Variation in hospital charges in patients with external ventricular drains: comparison between the intensive care and surgical floor settings

2019 ◽  
Vol 24 (1) ◽  
pp. 29-34
Author(s):  
Jason K. Chu ◽  
Abdullah H. Feroze ◽  
Kelly Collins ◽  
Lynn B. McGrath ◽  
Christopher C. Young ◽  
...  
Keyword(s):  
Intensive Care ◽  
Medical Center ◽  
External Ventricular Drain ◽  
Cost Savings ◽  
Medical Expenditure ◽  
Clinical Event ◽  
Hospital Charges ◽  
Adverse Clinical Event ◽  
Life Saving ◽  
The University

OBJECTIVEPlacement of an external ventricular drain (EVD) is a common and potentially life-saving neurosurgical procedure, but the economic aspect of EVD management and the relationship to medical expenditure remain poorly studied. Similarly, interinstitutional practice patterns vary significantly. Whereas some institutions require that patients with EVDs be monitored strictly within the intensive care unit (ICU), other institutions opt primarily for management of EVDs on the surgical floor. Therefore, an ICU burden for patients with EVDs may increase a patient’s costs of hospitalization. The objective of the current study was to examine the expense differences between the ICU and the general neurosurgical floor for EVD care.METHODSThe authors performed a retrospective analysis of data from 2 hospitals within a single, large academic institution—the University of Washington Medical Center (UWMC) and Seattle Children’s Hospital (SCH). Hospital charges were evaluated according to patients’ location at the time of EVD management: SCH ICU, SCH floor, or UWMC ICU. Daily hospital charges from day of EVD insertion to day of removal were included and screened for days that would best represent baseline expenses for EVD care. Independent-samples Kruskal-Wallis analysis was performed to compare daily charges for the 3 settings.RESULTSData from a total of 261 hospital days for 23 patients were included in the analysis. Ten patients were cared for in the UWMC ICU and 13 in the SCH ICU and/or on the SCH neurosurgical floor. The median values for total daily hospital charges were $19,824.68 (interquartile range [IQR] $12,889.73–$38,494.81) for SCH ICU care, $8,620.88 (IQR $6,416.76–$11,851.36) for SCH floor care, and $10,002.13 (IQR $8,465.16–$12,123.03) for UWMC ICU care. At SCH, it was significantly more expensive to provide EVD care in the ICU than on the floor (p < 0.001), and the daily hospital charges for the UWMC ICU were significantly greater than for the SCH floor (p = 0.023). No adverse clinical event related to the presence of an EVD was identified in any of the settings.CONCLUSIONSICU admission solely for EVD care is costly. If safe EVD care can be provided outside of the ICU, it would represent a potential area for significant cost savings. Identifying appropriate patients for EVD care on the floor is multifactorial and requires vigilance in balancing the expenses associated with ICU utilization and optimal patient care.

Hemorrhage rates after external ventricular drain placement

2009 ◽  
Vol 110 (5) ◽  
pp. 1021-1025 ◽  
Author(s):  
Paul A. Gardner ◽  
Johnathan Engh ◽  
Dave Atteberry ◽  
John J. Moossy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Operating Room ◽  
Medical Center ◽  
External Ventricular Drain ◽  
Significant Risk ◽  
Neurosurgical Procedures ◽  
University Of Pittsburgh ◽  
Drain Placement ◽  
The University

Object External ventricular drain (EVD) placement is one of the most common neurosurgical procedures performed. Rates and significance of hemorrhage associated with this procedure have not been well quantified. Methods All adults who underwent EVD placement at the University of Pittsburgh Medical Center between July 2002 and June 2003 were evaluated for catheter-associated hemorrhage. Patients without postprocedural imaging were excluded. Results Seventy-seven (41%) of 188 EVDs were associated with imaging evidence of hemorrhage after either placement or removal. Most of these were insignificant, punctate intraparenchymal, or trace subarachnoid hemorrhages (51.9%). Thirty-seven (19.7%) were associated with larger hemorrhages, which were divided into 3 groups according to volume of hemorrhage: 16 patients (8.5%) had < 15 ml of hemorrhage, 20 (10.6%) had hemorrhages of > 15 ml or associated intraventricular hemorrhage, and in 1 case there was a subdural hematoma that required surgical evacuation. No hemorrhages larger than punctate or trace were seen after EVD removal. Hemorrhage was associated with 44.3% of EVDs placed in an intensive care unit compared with 34.8% in EVDs placed in the operating room (p > 0.10). Conclusions External ventricular drain placement has a significant risk of associated hemorrhage. However, the hemorrhages are rarely large and almost never require surgical intervention. There is a favorable trend, but no significant risk reduction when EVDs are placed in the operating room rather than the intensive care unit.

scholarly journals A 5 Year Retrospective Analysis of Leave against Advice from the Medical Wards of a Nigerian Tertiary Hospital

2020 ◽  
pp. 351-356
Author(s):  
JE Ojobi ◽  
E Ugwu ◽  
PO Idoko ◽  
MO Ogiator ◽  
SS Gomerep ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Hospital ◽  
Third Party ◽  
Hospital Environment ◽  
Clinical Event ◽  
Health Care Administrators ◽  
Voluntary Consent ◽  
Adverse Clinical Event ◽  
Medical Wards ◽  
Attending Physician

Self discharge (SD) of hospitalized patients is an adverse clinical event often resulting from a fundamental disagreement between the patient or an interested third party and the attending physician and / or the hospital environment. This culminates in the patient’s withdrawal of their initial voluntary consent for hospitalisation and abrupt termination of in - patient medical care. Patients who left hospital admission against the advice of their doctors are both a concern and a challenge for individuals in the health industry. It negatively impacts treatment outcomes and exposes the clinician and health care administrators to the hazards of litigations. The study was aimed at determining the incidence of SD and associated factors in medical admissions. It was a retrospective descriptive hospital based study of patients who self discharged from medical wards of Federal Medical Center, Makurdi from June 2012 – May 2017. Approval was obtained from the institution’s research ethics board. Thirty one individuals (0.62% of total admission) self discharged within the study period. Financial constraints was responsible for 32.2% (10) of SD followed by proximity to social support 19.4% (6). Five patients (16.1%) elected not to disclose any reasons. The incidence reduced from 0.21% to 0.02% at the start and end of study period respectively. Though SD was relatively low in this study, the incidence could be reduced further by expanding the scope of health insurance scheme, skilful communication and negotiating patient management using patient – centred methods.

scholarly journals Impact of an Antiretroviral Stewardship Team on the Care of Patients With Human Immunodeficiency Virus Infection Admitted to an Academic Medical Center

2019 ◽  
Vol 6 (7) ◽  
Author(s):  
Ashley M DePuy ◽  
Rafik Samuel ◽  
Kerry M Mohrien ◽  
Elijah B Clayton ◽  
David E Koren
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Human Immunodeficiency Virus ◽  
Intensive Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Intensive Care Unit Care ◽  
Documentation System ◽  
Immunodeficiency Virus

Abstract Background Interdisciplinary antiretroviral stewardship teams, comprising a human immunodeficiency virus pharmacist specialist, an infectious diseases physician, and associated learners, have the ability to assist in identification and correction of inpatient antiretroviral-related errors. Methods Electronic medical records of patients with antiretroviral orders admitted to our hospital were evaluated for the number of interventions made by the stewardship team, number of admissions with errors identified, risk factors for occurrence of errors, and cost savings. Risk factors were analyzed by means of multivariable logistic regression. Cost savings were estimated by the documentation system Clinical Measures. Results A total of 567 admissions were included for analysis in a 1-year study period. Forty-three percent of admissions (245 of 567) had ≥1 intervention, with 336 interventions in total. The following were identified as risk factors for error: multitablet inpatient regimen (odds ratio, 1.834; 95% confidence interval, 1.160–2.899; P = .009), admission to the intensive care unit (2.803; 1.280–6.136; P = .01), care provided by a surgery service (1.762; 1.082–2.868; P = .02), increased number of days reviewed (1.061; 1.008–1.117; P = .02), and noninstitutional outpatient provider (1.375; .972–1.946; P = .07). The 1-year cost savings were estimated to be $263 428. Conclusions Antiretroviral stewardship teams optimize patient care through identification and correction of antiretroviral-related errors. Errors may be more common in patients with multitablet inpatient regimens, admission to the intensive care unit, care provided by a surgery service, and increased number of hospital days reviewed. Once antiretroviral-related errors are identified, the ability to correct them provides cost savings.

One Thousand Endoscopic Skull Base Surgical Procedures Demystifying the Infection Potential: Incidence and Description of Postoperative Meningitis and Brain Abscesses

2011 ◽  
Vol 32 (1) ◽  
pp. 77-83 ◽  
Author(s):  
Yuriko Kono ◽  
Daniel M. Prevedello ◽  
Carl H. Snyderman ◽  
Paul A. Gardner ◽  
Amin B. Kassam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Skull Base ◽  
Medical Center ◽  
External Ventricular Drain ◽  
Csf Leak ◽  
University Of Pittsburgh ◽  
History Of ◽  
Brain Abscesses ◽  
Postoperative Meningitis ◽  
The University

Background.Endonasal endoscopic skull base surgery (ESBS) is perceived as having a high risk of infection because it is performed through the sinuses, which are not sterile.Objective.To identify the bacteriological characteristics, incidence, mortality, and risk factors for intracranial infection after ESBS.Methods.A retrospective analysis of the first 1,000 ESBS procedures performed at the University of Pittsburgh Medical Center from 1998 to 2008.Results.In 18 cases (1.8%), the patient developed meningitis. In 2 cases, the patient died within 2 months after surgery, of noninfectious causes. In 11 cases, cerebrospinal fluid (CSF) cultures had positive results. There were no predominant pathogens. Male sex (odds ratio [OR], 3.97 [95% confidence interval {CI}, 1.21-13.03]; P = .02), history of a craniotomy or endonasal surgery (OR, 4.77 [95% CI, 1.68-13.56];P = .003), surgerywith higher levels of complexity (OR, 6.60 [95% CI, 1.77-24.70];P = .005), the presence of an external ventricular drain or ventriculoperitoneal shunt at the time of surgery (OR, 6.38 [95% CI, 1.07-38.09]; P = .04), and postoperative CSF leak (OR, 12.99 [95% CI, 4.24-39.82]; P<.001) were risk factors for infection.Conclusion.The incidence of infection of 1.8% in ESBS is comparable to that in open craniotomy. The most important risk factor was a postoperative CSF leak. All patients recovered from their infection.

NICU Procedures Are Getting Sweeter: Development of a Sucrose Protocol for Neonatal Procedural Pain

2010 ◽  
Vol 29 (5) ◽  
pp. 271-279 ◽  
Author(s):  
Larisa Mokhnach ◽  
Marilyn Anderson ◽  
Rachelle Glorioso ◽  
Katie Loeffler ◽  
Kelly Shinabarger ◽  
...  
Keyword(s):  
Intensive Care ◽  
Literature Review ◽  
Strong Evidence ◽  
Neonatal Intensive Care ◽  
Medical Center ◽  
Procedural Pain ◽  
Standardized Protocol ◽  
Intensive Care Nursery ◽  
The University ◽  
Daily Pain

Neonates in the neonatal intensive care nursery experience multiple, painful, tissue-damaging procedures daily. Pain among neonates is often underestimated and untreated, producing untoward consequences. A literature review established strong evidence supporting the use of sucrose as an analgesic for minor procedural pain among neonates. A review of unit practices and nurses’ experiential evidence initiated the production of a standardized protocol in our unit at the University of Washington Medical Center NICU in Seattle.Nursing practices surrounding sucrose use differed widely in dose, timing, and patient application. We carefully evaluated evidence documenting the effectiveness as well as the safety of sucrose administration and wrote a protocol and practice standards for our primarily premature patient population. This article describes the development and execution of a standardized, nurse-implemented, sucrose protocol to reduce procedural pain.

scholarly journals The PRESSURE score to predict decompressive craniectomy after aneurysmal subarachnoid haemorrhage

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Ramazan Jabbarli ◽  
Marvin Darkwah Oppong ◽  
Roland Roelz ◽  
Daniela Pierscianek ◽  
Mukesch Shah ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Risk Score ◽  
Decompressive Craniectomy ◽  
Medical Center ◽  
External Ventricular Drain ◽  
Area Under The Curve ◽  
Final Analysis ◽  
University Hospital ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
The University

Abstract The prognosis of patients with aneurysmal subarachnoid haemorrhage requiring decompressive craniectomy is usually poor. Proper selection and early performing of decompressive craniectomy might improve the patients’ outcome. We aimed at developing a risk score for prediction of decompressive craniectomy after aneurysmal subarachnoid haemorrhage. All consecutive aneurysmal subarachnoid haemorrhage cases treated at the University Hospital of Essen between January 2003 and June 2016 (test cohort) and the University Medical Center Freiburg between January 2005 and December 2012 (validation cohort) were eligible for this study. Various parameters collected within 72 h after aneurysmal subarachnoid haemorrhage were evaluated through univariate and multivariate analyses to predict separately primary (PrimDC) and secondary decompressive craniectomy (SecDC). The final analysis included 1376 patients. The constructed risk score included the following parameters: intracerebral (‘Parenchymal’) haemorrhage (1 point), ‘Rapid’ vasospasm on angiography (1 point), Early cerebral infarction (1 point), aneurysm Sac &gt; 5 mm (1 point), clipping (‘Surgery’, 1 point), age Under 55 years (2 points), Hunt and Hess grade ≥ 4 (‘Reduced consciousness’, 1 point) and External ventricular drain (1 point). The PRESSURE score (0–9 points) showed high diagnostic accuracy for the prediction of PrimDC and SecDC in the test (area under the curve = 0.842/0.818) and validation cohorts (area under the curve = 0.903/0.823), respectively. 63.7% of the patients scoring ≥6 points required decompressive craniectomy (versus 12% for the PRESSURE &lt; 6 points, P &lt; 0.0001). In the subgroup of the patients with the PRESSURE ≥6 points and absence of dilated/fixed pupils, PrimDC within 24 h after aneurysmal subarachnoid haemorrhage was independently associated with lower risk of unfavourable outcome (modified Rankin Scale &gt;3 at 6 months) than in individuals with later or no decompressive craniectomy (P &lt; 0.0001). Our risk score was successfully validated as reliable predictor of decompressive craniectomy after aneurysmal subarachnoid haemorrhage. The PRESSURE score might present a background for a prospective randomized clinical trial addressing the utility of early prophylactic decompressive craniectomy in aneurysmal subarachnoid haemorrhage.

Meaning of critical traumatic injury for a patient’s body and self

2021 ◽  
pp. 096973302098833
Author(s):  
Yu-Lun Tsai ◽  
Hsien-Hsien Chiang ◽  
Yu-Ju Chen ◽  
Hui-Hsun Chiang ◽  
Yuan-Hao Chen ◽  
...  
Keyword(s):  
Intensive Care ◽  
Medical Center ◽  
Traumatic Injury ◽  
Phenomenological Approach ◽  
The Body ◽  
Physical Trauma ◽  
Institutional Review ◽  
Life Saving ◽  
The Impact ◽  
The Relationship

Background: Patients with a traumatic injury often require intensive care for life-saving treatments. Physical suffering and emotional stress during critical care can be alleviated by ethical caring provided by nurses. The relationship between body and self are fundamentally inseparable. Nurses need to understand the impacts of traumatic injury on a patient’s body and self. Aim: To understand the meaning of traumatic injury for body and self for patients receiving intensive care. Research design: A qualitative descriptive study using Giorgi’s phenomenological approach. Participants and research context: Patients receiving intensive care for physical trauma were selected by purposive sampling (N = 15) from a medical center in Taiwan. Individual in-depth, face-to-face audiotaped interviews, guided by semi-structured questions, were used to collect data. Each interview lasted 30–60 min. Audiotaped interviews were transcribed and analyzed. Ethical considerations: This study was approved by the Institutional Review Board of the medical center. Findings: The impact of the experience of traumatic injury on participants’ body and self was described by three main themes: (1) Searching for the meaning of the injured body, (2) Feeling trapped in the bed, and (3) The carer and the cared-for. Discussion and conclusion: The implications of the three themes described in the findings are as follows: Trauma as a source of meaning; Body and self are mutually limiting or mutually enabling; and Ethical relationships. The experience of needing intensive care following a traumatic injury on the body and self was dynamic and mutual. The experience of the injury changed the relationship between body and self, and gave new meaning to life. Nurses play a crucial role in continuity of care by understanding the meaning of a traumatic injury for patient’s body and self that facilitates ethical care and recovery from injury.

Sign in / Sign up

Export Citation Format

Share Document