The value of advance care planning (ACP) in cancer critical care.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 109-109
Author(s):  
Diane G. Portman ◽  
Jeffrey E. Lancet ◽  
Hugo Francisco Fernandez
Keyword(s):  
Critical Care ◽  
Cost Savings ◽  
Living Will ◽  
Marrow Transplant ◽  
Cost Of Care ◽  
Potential Cost ◽  
Icu Patients ◽  
Specific Data ◽  
Advance Care ◽  
Critical Patients

109 Background: Findings from previous research on the effect of advance directives (ADs) on patient outcomes have been mixed and are limited in the oncology population. A palliative care project in our Cancer Center’s ICU revealed patients with long length of stay (LOS) and ICU death without ADs in place. The Center’s Bone Marrow Transplant (BMT) program has implemented a protocol to obtain ADs pre-transplant. We sought to determine the presence and effect of ADs on end-of-life cost of care (COC) and LOS in critical care patients at our Center. Methods: We compared the 2013 COC and LOS of all ICU patients to the subset of patients for whom ICU care proved futile. The presence of ADs and DNR orders for expired ICU patients were matched to their respective COC and LOS. The COC of floor and ICU care were compared to determine potential cost savings from ICU avoidance. BMT-specific data was reviewed to establish the effect of early ADs on care and LOS. Results: Floor care proved to cost on average $2,000 less per day than ICU care. Thirty-eight percent of ICU patients had ADs. Only 41% of patients who expired in the ICU had an AD. If an AD was present, it was most likely to be a Living Will (LW) with DNR. The daily COC was highest for patients without ADs and lowest for those with LWs with DNR, despite a longer LOS in the LW/DNR group. In the BMT group, AD prevalence was 83% and resulted in earlier discussions about futility and shorter LOS. Conclusions: Obtaining timely ADs with DNR is likely to result in the lowest daily COC for critical patients. The greatest savings is likely to result from early ACP and ICU avoidance. Further study is needed to understand and overcome barriers to timely ACP implementation.

Intensive Care Nurses’ Views and Practices for Eye Care: An International Comparison

2016 ◽  
Vol 26 (4) ◽  
pp. 504-524 ◽  
Author(s):  
Elem Kocaçal Güler ◽  
İsmet Eşer ◽  
Imad Hussein Deeb Fashafsheh
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Normal Saline ◽  
Descriptive Study ◽  
Sterile Water ◽  
Eye Care ◽  
Icu Patients ◽  
Intensive Care Nurses ◽  
Critical Patients

Eye care is an important area of critical care. However, lack of eye care studies is a common issue across the globe. The aim of this study is to determine the views and practices of intensive care unit (ICU) nurses on eye care in Turkey and Palestine. This descriptive study was conducted using a self-administrated questionnaire. The data were collected from 111 nurses in nine kinds of ICUs in two education hospital. Normal saline (75.9%) was the most commonly reported solution for eye hygiene among the Palestinian nurses, and gauze soaked in normal saline or sterile water (64.3%) were the most frequently used supplies by the Turkish nurses. Although both Palestinian and Turkish ICU nurses took some precautions to prevent eye complications in critical patients, there were some gaps and insufficiencies in the eye care of ICU patients. There is a need for continuing training in this area.

scholarly journals Healthcare providers’ perception of advance care planning for patients with critical illnesses in acute-care hospitals: a cross-sectional study

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Kanako Yamamoto ◽  
Yuki Yonekura ◽  
Kazuhiro Nakayama
Keyword(s):  
Critical Care ◽  
Acute Care ◽  
Healthcare Providers ◽  
Acute Care Hospitals ◽  
Cross Sectional Study ◽  
Decision Making Process ◽  
Sectional Study ◽  
Cross Sectional ◽  
Icu Patients ◽  
Advance Care

Abstract Background In acute-care hospitals, patients treated in an ICU for surgical reasons or sudden deterioration are treated in an outpatient ward, ICU, and other multiple departments. It is unclear how healthcare providers are initiating advance care planning (ACP) for such patients and assisting them with it. The purpose of this study is to clarify healthcare providers’ perceptions of the ACP support provided to patients receiving critical care in acute-care hospitals. Methods A cross-sectional study was conducted using questionnaires. In this study, 400 acute-care hospitals with ICUs in Japan were randomly selected, and 1490 subjects, including intensivists, surgeons, ICU nurses, surgical floor nurses, and surgical outpatient nurses, participated. Survey items examined whether ICU patients received ACP support, the participants’ degree of confidence in providing ACP support, the patients’ treatment preferences, and the decision-making process, and whether any discussion was conducted on change of values. Results Responses were obtained from 598 participants from 157 hospitals, 41.4% of which reportedly supported ACP provision to ICU patients. The subjects with the highest level of ACP understanding were surgeons (45.8%), and differences in understanding were observed across specialties (P < 0.001). Among the respondents, physicians and nurses expressed high levels of confidence in providing ACP support to patients requiring critical care. However, 15.2% of all the subjects mentioned that they would not attempt to resuscitate the patients. In addition, 25.7% of the participants handed over patients’ values to other departments or hospitals, whereas 25.3% handed over the decision-making process. Conclusions Among the participating hospitals, 40% provided ACP support to patients receiving critical care. The low number is possibly because support providers lack understanding of the content of patients’ ACP or about how to support and use ACP. Second, it is sometimes too late to start providing ACP support after ICU admission. Third, healthcare providers differ in their perception of ACP, widely considered an ambiguous concept. Finally, in acute-care hospitals with different healthcare settings, it is necessary to confirm and integrate the changes in feelings and thoughts of patients.

Retrospective Quality Improvement Study of Insulin-Induced Hypoglycemia and Implementation of Hospital-Wide Initiatives

2021 ◽  
pp. 193229682110085
Author(s):  
Carter Shelton ◽  
Andrew P. Demidowich ◽  
Mahsa Motevalli ◽  
Sam Sokolinsky ◽  
Periwinkle MacKay ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Community Hospital ◽  
Statistical Significance ◽  
Hospital Setting ◽  
Cost Savings ◽  
Cost Of Care ◽  
Potential Cost ◽  
Increased Risk ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

Background: Hospitalized patients who are receiving antihyperglycemic agents are at increased risk for hypoglycemia. Inpatient hypoglycemia may lead to increased risk for morbidity, mortality, prolonged hospitalization, and readmission within 30 days of discharge, which in turn may lead to increased costs. Hospital-wide initiatives targeting hypoglycemia are known to be beneficial; however, their impact on patient care and economic measures in community nonteaching hospitals are unknown. Methods: This retrospective quality improvement study examined the effects of hospital-wide hypoglycemia initiatives on the rates of insulin-induced hypoglycemia in a community hospital setting from January 1, 2016, until September 30, 2019. The potential cost of care savings has been calculated. Results: Among 49 315 total patient days, 2682 days had an instance of hypoglycemia (5.4%). Mean ± SD hypoglycemic patient days/month was 59.6 ± 16.0. The frequency of hypoglycemia significantly decreased from 7.5% in January 2016 to 3.9% in September 2019 ( P = .001). Patients with type 2 diabetes demonstrated a significant decrease in the frequency of hypoglycemia (7.4%-3.8%; P < .0001), while among patients with type 1 diabetes the frequency trended downwards but did not reach statistical significance (18.5%-18.0%; P = 0.08). Based on the reduction of hypoglycemia rates, the hospital had an estimated cost of care savings of $98 635 during the study period. Conclusions: In a community hospital setting, implementation of hospital-wide initiatives targeting hypoglycemia resulted in a significant and sustainable decrease in the rate of insulin-induced hypoglycemia. These high-leverage risk reduction strategies may be translated into considerable cost savings and could be implemented at other community hospitals.

Changing the Care Paradigm for Patients: Advanced Illness Beds Care Model

2020 ◽  
pp. 104990912098438
Author(s):  
Alexander Rimar ◽  
M. Isabel Friedman ◽  
Maria G. Quinteros ◽  
Rebecca A. Gooch ◽  
Kevin D. Masick ◽  
...  
Keyword(s):  
Critical Care ◽  
Cost Savings ◽  
Cost Of Care ◽  
Care Model ◽  
Advanced Illness ◽  
Critical Care Units ◽  
Efficient Resource ◽  
Specialized Care ◽  
Aggressive Interventions ◽  
The Impact

Background: Over 90 million Americans suffer from advanced illness (AI) and spend their last days of life in critical care units receiving costly, unwanted, aggressive medical care. Objective: Evaluate the impact of a specialized care model in medical/surgical units for hospitalized geriatric patients and patients with complex care requirements where designated AI beds align care with patient’s wishes/goals, minimize aggressive interventions, and influence efficient resource utilization. Design: US based multi-facility retrospective, longitudinal descriptive study of screened positive AI patients in AI Beds (N = 1,237) from 3 facilities from 2015 to 2017. Results: Patient outcomes included 60% referrals to AI beds from ICU, a decrease of 39-49% in average ICU LOS, a 23% reduction of AI bed patient expirations, 9.0% referrals to hospice, and projected cost savings of $4,361.66/patient, US dollars. Conclusion: Allocating AI beds to deliver care to AI patients resulted in a decreased cost of care by reducing overall hospital LOS, mortality, and efficient use of both critical care and hospital resources.

617 Changing Onboarding to Increase Retention

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S153-S154
Author(s):  
Melanie R Ladwig
Keyword(s):  
Critical Care ◽  
Learning Style ◽  
Time Management ◽  
Cost Savings ◽  
Management Skills ◽  
Potential Cost ◽  
In Situ Simulation ◽  
Burn Care ◽  
Burn Unit ◽  
Critical Care Management

Abstract Introduction Faced with some failed orientations and an increase in turnover, the Burn unit decided to change our orientation plan. There were 4 RNs who left or failed orientation in a period of a few months. The help of our practice council and feedback from preceptors was enlisted. In addition, the ABA Nursing Competencies were incorporated to revamp the orientation program. Most RNs onboarding to burn are not critical care RNs upon hire and therefore required an improved pathway to orient them to the burn care as well as critical care management. Methods Typical orientation started in the ICU. However, feedback following our traditional path led to specific changes based on the need to emphasize a sense of community as well as integrate specific time management skills particular to burn care. Orienting burn nurses now spend 12 shifts in the burn unit, 24–30 in the ICU, and then another 12–18 in the Burn unit. In addition, the staff taught Burn Care Principles course was restructured by practice council members and educators to focus on a case study-based learning style to emphasize important aspects of burn care. An in-situ simulation component to the Burn Care principles course was added to further solidify their learning. The competency tools used in orientation were changed to incorporate the American Burn Association Nurse competencies. Results Turnover was decreased from 33% (2017–2018) to 7.7% (2019). Preceptors and new RNs state they felt much more competent to begin their journey as a burn RNs the potential cost savings related to decreasing turnover would be well over $75,000. Conclusions The interventions made were staff driven by the orientees and preceptors, the practice council, and staff on the unit. the change in orientation allowed for less extensions and more successes. Burn RNs were more confident and less overwhelmed during their orientation. The team morale improved with their involvement with the process which was an added win. Applicability of Research to Practice This process needs to be followed so be able to ascertain if there will be lasting effects to retention.

Integrated Tubulars Supply Model Provides Cost Savings to Drilling Projects

2020 ◽  
Author(s):  
M. Hamzah
Keyword(s):  
Supply Chain ◽  
Cost Savings ◽  
Asia Pacific ◽  
Potential Cost ◽  
Alternative Scheme ◽  
Safety Stocks ◽  
Storage Location ◽  
Supply Planning ◽  
Drilling Site ◽  
Drilling Project

Classical Oil Country Tubular Goods (OCTG) procurement approach has been practiced in the indus-try with the typical process of setting a quantity level of tubulars ahead of the drilling project, includ-ing contingencies, and delivery to a storage location close to the drilling site. The total cost of owner-ship for a drilling campaign can be reduced in the range of 10-30% related to tubulars across the en-tire supply chain. In recent decades, the strategy of OCTG supply has seen an improvement resulting in significant cost savings by employing the integrated tubular supply chain management. Such method integrates the demand and supply planning of OCTG of several wells in a drilling project and synergize the infor-mation between the pipes manufacturer and drilling operators to optimize the deliveries, minimizing inventory levels and safety stocks. While the capital cost of carrying the inventory of OCTG can be reduced by avoiding the procurement of substantial volume upfront for the entire project, several hidden costs by carrying this inventory can also be minimized. These include storage costs, maintenance costs, and costs associated to stock obsolescence. Digital technologies also simplify the tasks related to the traceability of the tubulars since the release of the pipes from the manufacturing facility to the rig floor. Health, Safety, and Environmental (HSE) risks associated to pipe movements on the rig can be minimized. Pipe-by-pipe traceability provides pipes’ history and their properties on demand. Digitalization of the process has proven to simplify back end administrative tasks. The paper reviews the OCTG supply methods and lays out tangible improvement factors by employ-ing an alternative scheme as discussed in the paper. It also provides an insight on potential cost savings based on the observed and calculated experiences from several operations in the Asia Pacific region.

Improved Oxygen Dissolution Control for Oxygen Activated Sludge

1988 ◽  
Vol 20 (4-5) ◽  
pp. 101-108 ◽  
Author(s):  
R. C. Clifft ◽  
M. T. Garrett
Keyword(s):  
Activated Sludge ◽  
Control Method ◽  
Control Strategies ◽  
Cost Savings ◽  
Utilization Efficiency ◽  
Oxygen Production ◽  
Oxygen Utilization ◽  
Potential Cost ◽  
Oxygen Dissolution ◽  
The City

Now that oxygen production facilities can be controlled to match the requirements of the dissolution system, improved oxygen dissolution control can result in significant cost savings for oxygen activated sludge plants. This paper examines the potential cost savings of the vacuum exhaust control (VEC) strategy for the City of Houston, Texas 69th Street Treatment Complex. The VEC strategy involves operating a closed-tank reactor slightly below atmospheric pressure and using an exhaust apparatus to remove gas from the last stage of the reactor. Computer simulations for one carbonaceous reactor at the 69th Street Complex are presented for the VEC and conventional control strategies. At 80% of design loading the VEC strategy was found to provide an oxygen utilization efficiency of 94.9% as compared to 77.0% for the conventional control method. At design capacity the oxygen utilization efficiency for VEC and conventional control was found to be 92.3% and 79.5%, respectively. Based on the expected turn-down capability of Houston's oxygen production faciilities, the simulations indicate that the VEC strategy will more than double the possible cost savings of the conventional control method.

Cost-minimization analysis of drugs used in the treatment of Asthma and COPD diseases in India

2020 ◽  
Vol 15 ◽  
Author(s):  
Billu Payal ◽  
Anoop Kumar ◽  
Harsh Saxena
Keyword(s):  
Generic Drugs ◽  
Cost Minimization ◽  
Cost Savings ◽  
Chronic Obstructive ◽  
Pulmonary Medicine ◽  
Potential Cost ◽  
Maximum Cost ◽  
Cost Minimization Analysis ◽  
Cost Variation ◽  
The Cost

Background: Asthma and Chronic Obstructive Pulmonary Diseases (COPD) are well known respiratory diseases affecting millions of peoples in India. In the market, various branded generics, as well as generic drugs, are available for their treatment and how much cost will be saved by utilizing generic medicine is still unclear among physicians. Thus, the main aim of the current investigation was to perform cost-minimization analysis of generic versus branded generic (high and low expensive) drugs and branded generic (high expensive) versus branded generic (least expensive) used in the Department of Pulmonary Medicine of Era Medical University, Lucknow for the treatment of asthma and COPD. Methodology: The current index of medical stores (CIMS) was referred for the cost of branded drugs whereas the cost of generic drugs was taken from Jan Aushadi scheme of India 2016. The percentage of cost variation particularly to Asthma and COPD regimens on substituting available generic drugs was calculated using standard formula and costs were presented in Indian Rupees (as of 2019). Results: The maximum cost variation was found between the respules budesonide high expensive branded generic versus least expensive branded generic drugs and generic versus high expensive branded generic. In combination, the maximum cost variation was observed in the montelukast and levocetirizine combination. Conclusion: In conclusion, this study inferred that substituting generic antiasthmatics and COPD drugs can bring potential cost savings in patients.

Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

2021 ◽  
pp. 193229682110025
Author(s):  
Urooj Najmi ◽  
Waqas Zia Haque ◽  
Umair Ansari ◽  
Eyerusalem Yemane ◽  
Lee Ann Alexander ◽  
...  
Keyword(s):  
Insulin Aspart ◽  
Community Hospital ◽  
Task Force ◽  
Hospital Setting ◽  
Cost Savings ◽  
Self Management ◽  
Self Administration ◽  
Potential Cost ◽  
Hospital Leadership ◽  
Insulin Pens

Background: Insulin pen injectors (“pens”) are intended to facilitate a patient’s self-administration of insulin and can be used in hospitalized patients as a learning opportunity. Unnecessary or duplicate dispensation of insulin pens is associated with increased healthcare costs. Methods: Inpatient dispensation of insulin pens in a 240-bed community hospital between July 2018 and July 2019 was analyzed. We calculated the percentage of insulin pens unnecessarily dispensed for patients who had the same type of insulin pen assigned. The estimated cost of insulin pen waste was calculated. A pharmacist-led task force group implemented hospital-wide awareness and collaborated with hospital leadership to define goals and interventions. Results: 9516 insulin pens were dispensed to 3121 patients. Of the pens dispensed, 6451 (68%) were insulin aspart and 3065 (32%) were glargine. Among patients on insulin aspart, an average of 2.2 aspart pens was dispensed per patient, but only an estimated 1.2 pens/patient were deemed necessary. Similarly, for inpatients prescribed glargine, an average of 2.1 pens/patient was dispensed, but only 1.3 pens/patient were necessary. A number of gaps were identified and interventions were undertaken to reduce insulin pen waste, which resulted in a significant decrease in both aspart (p = 0.0002) and glargine (p = 0.0005) pens/patient over time. Reductions in pen waste resulted in an estimated cost savings of $66 261 per year. Conclusions: In a community hospital setting, identification of causes leading to unnecessary insulin dispensation and implementation of hospital-wide staff education led to change in insulin pen dispensation practice. These changes translated into considerable cost savings and facilitated diabetes self-management education.

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