345 A Novel Study Exploring the Hidden Cost of Insufficient Investment in Computer Technology in a District General Hospital

Introduction The NHS’ move towards increasing digitisation is limited by inadequate resourcing. It is estimated 70% of a junior doctor’s time is spent completing computer-based administrative work. Aging and insufficient equipment leads to inefficiency. The objective of this study is to investigate the hidden cost of insufficient and poorly performing computer technology. Method Surveys were disseminated to doctors and data was collected regarding designation, ward, salary and estimated ‘minutes-waiting’ for computers to become free (CF) and to load (CL). Results 33 surveys were completed. The hospital-wide average CF and CL were 25 minutes and 31.06 minutes respectively, with a corresponding average daily cost per doctor of £10.16 (CF) and £12.63 (CL), totalling £22.79/doctor/day. In the highest-expense ward, CF (31.66 minutes) and CL (38.33 minutes) equated to £30.28/doctor/day. Following acquisition of new hardware and re-audit, CL was significantly reduced to 20.4 minutes (p = 0.0142). Conclusions This study highlights the hidden cost of insufficient, poorly performing hardware. Every day the total cost of time-wasted greatly surpasses the cost of a single computer unit, illustrating the false economy of reduced capital investment in computer technology.

Influence of Government Price Regulation on the Price, Volume and Spending of Antibiotics in China: A Controlled Interrupted Time Series Study

Background: Chinese government established maximum retail prices for antibiotics listed in China’s National Reimbursement List in February 2013. This study aimed to analyze the impact of pharmaceutical price regulation on the price, volume and spending of antibiotics in China. Methods: An interrupted time series design with comparison series was used to examine impacts of the policy changes on average daily cost, monthly hospital purchase volume and spending of the 11 price-regulated antibiotics and 40 priceunregulated antibiotics in 699 hospitals. One intervention point was applied to assess the impact of policy. Results: After government price regulation, compared to price-unregulated antibiotics, the average daily cost of the price-regulated group declined rapidly (β=-5.68, P<.001). The average hospital monthly purchase spending of priceregulated antibiotics also decreased rapidly (β=-0.49, P<.010) and a positive trend change (β=0.04, P<.001) in average hospital spending of price-unregulated antibiotics was found. Conclusion: Government regulation can reduce the prices and spending of price-regulated antibiotics. To control increasing expenditure, besides price caps regulation, factors determining drug utilization also need to be considered in policy designing.

Application and Evaluation of SPD Based Logistics Management Model for Medical Consumables in Clinical Nursing Departments

Background: Supply, processing, and distribution (SPD) model is sparingly used in hospitals in China. We evaluated its effects on the management efficiency, quality control, and operating costs of medical consumables (MCs) in the clinical nursing surroundings in a single Chinese hospital-Anhui Provincial Hospital from 2014 to 2015. Methods: Amount-based packages (ABP) and procedure-based packages (PBP) models were created. They were introduced the use of quick response (QR) code scanning for using in clinical nursing departments (CNDs). Questionnaires were prepared by referring to previous literature and using Delphi method repeatedly, further discussed and formalized. Partial results of the formal questionnaire were analyzed using SPSS. Results: Frequency of MCs claims reduced without any requirements of MCs in 70% of CNDs. Average time spent on the inventory per week decreased and the time required to procure MCs reduced. Moreover, the average satisfaction score with MCs management increased, reaching 100%. Average space occupied by MCs decreased significantly, reducing by 1.2444m3. Overall, 100% of the respondents concluded that the management of MCs improved effectively and the inventory turnover rate had accelerated. The cost of MCs decreased by 15% with more than 10% increase in in-hospital amount, and the average daily cost of MCs also showed decrease. Conclusion: SPD can improve the efficiency of MCs management in CNDs, reducing medical risks and disputes, saving hospital operating costs, and decreasing capital occupation.

Estimativa do Custo do Tratamento da Lesão por Pressão, Como Prevenir e Economizar Recursos

O objetivo é estimar o custo hospitalar do tratamento da lesão por pressão e rever a literatura a respeito da prevençãode tais lesões. Estudo descritivo, retrospectivo, de março a dezembro de 2015, incluindo 58 pacientes, com um total de87 lesões por pressão, em uma unidade hospitalar de Niterói, Rio de Janeiro. Foram realizadas visitas aos setoresidentificando pacientes com lesão por pressão e as tecnologias utilizadas, e elaboração de planilha de custos e revisamosos métodos de prevenção à lesão por pressão. Foi encontrado um custo médio diário por paciente de R$ 14,24 e umcusto total de R$ 2992,03 para estes tratamentos. O tratamento da lesão por pressão teve um alto custo e exigiu aumentono tempo de internação. A revisão da literatura evidenciou modelos possíveis de serem adotados para atuar na prevençãodas lesões por pressão, os quais podem diminuir o tempo de internação e economizar recursos.Palavras-chave: Lesão por Pressão; Custos e Análise de Custo; Prevenção de Doenças. AbstractThe aim is to estimate the hospital costs of pressure-wound treatment and to review the literature regarding the injuriesprevention. Descriptive and retrospective study, from March to December 2015, including 58 patients, with a total of 87pressure injuries, in a hospital unit in Niterói, Rio de Janeiro. Visits were made to the sectors identifying patients withpressure injury and the used technologies, and elaboration of a cost sheet and we reviewed the pressure injureprevention methods. An average daily cost per patient of R$ 14.24 was found and a total cost of R$ 2992.03 for thesetreatments. The pressure lesion treatment had a high cost and demanded an increase in the hospitalization time. Theliterature review showed possible models to be adopted to act in the pressure injuries prevention, which can reducehospitalization time and save resources.Keywords: Pressure Ulcer; Costs and Cost Analysis; Disease Prevention.

A Supportive Care in Cancer Unit Reduces Costs and Hospitalizations for Transfusions in a Comprehensive Cancer Center

Purpose Among patients with solid or hematologic malignancies undergoing oncologic therapies, blood product transfusions (BPT) are a relevant reason for planned/unplanned hospitalizations, as well as a possible cause of delay in administration of the oncologic therapies. Furthermore, they create additional costs for the healthcare system (HCS). The aim of this study was to compare the costs of performing BPT (erythrocytes and platelets) in medical units/wards to the costs derived from the administration of BPT in a dedicated outpatient supportive care in cancer unit (SCCU). Methods Costs were analyzed from June 3, 2009 (when the SCCU started), until December 2013. Four inpatient oncologic units (bone marrow transplantation, radiotherapy, medical oncology I and II) were compared to the SCCU. Data regarding the transfusions performed by the SCCU of the patients who were previously hospitalized for transfusions were extracted, checked, and analyzed through a cross-check on the tax codes. Therefore, patients were considered suitable for the analysis if they had received BPT in the SCCU after a previous hospitalization for transfusion in one of the 4 units/wards. The average daily cost deriving from blood product units and from the hospitalization in each ward (irrespective of pharmaceutical expenses) was compared with the average daily cost deriving from blood product units and from the management of patients in the SCCU. Results We analyzed 227 patients (112 female) with a mean age of 60 years (range 20-90) with hematologic malignancies in 79% of cases. The number of transfusions performed by the SCCU has grown constantly and consistently over the years, reaching 1,402 transfusions in 2013, thus exceeding the other considered units. The total savings for the HCS was €282.204.71, €151.182.85 in 2013 only. We saved €124.319,26 for each patient transfused at the SCCU. Conclusions A dedicated outpatient SCCU, aimed at monitoring and treating cancer therapy-related toxicities and comorbidities and in which it is also possible to perform BPT promptly and effectively, reduces the number of hospitalizations and provides an economical benefit for HCS.

HİZMET İŞLETMELERİNDE MALIYET ANALİZİ: SİVAS NUMUNE HASTANESİ YANIK ÜNİTESİNDE YATAN HASTALARIN MALİYET ANALİZİ

Aim. The aim of this study is to investigate retrospectively the average cost per patient between the time 1May 2012-15 June 2013 in 68 patients who were hospitalized in the Burn Section of Numune State Hospital. Methods. This investigation includes age, degree of burn, burn percentage, burn type, hospitalization days and bills. Rates were determined according to the burn type of patients and costs were determined according to these types. Results. 80.9% of patients had hot water burn, 7.4% were burned due to burst flames, 4.4% had milk burns, 4.4% had steam burns and 2.9% were identified to have electrical burns. Average costs of burn injury inpatients was reported as TL values. Conclusion. The degree of burn injury, burn ratio and number of days during hospitalization were found to be dependent while age and type of burn injury were found to be independent variable that affect burn costs. The most important paramater that increased cost was number of days of hospitalization. Total cost of 68 patients was 1193,65 TL and average daily cost of a patient was found to be 110,12TL.

The Analysis of the Disease Spectrum in China

Analysis of the related risks of disease provides a scientific basis for disease prevention and treatment, hospital management, and policy formulation by the changes in disease spectrum of patients in hospital. Retrospective analysis was made to the first diagnosis, age, gender, daily average cost of hospitalized patients, and other factors in the First Affiliated Hospital of Nanjing Medical University during 2006–2013. The top 4 cases were as follows: cardiovascular disease, malignant tumors, lung infections, and noninsulin dependent diabetes mellitus. By the age of disease analysis, we found a younger age trend of cardiovascular disease, and the age of onset of cancer or diabetes was somewhat postponed. The average daily cost of hospitalization and the average daily cost of the main noncommunicable diseases were both on the rise. Noncommunicable diseases occupy an increasingly important position in the constitution of the disease, and they caused an increasing medical burden. People should pay attention to health from the aspects of lifestyle changing. Hospitals should focus on building the appropriate discipline. On the other hand, an integrated government response is required to tackle key risks. Multiple interventions are needed to lower the burden of these diseases and to improve national health.

Long-Acting Serotonin Antagonist Palonosteron To Prevent Nausea and Vomiting after High-Dose Melphalan and Autograft in Myeloma.

Palonosteron is a long-acting serotonin antagonist active in chemotherapy-induced nausea and vomiting (N/V). High-dose melphalan (HDM) is highly emetogenic. Even with pre-HDM anti-emetic administration, patients require anti-emetics in the following few days. This retrospective analysis was undertaken to see if the serotonin antagonist used prior to HDM affected anti-emetic use in the first week after HDM. The treatment group comprised 20 myeloma patients who received 140–200 mg/m2 melphalan the day prior to autograft (day -1), and 0.25 mg palonosteron IV prior to HDM. The control group comprised 49 myeloma patients receiving HDM in a similar fashion with 24 mg ondasteron IV prior to HDM. The groups were otherwise comparable. In accordance with our standard policy, no anti-emetic administration was scheduled from the day of transplant (day 0) onwards, and anti-emetics were administered based on patient needs as assessed by the nursing staff, the clinical team on rounds, and patient symptoms/request. The agents administered for breakthrough symptoms were lorazepam (1 mg/dose), prochlorperazine (10 mg/dose), metoclopramide (10 mg/dose), ondansetron (8 mg/dose), and promethazine (12.5 mg/dose) singly or in combination. As the table below shows, starting 2 days after palonosetron administration, about half the patient complained of some nausea and 10–25% experienced emesis. Day Nausea Vomiting 0 10% 5% 1 50% 25% 2 60% 5% 3 50% 10% 4 60% 15% 5 35% 10% 6 40% 25% The palonosteron and ondansetron groups were compared based on the actual use of breakthrough anti-emetic medications starting the day after drug administration rather than symptoms to avoid bias. Day Any drug used for breakthrough Ondansetron used for breakthrough (0=HSCT) Palonosetron group Ondansetron group P Palonosetron group Ondansetron group P 0 30% 84% <0.0001 0% 41% <0.0001 1 50% 78% 0.024 5% 51% <0.0001 2 55% 86% 0.006 5% 59% <0.0001 3 55% 92% <0.0001 5% 59% <0.0001 4 70% 90% 0.042 20% 47% 0.056 5 65% 84% 0.16 15% 53% 0.006 6 75% 86% 0.29 20% 47% 0.056 As the table above shows, the need for breakthrough anti-emetic medications was significantly less in the palonosetron group than in the ondansetron group. Approximately 50% of patients in the ondansetron group needed ondansetron every day after the initial dose on day -1. The proportion of patients getting ondansetron in the palonosetron group was 5–20% - significantly lower for first 4 days. For the 7 days studied, the average daily cost for breakthrough medications in the palonosteron group per patient was $11.37 (range 0.90–24.49) compared to $56.21 (range 28.15–62.97) in the ondansetron group. The total average drug cost per patient (including the prophylactic drug) was $473.89 in the palonosteron group and $511.30 in the ondansetron group. We conclude that the use of palonosetron before HDM and autotransplantation, because of the long-acting nature of the drug, results in significantly better control of N/V than ondansteron. In addition to being better from the symptomatic perspective, the decreased requirement for other agents to treat breakthrough N/V after palonosetron - especially reduction in the use of ondansetron - results in an overall cost saving.

Reduction in neonatal mortality by simple interventions

Newborn infants are among those which generate the highest health care costs. For instance, the cost of hospital care until discharge was assessed at US $ 14,200 (Boyle et al., 1983) for babies weighing 1000–1499g at birth. The average hospital stay for a baby weighing less than 1500g at birth in 1981 was 100 days at an average daily cost of US$ 898 (Stahlman, 1984). Achievements in neonatal survival, especially of extremely low birth weight babies, have necessitated frequent revision of the definition of viability. However, modern neonatal intensive care cannot be regarded as appropriate for developing countries as it cannot be made accessible to all at an affordable cost.