scholarly journals The Cost of Ignoring Acute Cholecystectomy

2009 ◽  
Vol 91 (1) ◽  
pp. 39-42 ◽  
Author(s):  
JP Garner ◽  
SK Sood ◽  
J Robinson ◽  
W Barber ◽  
K Ravi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Elective Surgery ◽  
Waiting Times ◽  
Hospital Costs ◽  
Cost Savings ◽  
The Uk ◽  
Elective Cholecystectomy ◽  
First Admission

INTRODUCTION Biliary symptoms whilst awaiting elective cholecystectomy are common, resulting in hospital admission, further investigation and increased hospital costs. Immediate cholecystectomy during the first admission is safe and effective, even when performed laparoscopically, but acute laparoscopic cholecystectomy has only recently become increasingly commonplace in the UK. This study was designed to quantify this problem in our hospital and its cost implications. PATIENTS AND METHODS The case notes of all patients undergoing laparoscopic cholecystectomy in our hospital between January 2004 and June 2005 were examined for details of hospital admissions with biliary symptoms or complications whilst waiting for elective cholecystectomy. Additional bed occupancy and radiological investigations were recorded and these costs to the trust calculated. We compared the potential tariff income to the hospital trust for the actual management of these patients and if a policy of acute laparoscopic cholecystectomy on first admission were in place. RESULTS In the 18-month study period, 259 patients (202 females) underwent laparoscopic cholecystectomy. Of these, 147 presented as out-patients and only 11% required hospital admission because of biliary symptoms whilst waiting for elective surgery. There were 112 patients who initially presented acutely and were managed conservatively. Twenty-four patients were re-admitted 37 times, which utilised 231 hospital bed-days and repeat investigations costing over £40,000. There would have been a marginal increase in tariff income if a policy of acute laparoscopic cholecystectomy had been in place. CONCLUSIONS Adoption of a policy of acute laparoscopic cholecystectomy on the index admission would result in substantial cost savings to the trust, reduce elective cholecystectomy waiting times and increase tariff income.

scholarly journals Mobile Stroke Unit in the UK Healthcare System: Avoidance of Unnecessary Accident and Emergency Admissions

2020 ◽  
Vol 49 (4) ◽  
pp. 388-395
Author(s):  
Iris Q. Grunwald ◽  
Daniel J. Phillips ◽  
David Sexby ◽  
Viola Wagner ◽  
Martin Lesmeister ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Acute Stroke ◽  
Stroke Unit ◽  
Hospital Admissions ◽  
Hospital Treatment ◽  
Stroke Patients ◽  
Transient Ischaemic Attacks ◽  
Accident And Emergency ◽  
Mobile Stroke Unit ◽  
The Uk

Background: Acute stroke patients are usually transported to the nearest hospital regardless of their required level of care. This can lead to increased pressure on emergency departments and treatment delay. Objective: The aim of the study was to explore the benefit of a mobile stroke unit (MSU) in the UK National Health Service (NHS) for reduction of hospital admissions. Methods: Prospective cohort audit observation with dispatch of the MSU in the East of England Ambulance Service area in Southend-on-Sea was conducted. Emergency patients categorized as code stroke and headache were included from June 5, 2018, to December 18, 2018. Rate of avoided admission to the accident and emergency (A&E) department, rate of admission directly to target ward, and stroke management metrics were assessed. Results: In 116 MSU-treated patients, the following diagnoses were made: acute stroke, n = 33 (28.4%); transient ischaemic attacks, n = 13 (11.2%); stroke mimics, n = 32 (27.6%); and other conditions, n = 38 (32.8%). Pre-hospital thrombolysis was administered to 8 of 28 (28.6%) ischaemic stroke patients. Pre-hospital diagnosis avoided hospital admission for 29 (25.0%) patients. As hospital treatment was indicated, 35 (30.2%) patients were directly triaged to the stroke unit, 1 patient (0.9%) even directly to the catheter laboratory. Thus, only 50 (43.1%) patients required transfer to the A&E department. Moreover, the MSU enabled thrombolysis with a median dispatch-to-needle time of 42 min (interquartile range, 40–60). Conclusion: This first deployment of an MSU in the UK NHS demonstrated improved triage decision-making for or against hospital admission and admission to the appropriate target ward, thereby reducing pressure on strained A&E departments.

Hospital Costs and Severity of Illness in Three Types of Elective Surgery

1997 ◽  
Vol 86 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Alex Macario ◽  
Terry S. Vitez ◽  
Brian Dunn ◽  
Tom McDonald ◽  
Byron Brown
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Operating Room ◽  
Knee Replacement ◽  
Charlson Comorbidity Index ◽  
Elective Surgery ◽  
Hospital Costs ◽  
Severity Of Illness ◽  
Total Hospital ◽  
Comorbidity Index

Background If patients who are more severely ill have greater hospital costs for surgery, then health-care reimbursements need to be adjusted appropriately so that providers caring for more seriously ill patients are not penalized for incurring higher costs. The authors' goal for this study was to determine if severity of illness, as measured by either the American Society of Anesthesiologists Physical Status (ASA PS) or the comorbidity index developed by Charlson, can predict anesthesia costs, operating room costs, total hospital costs, or length of stay for elective surgery. Methods The authors randomly selected 224 inpatients (60% sampling fraction) having either colectomy (n = 30), total knee replacement (n = 100), or laparoscopic cholecystectomy (n = 94) from September 1993 to September 1994. For each surgical procedure, backward-elimination multiple regression was used to build models to predict (1) total hospital costs, (2) operating room costs, (3) anesthesia costs, and (4) length of stay. Explanatory candidate variables included patient age (years), sex, ASA PS, Charlson comorbidity index (which weighs the number and seriousness of coexisting diseases), and type of insurance (Medicare/Medicaid, managed care, or indemnity). These analyses were repeated for the pooled data of all 224 patients. Costs (not patient charges) were obtained from the hospital cost accounting software. Results Mean total hospital costs were $3,778 (95% confidence interval +/- 299) for laparoscopic cholecystectomy, $13,614 (95% CI +/- 3,019) for colectomy, and $18,788 (95% CI +/- 573) for knee replacement. The correlation (r) between ASA PS and Charlson comorbidity scores equaled 0.34 (P < .001). No consistent relation was found between hospital costs and either of the two severity-of-illness indices. The Charlson comorbidity index (but not the ASA PS) predicted hospital costs only for knee replacement (P = .003). The ASA PS, but not the Charlson index, predicted operating room and anesthesia costs only for colectomy (P < .03). Conclusions Severity of illness, as categorized by ASA PS categories 1-3 or by the Charlson comorbidity index, was not a consistent predictor of hospital costs and lengths of stay for three types of elective surgery. Hospital resources for these lower-risk elective procedures may be expended primarily to manage the consequences of the surgical disease, rather than to manage the patient's coexisting diseases.

scholarly journals Mobile stroke unit in the UK healthcare system: avoidance of unnecessary accident and emergency admissions

2021 ◽  
Vol 5 (4) ◽  
pp. 64-64
Author(s):  
Daniel Phillips ◽  
Iris Q. Grunwald ◽  
Silke Walter ◽  
Klaus Faßbender
Keyword(s):  
Hospital Admission ◽  
Stroke Unit ◽  
Hospital Admissions ◽  
Hospital Treatment ◽  
Transient Ischaemic Attacks ◽  
Accident And Emergency ◽  
Mobile Stroke Unit ◽  
Catheter Laboratory ◽  
Uk National Health Service ◽  
The Uk

<sec id="s1"> Aims: The aim of the study was to explore the benefit of a mobile stroke unit (MSU) in the UK National Health Service (NHS) for reduction of hospital admissions. </sec> <sec id="s2"> Methods: Prospective cohort audit observation with dispatch of the MSU in the East of England Ambulance Service was conducted. Emergency patients categorised as code stroke and headache were included from 5 June to 18 December 2018. Rate of avoided admission to the accident and emergency (A&E) department, rate of admission directly to target ward and stroke management metrics were assessed. </sec> <sec id="s3"> Results: In 116 MSU-treated patients, the following diagnoses were made: acute stroke, n = 33 (28.4%); transient ischaemic attacks, n = 13 (11.2%); stroke mimics, n = 32 (27.6%); and other conditions, n = 38 (32.8%). Pre-hospital thrombolysis was administered to eight of 28 (28.6%) ischaemic stroke patients. Pre-hospital diagnosis avoided hospital admission for 29 (25.0%) patients. As hospital treatment was indicated, 35 (30.2%) patients were directly triaged to the stroke unit, one patient (0.9%) even directly to the catheter laboratory. Thus, only 50 (43.1%) patients required transfer to the A&E department. Moreover, the MSU enabled thrombolysis with a median dispatch-to-needle time of 42 mins (interquartile range, 40‐60). </sec> <sec id="s4"> Conclusion: This first deployment of an MSU in the UK NHS demonstrated improved triage decision-making for or against hospital admission and admission to the appropriate target ward, thereby reducing pressure on strained A&E departments. </sec>

scholarly journals P-EGS14 From Gallstone Disease to Cholecystectomy: An audit looking at the waiting times for cholecystectomy in a small District General Hospital

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Jacob Mewse ◽  
Virginia Ledda ◽  
Ellie Connor ◽  
Peter Frank Mason
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Waiting Time ◽  
Negative Impact ◽  
Elective Surgery ◽  
Waiting Times ◽  
Gallstone Disease ◽  
Gastrointestinal Surgery ◽  
Emergency Operation ◽  
Biliary Colic ◽  
Emergency General Surgery

Abstract Background Gallstone-related disease accounts for a third of emergency general surgery admissions and referrals. The average waiting time for acute gallstone presentations to laparoscopic cholecystectomy is about 7 days in England. This audit aims to identify emergency admissions and compare local management to the Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS) guidelines standards with a focus on waiting times for laparoscopic cholecystectomy (LC). Where AUGIS standards were not met, number of re-admissions and complications were identified. A cost analysis was also completed looking at the overall costs of delayed treatment. Methods We identified all patients admitted as an emergency between September 2019 and September 2020 with gallstone-related pathology. Patients not referred to the surgical team, with negative Ultrasound Scans (USS) or known HPB malignancy were excluded. The patients were divided into a pre- COVID -19 and during COVID-19 category (respectively before and after March 2020), to identify whether the cancellation to non- urgent elective surgery (due to COVID-19) had caused further delays or complications. Each patient’s management was compared to AUGIS guidelines depending on their diagnosis at presentation (biliary colic, cholecystitis, cholangitis, gallstone-related pancreatitis), focusing on the timing between presentation and LC. Results A total of 99 patients were identified. Of the patients presenting with biliary colic (n = 9 pre-COVID, n = 5 during COVID), none underwent LC within 72 hours from presentation as recommended by AUGIS. Of the patients presenting with cholecystitis (n = 20 pre-COVID and n = 16 during COVID), none had LC within the recommended 72 hours. 5 patients in each COVID group had LC, with a significantly longer waiting time compared to the pre-COVID group. Re-admissions and complications were similar for the cholecystitis patients in both COVID groups. In the gallstone-related pancreatitis group, only 1 patient underwent LC within the recommended 2 weeks. Conclusions This audit showed that locally we are failing to meet AUGIS guidelines for LC within 72 hrs, 2 weeks or 6 weeks both pre and during COVID. This has caused re-admissions of patients with cholecystitis, pancreatitis and perforated gallbladders. Factors that cause delay are limited access to USS, limited staff and theatre availability. To improve outcomes, it is necessary to implement a hot gallbladder service with dedicated theatre slots. A change in the overall perception of LC is also needed: this is should be considered an emergency operation as its delay has a significant negative impact on patients’ outcomes.

scholarly journals A laparoszkópia szerepe a 80 évesnél idősebb betegek epekövességének megoldásában

2016 ◽  
Vol 157 (5) ◽  
pp. 185-190 ◽  
Author(s):  
Tímea Kakucs ◽  
László Harsányi ◽  
Péter Kupcsulik ◽  
Péter Lukovich
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Elective Surgery ◽  
Length Of Hospital Stay ◽  
Common Bile Duct Stones ◽  
Age Group ◽  
Type Conversion ◽  
Emergency Group ◽  
Elective Group ◽  
Elective Cholecystectomy

Introduction: The incidence of cholelithiasis increases with age, however, there is still little data about the outcomes of cholecystectomy in patients with age of 80 and above. Population ageing presents tremenduous challenges for surgeons. Aim: The aim of the authors was to compare emergency and elective cholecystectomies performed in these elderly patients. Method: This retrospective study was based on the analysis of operation type, conversion rate, complications, mortality, length of hospital stay of all patients over 80 who underwent cholecystectomy in the last 6 years at the 1st Department of Surgery, Semmelweis University. Results: 69 elective and 51emergency operations were performed. In the emergency group pancreatitis was found in 9.8%, liver abscess in 14%, and common bile duct stones in 27% of the patients on admission. Laparoscopic cholecystectomy could be performed in 84% of patients in the elective group, while in 17.7% of patients in the emergency group. The length of stay at the intensive care unit was 9.1 and 1 days, while the total length of hospital stay was 12 and 3.6 days for the elective and emergency groups, respectively. In the emergency group mortality was 20% and reoperation was performed in 16% of patients, while at the elective group none of these occured. Conclusion: Laparoscopic cholecystectomy is safe as elective surgery for patients with age of 80 and above. For this reason the authors recommend elective cholecystectomy in this age group. Orv. Hetil., 2016, 157(5), 185–190.

scholarly journals End-stage organ disease–Healthcare utilisation: Impact of palliative medicine

2021 ◽  
pp. bmjspcare-2021-003288
Author(s):  
Allyn Hum ◽  
Chun Wei Yap ◽  
Mervyn Yong Hwang Koh
Keyword(s):  
Palliative Care ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Cost Savings ◽  
Length Of Hospital Stay ◽  
Healthcare Utilisation ◽  
Exact Matching ◽  
Inpatient Hospital ◽  
Ed Visits ◽  
End Stage

ObjectivesAlthough patients living with end-stage organ disease (ESOD) suffer unmet needs from the physical and emotional burdens of living with chronic illness, they are less likely to receive palliative care.The aims of the study were to determine if palliative care referrals reduced healthcare utilisation and if impact on healthcare utilisation was dependent on the timing of the referral.MethodsPatients with ESOD who received palliative care support were matched with those who did not using coarsened exact matching and propensity score matching, and compared in this retrospective cohort study. Primary outcomes of interests were reduction in all-cause emergency department (ED) visits and costs, reduction in all-cause tertiary hospital admissions, length of hospital stay and inpatient hospital costs.ResultsPatients with ESOD referred to palliative care experienced a reduction in the frequency of all cause ED visits and inpatient hospital admissions. Significant impact of a palliative care referral was at 3 months, rather than 1 month prior to death with a greater reduction in the frequency of ED visits, inpatient hospital admissions, length of stay and charges (p all <0.05). The most common ESOD referred to palliative care for 1110 matched patients was end-stage renal failure (57.7%), and least commonly for respiratory failure (7.6%).ConclusionPalliative care can reduce healthcare utilisation, with reduction greatest when the referral is timed earlier in the disease trajectory. Cost savings can be judiciously redirected to the development of palliative care resources for integrated support of patients and caregivers.

scholarly journals Pre-operative Over-investigation of Routine Tests Prior to Elective Surgeries

2020 ◽  
Vol 5 (2) ◽  
pp. p78
Author(s):  
Osama Samara ◽  
Saif Aldeen AlRyalat ◽  
Ahmad Al Owaidat ◽  
Mohammad Marwan Al Omar ◽  
Mohammad Farraj ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Urine Analysis ◽  
Complete Blood Count ◽  
Elective Surgery ◽  
Tertiary Hospital ◽  
Physical Status ◽  
X Ray ◽  
Chest X Ray ◽  
Test Ordering ◽  
Elective Cholecystectomy

Background: Previous studies stressed on the burden raised by routine pre-operative test ordering, which should be based on the assessment of patient physical status. In a tertiary hospital in Jordan, we aim to study the compliance with guidelines regarding pre-operative routine testing prior to an elective surgery, cholecystectomy, and calculate the estimated cost from non-compliance with the guidelines.Methods: We included laparoscopic cholecystectomy (through ICD-9 code) to represent an elective surgery. For each surgery done from the period 1/1/2016 to 31/12/2016, data regarding preoperative investigations, admission history note, operative and discharge note were obtained. Tests that are considered routine investigations are Complete blood count (CBC), kidney function tests (KFT), electrolytes, chest X-ray, electrocardiogram, coagulation studies, and urine-analysis. We classified patients who underwent cholecystectomy according to the latest version of the American Society of Anesthesiologists (ASA) physical status system to assess the need for routine tests, then we calculated the number and cost of excess tests.Results: A total 382 routine, non-emergent laparoscopic cholecystectomy surgeries were performed. 319 (83.5%) of patients were classified as ASA-1, 60 (15.7%) were classified as ASA-2, and only 3 (0.8%) were classified as ASA-3. Age was a significant determinant in obtaining chest X-ray ordering and findings (p< 0.001) and electrolytes ordering and findings (p= 0.001). Total routine tests cost for elective cholecystectomy during 2016 was 16,021$. Regarding operative compilations, only 14 (3.7%) complication occurred, all of which were bleeding related.Conclusion: Oversighting routine preoperative test ordering before elective cholecystectomy will significantly reduce the cost without increasing post-operative complications.

scholarly journals Hospital admissions for non-communicable disease in the UK military and associations with alcohol use and mental health: a data linkage study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
L. Goodwin ◽  
D. Leightley ◽  
Z. E. Chui ◽  
S. Landau ◽  
P. McCrone ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Alcohol Use ◽  
Hospital Admission ◽  
Military Personnel ◽  
Data Linkage ◽  
Hospital Admissions ◽  
Phase 2 ◽  
Physical And Mental Health ◽  
The Uk

Abstract Background Since the recent conflicts in Iraq and Afghanistan, the short-term focus of military healthcare research has been on the consequences of deployment for mental health and on those wounded or injured in combat. Now that these conflicts have ended for the UK Armed Forces, it is important to consider the longer term physical and mental health consequences, and just as importantly, the links between these. The aims of this study were to determine the most common physical conditions requiring a hospital admission in UK military personnel and whether they were more common in personnel with a mental health condition, smokers, and/or those misusing alcohol compared to those without. Methods Data linkage of a prospective UK military cohort study to electronic admitted patient care records for England, Wales and Scotland. Nine thousand nine hundred ninety military personnel completed phase 2 of a military cohort study (56% response rate, data collected from 2007 to 2009), with analyses restricted to 86% of whom provided consent for linkage to healthcare records (n = 8602). Ninety percent were male and the mean age at phase 2 was 36 years. The outcome was physical non communicable diseases (NCDs) requiring a hospital admission which occurred after phase 2 of the cohort when the mental health, smoking and alcohol use exposure variables had been assessed until the end of March 2014. Results The most common NCDs requiring a hospital admission were gastrointestinal disorders 5.62% (95% Confidence Intervals (CI) 5.04, 6.19) and joint disorders 5.60% (95% CI 5.02, 6.18). Number of NCDs requiring a hospital admission was significantly higher in those with a common mental disorder (Hazard ratio (HR) 1.40 (95% CI 1.16–1.68), post-traumatic stress disorder (HR 1.78 (95% CI 1.32–2.40)) and in current smokers (HR 1.35 (95% CI 1.12–1.64) compared to those without the disorder, and non-smokers, respectively. Conclusions Military personnel with a mental health problem are more likely to have an inpatient hospital admission for NCDs compared to those without, evidencing the clear links between physical and mental health in this population.

scholarly journals Prompt laparoscopic cholecystectomy would reduce morbidity and save hospital resources

2014 ◽  
Vol 96 (4) ◽  
pp. 294-296 ◽  
Author(s):  
BWP Rossi ◽  
E Bassett ◽  
M Martin ◽  
S Andrews ◽  
S Wajed
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Elective Surgery ◽  
Waiting Times ◽  
Emergency Admission ◽  
Waiting List ◽  
Document Management ◽  
Document Management System ◽  
Patient Morbidity ◽  
Hospital Resources

Introduction Limited resources and organisational problems often result in significant waiting times for patients presenting with an indication for cholecystectomy. This study investigated the potential false economy of such practice. Methods Retrospective analysis of all patients on a waiting list for cholecystectomy between July 2007 and October 2010 was performed. The hospital computer document management system and patients’ notes were used to collect data. Results A total of 1,021 patients were included in the study; 701 were listed from clinic and 320 were listed following an emergency admission. The median time on a waiting list before surgery was 96 days (range: 5–381 days). Eighty-seven patients (8.5%) had an emergency admission with a gallstone related problem while on a waiting list. This resulted in 488 cumulative inpatient days. There was a significant correlation between increased time spent on the waiting list and increased chance of an emergency admission (p=0.01). Patients added to the waiting list from emergency admissions were more likely to be admitted with complications than those listed from clinic (15.3% vs 5.4%, p<0.01). There was no association between age (p=0.53) or sex (p=0.23) and likelihood of emergency admission while on a waiting list. Conclusions Prompt elective surgery and same-admission emergency laparoscopic cholecystectomy can reduce waiting list patient morbidity and is likely to save resources in the long term.

scholarly journals The relationship between alcohol-related hospital admission and specialist alcohol treatment provision across local authorities in England since passage of the Health and Social Care Act 2012

2020 ◽  
pp. 1-3 ◽  
Author(s):  
Emmert Roberts ◽  
Matthew Hotopf ◽  
Colin Drummond
Keyword(s):  
Hospital Admission ◽  
Social Care ◽  
Local Authority ◽  
Hospital Admissions ◽  
Alcohol Treatment ◽  
Data Sets ◽  
Treatment Provision ◽  
Health And Social Care ◽  
High Prevalence ◽  
The Uk

Summary To our knowledge no previous studies have been conducted at the local authority level assessing relationships between alcohol-related hospital admission, specialist alcohol treatment provision and socioeconomic deprivation since the UK government passed the Health and Social Care Act in 2012. Our results, using publicly available national data-sets, suggest that the local authority areas in England most in need of adequately funded specialist alcohol treatment, because of high prevalence of alcohol dependence and deprivation, are not receiving targeted increased funding, and that the national rise in alcohol-related hospital admissions may be fuelled by local authority funding cuts to specialist alcohol treatment.

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