Optimizing surgical instrument sets for cases involving breast and plastic surgeons.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 33-33
Author(s):  
Abigail Suzanne Caudle ◽  
Jason B. Fleming ◽  
Brian M Garcia ◽  
Marina Lozano ◽  
Darryl Rigby ◽  
...  
Keyword(s):  
Cancer Care ◽  
Breast Surgery ◽  
Cost Savings ◽  
High Volume ◽  
Median Number ◽  
Surgical Instrument ◽  
Independent Observer ◽  
Set Up ◽  
Instrument Processing ◽  
Standard Sets

33 Background: Processing operative instrumemt sets is a major cost for surgical cancer care. Optimizing standard sets requires availability of instruments reflecting varied surgeon preferences while minimizing unnecessary instruments. Additionally, increasing utilization of oncoplastic reconstruction after mastectomy and lumpectomy requiring breast and plastic surgery sets further expands the number of instruments required. The goal of our study was to optimize standard sets used for cases combining breast and plastic surgeons and to determine cost savings Methods: Baseline data was recorded over a 2 week period (13 cases) including number of instruments available and number unused for non- flap breast-plastics combo (BPC) cases. An independent observer timed instrument set-up times. 22 breast and 14 plastic surgeons were polled for their requested instruments for designated cases. A BPC set was designed based on this data and reviewed with surgeons to update preference cards. After a 6 week implamentation/education period, repeat data was recorded (18 cases). Cost of instrument processing was based on labor and supply cost of $0.22/instrument. Results: Two breast surgery sets (65 and 97 instruments) and one plastics set ( 93 instruments) were used at baseline. The median number of available instrumeets was 172.5/case, with median 126.5 instruments unused. A mean of 3.8 separately packaged instruments were required per case with mean set-up time of 4m46s. The new BPC set contains 103 instruments. A median of 106.5 instruments were available after implementation. The median number of unused was reduced by 53% to 59.5, with a drop in number of separately processed instruments to 2.5. Mean set-up time was reduced to 2m16s. Reducing the size of of standard sets reduced processing costs by $12.10 or $19.14/case (depending on the breast set used for comparison). Combining sets resulted in an additional cost savings of $6.56/case by reducing extra packaging costs. Conclusions: combining breast and plastic sets and eliminating unnecessary instruments resulted in cost savings of $18.66-$25.70/case. It also reduced OR instrument set-up time by 2.5 minutes/case which has significant impact at high volume centers.

scholarly journals Predictors of Urgent Cancer Care Clinic and Emergency Department Visits for Individuals Diagnosed with Cancer

2021 ◽  
Vol 28 (3) ◽  
pp. 1773-1789
Author(s):  
Kathleen Decker ◽  
Pascal Lambert ◽  
Katie Galloway ◽  
Oliver Bucher ◽  
Marshall Pitz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mixed Models ◽  
Cancer Care ◽  
Median Number ◽  
Emergency Department Visits ◽  
Planning Service ◽  
Care Clinic ◽  
Future Studies ◽  
Acute Complications ◽  
Ed Visits

In 2013, CancerCare Manitoba (CCMB) launched an urgent cancer care clinic (UCC) to meet the needs of individuals diagnosed with cancer experiencing acute complications of cancer or its treatment. This retrospective cohort study compared the characteristics of individuals diagnosed with cancer that visited the UCC to those who visited an emergency department (ED) and determined predictors of use. Multivariable logistic mixed models were run to predict an individual’s likelihood of visiting the UCC or an ED. Scaled Brier scores were calculated to determine how greatly each predictor impacted UCC or ED use. We found that UCC visits increased up to 4 months after eligibility to visit and then decreased. ED visits were highest immediately after eligibility and then decreased. The median number of hours between triage and discharge was 2 h for UCC visits and 9 h for ED visits. Chemotherapy had the strongest association with UCC visits, whereas ED visits prior to diagnosis had the strongest association with ED visits. Variables related to socioeconomic status were less strongly associated with UCC or ED visits. Future studies would be beneficial to planning service delivery and improving clinical outcomes and patient satisfaction.

scholarly journals HL7 Terminology Management for Disease Surveillance

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Emily Roberts ◽  
Theron Jeppson ◽  
Rachelle Boulton ◽  
Josh Ridderhoff
Keyword(s):  
Disease Surveillance ◽  
Communicable Disease ◽  
Laboratory Data ◽  
Data Entry ◽  
High Volume ◽  
Electronic Data ◽  
Disease Surveillance System ◽  
Department Of Health ◽  
Message Structure ◽  
Set Up

Objective: The objective of this abstract is to illustrate how the Utah Department of Health processes a high volume of electronic data. We do this by translating what reporters send within an HL7 message into "epidemiologist" language for consumption into our disease surveillance system.Introduction: In 2013, the Utah Department of Health (UDOH) began working with hospital and reference laboratories to implement electronic laboratory reporting (ELR) of reportable communicable disease data. Laboratories utilize HL7 message structure and standard terminologies such as LOINC and SNOMED to send data to UDOH. These messages must be evaluated for validity, translated, and entered into Utah’s communicable disease surveillance system (UT-NEDSS), where they can be accessed by local and state investigators and epidemiologists. Despite the development and use of standardized terminologies, reporters may use different, outdated versions of these terminologies, may not use the appropriate codes, or may send local, home-grown terminologies. These variations cause problems when trying to interpret test results and automate data processing. UDOH has developed a two-step translation process that allows us to first standardize and clean incoming messages, and then translate them for consumption by UT-NEDSS. These processes allow us to efficiently manage several different terminologies and helps to standardize incoming data, maintain data quality, and streamline the data entry process.Methods: UDOH uses the Electronic Message Staging Area (EMSA) to receive ELR messages, manage terminologies such as LOINC and SNOMED, translate messages, and automatically enter laboratory data into UT-NEDSS. LOINCs and other terms, such as facility name, sent by reporting facilities in an HL7 message are considered child terms. All child terms are mapped to a master LOINC or term and each master LOINC or term is mapped to a specific value within UT-NEDSS. In EMSA, the rules engine used for automated processing of electronic data is set to run at the master level and these rules will determine how the message is processed. No rules are set up or run on child terms.Results: As of 09/20/2017, EMSA contains 2,613 unique child LOINCs that are mapped to 906 master LOINCs. Those 906 master LOINCs are mapped to 179 UT-NEDSS test types and 2003 child facility names are mapped to 1043 master facility namesConclusions: Mapping child terminologies from an HL7 message to a master vocabulary helps us to standardize incoming data, allows us to accept non-standard terminologies and correct reporting errors. Translating this data into a format that is understandable to epidemiologists and investigators enables UT-NEDSS to work effectively in identifying outbreaks and improving health outcomes. This framework is working for ELR and will continue to grow and accept more data and the different terminologies that come with that.

scholarly journals Generic drugs: international trends and policy developments in Australia

2004 ◽  
Vol 27 (1) ◽  
pp. 39 ◽  
Author(s):  
Hans Lofgren
Keyword(s):  
Generic Drugs ◽  
Cost Savings ◽  
High Volume ◽  
Third Party ◽  
Public And Private ◽  
International Trends ◽  
Speed Up ◽  
Policy Measures ◽  
Pharmaceutical Benefits Scheme

Public and private third-party payers in many countries encourage or mandate the use of generic drugs. This articleexamines the development of generics policy in Australia, against the background of a description of internationaltrends in this area, and related experiences of reference pricing programs. The Australian generics market remainsunderdeveloped due to a historical legacy of small Pharmaceutical Benefits Scheme price differentials betweenoriginator brands and generics. It is argued that policy measures open to the Australian government can be conceivedas clustering around two different approaches: incremental changes within the existing regulatory framework, or a shifttowards a high volume/low price role of generics which would speed up the delivery of substantial cost savings, andcould provide enhanced scope for the financing of new, patented drugs.

scholarly journals Is There Any Role for Super-Extended Limphadenectomy in Advanced Gastric Cancer? Results of an Observational Study from a Western High Volume Center

2019 ◽  
Vol 8 (11) ◽  
pp. 1799 ◽  
Author(s):  
Maria Bencivenga ◽  
Giuseppe Verlato ◽  
Valentina Mengardo ◽  
Lorenzo Scorsone ◽  
Michele Sacco ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Observational Study ◽  
Advanced Gastric Cancer ◽  
Cox Model ◽  
High Volume ◽  
Median Number ◽  
D3 Lymphadenectomy ◽  
High Volume Center ◽  
Gastric Cancer Patients ◽  
Risk Of Cancer

Background: Although the Japan Clinical Oncology Group (JCOG) 9501 trial did not find that prophylactic D3 lymphadenectomy led to any survival advantage over D2 lymphadenectomy, it did find that the prognosis of subserosal and N0 gastric cancer patients improved. The aim of this retrospective observational study was to compare survival after D2 or D3 lymphadenectomy in different patient subgroups. Methods: The study considered all of the patients who underwent D2 or D3 lymphadenectomy at a high-volume center in Verona (Italy) between 1992 and 2011. After excluding patients with Bormann IV or neuroendocrine tumors, early gastric cancers, or non-curative resections, the analysis involved 301 R0 patients: 100 who underwent D2, and 201 who underwent D3 lymphadenectomy. Post-operative deaths and deaths due to recurrences were considered as terminal events in the survival analysis. Results: The D2 patients were significantly older than the D3 patients at baseline (69.8 ± 2.3 vs. 62.2 ± 10.7 years). The median number of retrieved nodes was 29 (interquartile range: 24.5–39) after D2, and 43 (34–52) after D3. The five-year disease-related survival rate was similar after D2 (44%, 95% confidence interval (CI) 34–54%) and D3 (41%, 34–48%) (p = 0.766). A Cox model controlling for sex, age, tumor site, Laurén histology, and T and N stages showed that the risk of cancer-related death after D3 was similar to that recorded after D2 (hazard ratio 0.97, 95% CI 0.67–1.42). There was a significant interaction between the T status and the extension of the lymphadenectomy (p = 0.012), with the prognosis being better after D2 in T2 and T4b patients, and after D3 in T3 patients. Conclusions: The findings of this study suggest that D3 lymphadenectomy is not routinely indicated for patients with advanced gastric cancer, although differences in survival after D3 across T tiers deserve further consideration.

scholarly journals The British Association of Urological Surgeons radical cystectomy audit 2014/2015: An update on current practice, and an analysis of the effect of centre and surgeon case volume

2018 ◽  
Vol 12 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Sinan Khadhouri ◽  
Catherine Miller ◽  
Joanne Cresswell ◽  
Edward Rowe ◽  
Sarah Fowler ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Transitional Cell ◽  
High Volume ◽  
Median Number ◽  
British Association ◽  
Case Volume ◽  
Level Of Evidence ◽  
Laparoscopic Cystectomy ◽  
Open Radical Cystectomy ◽  
Muscle Invasive

Objective: The Consultant Outcomes Publication has made it mandatory to submit surgeon-level data on radical cystectomy (RC) practice in England. The current analysis describes contemporary surgical practice and compares this by surgeon and centre case volume. Materials and methods: Between 1 January 2014 and 31 December 2015, data on 3742 RCs performed by 161 surgeons over 84 centres were recorded on the British Association of Urological Surgeons audit and data platform. Centre case volumes were grouped as high (> 60), medium (30–60) and low (< 30), while surgeon case volumes were grouped as high (> 30), medium (8–30) and low (< 8). All data averages were for the combined 2-year period. Results: The median number of RCs performed was 16/surgeon and 31/centre; 45.4% of cases were performed for muscle-invasive transitional cell carcinoma (TCC). The commonest performed urinary diversion was ileal conduit (85.2%), followed by orthotopic bladder substitution (5.7%). Open radical cystectomy (ORC) was performed in 67.8%, robotically-assisted cystectomy (RARC) in 20.6% and laparoscopic cystectomy (LRC) in 9.1% of cases. RARC was more likely to be performed by high-volume surgeons and centres. The majority of patients underwent a lymph node dissection (LND), with rates varying from 79.5% to 90.3%. Reported rates of high-grade complication were generally low across all groups, suggesting under-reporting. There was a trend towards higher reported transfusion rates as centre volumes decreased. The median length of stay (LOS) was 7–9 days for minimally invasive approaches compared to open surgery, which was 11–12 days. Mortality rates were low across all groups. Conclusions: Compliance with the data registry is high. ORC remains the most common approach. High-case volume surgeons and centres more commonly offer RARC. The majority of patients undergo LND. There is a trend towards higher reported rates of transfusion as centre volume decreases. LOS is shorter in RARC and LRC in comparison to ORC, but is otherwise similar across centres and surgeons. Level of evidence: 2b

scholarly journals Timeliness of cancer care in a regional Victorian health service: A comparison of high‐volume (Lung) and low‐volume (oesophagogastric) tumour streams

2020 ◽  
Author(s):  
Mwila Kabwe ◽  
Amanda Robinson ◽  
Yachna Shethia ◽  
Carol Parker ◽  
Robert Blum ◽  
...  
Keyword(s):  
Health Service ◽  
Cancer Care ◽  
High Volume ◽  
Low Volume

scholarly journals Setting up an arthroplasty care practitioner-led virtual clinic for follow-up of orthopaedic patients

2019 ◽  
Vol 28 (20) ◽  
pp. 1326-1330 ◽  
Author(s):  
Sharon Ferdinandus ◽  
Lindsay K Smith ◽  
Hemant Pandit ◽  
Martin H Stone
Keyword(s):  
Patient Satisfaction ◽  
Teaching Hospital ◽  
Waiting Times ◽  
Cost Savings ◽  
University Teaching ◽  
Local Hospital ◽  
X Ray ◽  
Orthopaedic Patients ◽  
Set Up

This article provides an overview of the set up for an arthroplasty care practitioner (ACP)-led virtual orthopaedic clinic (VOC). Suitable patients attend a local hospital for an X-ray and complete a questionnaire, but do not physically attend a clinic. This has been running successfully in a university teaching hospital and has led to cost savings, a reduction in outpatient waiting times and high levels of patient satisfaction. Similar clinics have the potential to become normal practice across the NHS. This article outlines the steps necessary to implement a successful VOC. The lessons learnt during this exercise may be useful for other ACPs when setting up a VOC.

scholarly journals Cost Savings Analysis of Individualized Exercise Oncology Programs

2019 ◽  
Vol 18 ◽  
pp. 153473541983946 ◽  
Author(s):  
Karen Y. Wonders ◽  
Rob Wise ◽  
Danielle Ondreka ◽  
Josh Gratsch
Keyword(s):  
Cancer Care ◽  
Cost Savings ◽  
Length Of Hospital Stay ◽  
Standard Of Care ◽  
National Standard ◽  
Cost Burden ◽  
Post Intervention ◽  
Before And After ◽  
The Impact ◽  
Exercise Oncology

Background: The physical and economic toll of cancer make it a high health priority. The rising cost of cancer care is now a primary focus for patients, payers, and providers. Escalating costs of clinical trials and national drug regulations have led the median monthly costs of cancer drugs to rise from less than $100 in 1965 to 1969, to more than $5000 in 2005 to 2009, stressing the importance of finding innovative ways to reduce cost burden. In the present study, we report the economic evaluation of an individualized exercise oncology program beginning early after diagnosis. Methods: An independent research group, ASCEND Innovations, retrospectively analyzed patient records to statistically demonstrate the impact of exercise oncology during cancer treatment. All patients completed 12 weeks of prescribed, individualized exercise that included cardiovascular, strength training, and flexibility components. The 3 primary hospital measures leveraged for statistical comparison before and after supportive care enrollment were number of encounters, number of readmissions, and average total charges, as well as emergency room visits and length of hospital stay ( P < .05). Results: The resulting dataset consisted of 1493 total hospital encounters for 147 unique patients. The results statistically demonstrate a positive effect of exercise oncology during cancer care, in terms of reductions in overall cost per patient pre- to post-intervention. Conclusions: Individualized exercise oncology programs should be employed as part of the national standard of care for individuals battling cancer, in order to improve patient outcome and reduce cost burden.

Adaptive-predictive organ localization (a-POLO) in the clinic: Updated results in hypofractionated bladder radiotherapy.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 282-282
Author(s):  
F. McDonald ◽  
S. Lalondrelle ◽  
H. Taylor ◽  
V. Harris ◽  
V. Hansen ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Cone Beam Ct ◽  
Outcome Data ◽  
Target Coverage ◽  
Independent Observer ◽  
Distant Relapse ◽  
Plan Selection ◽  
The Mean ◽  
Set Up ◽  
Muscle Invasive

282 Background: The A-POLO strategy allows the optimal 'plan of the day' to be selected online for radiotherapy (RT) delivery. The methodology is implemented in a phase II study of patients with muscle-invasive bladder cancer who are not suitable for cystectomy/daily RT and are receiving hypofractionated RT. Methods: Planning scans were performed at 0 and 30 minutes post void (CT0 and CT30). Three conformal plans were created (small, intermediate, large) ( Table ). Patients were prescribed 6Gy weekly for 5–6 weeks. A pre-RT cone beam CT (CBCT) scan and online set-up correction were performed. The plan giving the optimal target coverage was selected by 2 observers. Offline plan selection was also carried out by an independent observer. A post-RT CBCT was acquired to calculate the percentage of the CTV covered by 95% of the dose (V95). The mean A- POLO volume was compared to our previous institutional standard PTV (1.5cm isotropic margins) (PTViso). Outcome data were collected. Results: A total of 77 RT fractions were delivered to 14 patients. The small plan was delivered for 38 (49%) fractions and the large for 6 (8%) fractions. The concordance rate between online and offline plan selection was 71/77 (92%). The mean CTV V95 was 99% (patient mean range 97–100%). The mean time between the pre- and post-treatment CBCT was 15 minutes. The mean reduction between PTViso and mean A-POLO PTV was 42% (range 16– 59%). 2 patients had grade (G) 3 (CTCv3.0) treatment-related acute toxicity. There have been no treatment-related G4 acute or G3 late toxicities. With a median follow-up of 7.3 months 10 patients are alive with 8 disease free (1 local and 1 distant relapse). Conclusions: Implementation of A-POLO RT is feasible, well tolerated, and associated with good concordance in 'plan of the day' selection. An individualized treatment plan can be delivered with each fraction to achieve a reduction in PTV compared to PTViso with maintenance of target coverage. [Table: see text] No significant financial relationships to disclose.

Creating an online resource providing hospital cancer surgery volumes in California.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 172-172
Author(s):  
Christina A Clarke ◽  
Laurence C Baker ◽  
Jennifer Malin ◽  
Joseph Parker ◽  
Merry Holliday-Hanson ◽  
...  
Keyword(s):  
Health Planning ◽  
Public Information ◽  
High Volume ◽  
Median Number ◽  
Cancer Surgery ◽  
Sufficient Evidence ◽  
Cancer Site ◽  
Volume Data ◽  
Volume Calculation ◽  
Low Volume

172 Background: Little evidence is available to help patients and providers, payers and policymakers find the highest-quality hospitals for cancer surgery. We initiated a groundbreaking effort in California ( www.calqualitycare.org ) to publicly report hospital cancer surgery volume data online. Methods: With financial support from the nonprofit California HealthCare Foundation, we assembled a multidisciplinary team to oversee the project and ensure sound methodology. We obtained existing hospital discharge summary data from the California Office of Statewide Health Planning and Development (OSHPD). We selected cancer surgeries eligible for display through comprehensive review of the literature addressing the association of hospital volume and mortality. We found eleven cancer sites with sufficient evidence of association including bladder, brain, breast, colon, esophagus, liver, lung, pancreas, prostate, rectum, and stomach. Experts advised volume calculation and display of results. Leaders of low volume hospitals were interviewed to understand the reasons for low volume. Results: In 2014, about 60% of cancer surgeries in California were performed at hospitals in the top 20% of volume, but many hospitals performed low numbers of complex procedures, with the per hospital median number of surgeries for esophageal, pancreatic, stomach, liver, or bladder cancer surgeries at 4 or less. Low-volume hospitals included rural and urban hospitals, with small and large bed sizes, and teaching and non-teaching status. At least 670 Californians received cancer surgery at hospitals that performed only one or two surgeries for a particular cancer site; 72% of those patients lived within 50 miles of a top-20% volume hospital. Conclusions: This project demonstrates the potential for public information about hospital volumes to point patients towards high-volume and away from low-volume hospitals. Data regarding 2014 volumes are now available online.

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