Fire Scenarios

The present study compares the progressive collapse approach with the traditional temperature screening method on determination of PFP requirements at topside offshore structures. The advantage to evaluate the consequences of fire scenarios on the global integrity and stability of topside modules can be revealed by a substantial reduction of the required amount of PFP, and consequently significant cost savings for operators, when compared to the traditional approach. In the case study presented in this paper, there is a reduction of 79% in PFP allocation.

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