Importance of nondrug costs of intravenous antibiotic therapy.
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INTRODUCTION: Costs are one of the factors determining physicians' choice of medication to treat patients in specific situations. However, usually only the drug acquisition costs are taken into account, whereas other factors such as the use of disposable materials, the drug preparation time and the staff workload are insufficiently taken into consideration. We therefore decided to assess true overall costs of intravenous (IV) antibiotic administration by performing an activity-based costing approach. METHODS: A prospective survey on costs and workload by means of a time and motion analysis and activity-based costing was performed in a 605-bed secondary referral centre with 20 intensive care unit beds. The subjects were 50 consecutive patients admitted to our hospital with community-acquired pneumonia or intra-abdominal infections requiring treatment with IV antibiotics. A time and motion analysis of 103 routine acts of preparing and administering IV antibiotics was performed in the intensive care unit and in the Department of Internal Medicine. To measure the entire process an inventory and work flowchart were made using detailed questionnaires completed by members of the nursing staff, the medical staff and the pharmacy staff. In addition, questionnaires were distributed to management and secretarial staff to determine additional overhead costs. The average costs for different methods of IV antibiotic administration were then compared by timing all steps in the process. Four different methods of drug administration were used: administration by volumetric pump, administration by syringe pump, administration by 'unaided' infusion bag, and administration by direct IV injection. RESULTS: The average times required for each of these procedures, including preparation and administration of the drug, were 4:49 +/- 2:37, 4:56 +/- 2:03, 5:51 +/- 3:33 and 9:21 +/- 2:16 min (mean minutes:seconds +/- standard deviation), respectively. When the costs for expended staff time and materials (not including drug costs) were calculated this resulted in average costs of 5.65, 7.28, 5.36 and 3.83, respectively, for administration of each dose of antibiotics. These costs represent between 11% and 53% of the total daily costs of antibiotic therapy. Compared with the acquisition costs, these indirect costs ranged from 13% to 113%. Not included in this comparison is the time required for insertion of an IV catheter, which was found to be 10:15 +/- 6:31 min with an average calculated cost of 9.17. CONCLUSIONS: Total costs of IV antibiotic administration are formed not only by the costs of the drugs themselves, but also, to a substantial degree, by the time expended by medical and nursing staff, costs of disposable materials and overhead costs. Physicians making decisions regarding the use of specific medications in intensive care unit patients should take these factors into account. Use of IV antibiotics is associated with considerable workload and additional costs that can exceed the acquisition costs of the medications themselves. (+info)
Impact of electronic signature on radiology report turnaround time.
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The purpose of this study was to measure the impact of electronic signature on report turnaround time. The Radiology Information System (RIS) database was interrogated to obtain a file containing all examinations recorded within a one-month period. Two sectors were specifically studied: abdominal ultrasound and chest radiography. Each of these sectors had one reader per day. The periods studied were October 2001 (before implementation of electronic signature) and February 2002 (3 months after electronic signature implementation). For the abdominal ultrasound examinations, the median time from transcription to final signature decreased from 11 days to 3 days with the introduction of electronic signature ( P < 0.001). For the chest radiographs, the median time from transcription to final signature decreased from 10 days to 5 days with the introduction of electronic signature ( P < 0.001). Electronic signature significantly shortens the time interval between transcription and finalization of radiology reports. (+info)
Handheld computer application for time-motion studies in the emergency department.
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Urban academic emergency departments face significant challenges of increasing patient volumes and sicker patients. Better understanding of the timing and interactions between provider activities may assist in efforts directed toward improving patient-care processes to decrease length of stay. Rapidly chang-ing and overlapping activities in the emergency department make time-motion study difficult. This poster describes a handheld computer application that enables synchronized capture of task description and times across multiple patient care providers in the emergency department. (+info)
Minimally invasive surgical practice: a survey of general surgeons in Ontario.
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INTRODUCTION: With the rapidly evolving techniques for minimally invasive surgery (MIS), general surgeons are challenged to incorporate advanced procedures into their practices. We therefore carried out a study to assess the state of MIS practice in Ontario. METHODS: A questionnaire was mailed to 390 general surgeons in Ontario. It addressed the surgeon's practice demographics, performance of both basic and advanced MIS procedures, the factors influencing this practice and the means of obtaining MIS training. RESULTS: Of the 390 general surgeons surveyed, 309 (79%) responded. Thirty-six of these were retired and were excluded from the analysis, leaving 273 available for study. The average age in the study group was 49.7 years; 247 (90%) were men. Of 272 who responded to the question, 116 (43%) had subspecialty training. The average surgeon's operating room (OR) time was 1.5 d/wk and the average waiting time for elective procedures was 4 weeks. We found that 257 (94%) respondents performed basic laparoscopic procedures, and 164 (60%) performed appendectomy; 135 (49%) performed at least 1 advanced laparoscopic procedure in their practice, although only 30 (22%) of these performed inguinal hernia repair. Using a Likert scale, we found that the most important factors influencing the incorporation of advanced laparoscopic procedures into surgical practice were a lack of OR time (median 4), lack of OR financial resources (median 4) and lack of training opportunities (median 4). Of surgeons responding to questions, 161 (64%) of 251 felt that the present medical environment did not allow them to meet standard-of-care requirements; they felt that it was the responsibility of academic surgical departments (214 [80%] of 268), the Canadian Association of General Surgeons (177 [68%] of 262) and the Ontario Association of General Surgeons (141 [53%] of 264) to provide continuing medical education courses for MIS training. CONCLUSION: The ability of practising general surgeons to incorporate advanced MIS procedures into their surgical practice remains a complex issue. (+info)
Planning versus speed: an experimental examination of what Planned Codes of the Cognitive Assessment System measures.
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This study provided validity evidence that the Cognitive Assessment System, Planned Codes subtest measures planning rather than speed. Each of 156 children completed Planned Codes using two different sets of directions. The first set of directions allowed each child to use strategies to complete Planned Codes. The second set of directions allowed the child only to use speed to complete Planned Codes. The results of the study indicated significantly higher scores (t = 11.5, P < .0001) when the child was allowed to use strategies (mean = 34.1, S.D. = 9.2) compared to the same child's score when speed (mean = 25.6, S.D. = 7.5) alone was used to complete Planned Codes. A partial correlation, with age effects removed, between the scores each child earned under the two conditions was very low (r = .23, P < .01). Calculation of the magnitude of difference between the two groups yielded an effect size of 1.0. The results of this study provided validity support that the Cognitive Assessment System Planned Codes subtest measures planning. (+info)
Email triage of new neurological outpatient referrals from general practice.
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OBJECTIVES: To determine whether an email triage system between general practitioners and a neurologist for new outpatient referrals is feasible, acceptable, efficient, safe, and effective. METHODS: This was a prospective single cohort study on the interface between primary care practitioners and the neurology clinic of a district general hospital. Seventy six consecutive patients with neurological symptoms from nine GPs, for whom a specialist opinion was deemed necessary, were entered in the study. The number of participants managed without clinic attendance and the reduction in neurologist's time compared with conventional consultation was measured, as was death, other specialist referral, and change in diagnosis in the 6 months after episode completion. The acceptability for GPs was ascertained by questionnaire. RESULTS: Forty three per cent of participants required a clinic appointment, 45% were managed by email advice alone, and 12% by email plus investigations. GP satisfaction was high. Forty four per cent of the neurologist's time was saved compared with conventional consultation. No deaths or significant changes in diagnosis were recorded during the 6 month follow up period. CONCLUSIONS: Email triage is feasible, acceptable to GPs, and safe. It has the potential for making the practice of neurologists more efficient, and this needs to be tested in a larger randomised study. (+info)
Evacuation priorities in mass casualty terror-related events: implications for contingency planning.
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OBJECTIVE: To assess evacuation priorities during terror-related mass casualty incidents (MCIs) and their implications for hospital organization/contingency planning. SUMMARY BACKGROUND DATA: Trauma guidelines recommend evacuation of critically injured patients to Level I trauma centers. The recent MCIs in Israel offered an opportunity to study the impositions placed on a prehospital emergency medical service (EMS) regarding evacuation priorities in these circumstances. METHODS: A retrospective analysis of medical evacuations from MCIs (29.9.2000-31.9.2002) performed by the Israeli National EMS rescue teams. RESULTS: Thirty-three MCIs yielded data on 1156 casualties. Only 57% (506) of the 1123 available and mobilized ambulances were needed to provide 612 evacuations. Rescue teams arrived on scene within <5 minutes and evacuated the last urgent casualty within 15-20 minutes. The majority of non-urgent and urgent patients were transported to medical centers close to the event. Less than half of the urgent casualties were evacuated to more distant trauma centers. Independent variables predicting evacuation to a trauma center were its being the hospital closest to the event (OR 249.2, P < 0.001), evacuation within <10 minutes of the event (OR 9.3, P = 0.003), and having an urgent patient on the ambulance (OR 5.6, P < 0.001). CONCLUSIONS: Hospitals nearby terror-induced MCIs play a major role in trauma patient care. Thus, all hospitals should be included in contingency plans for MCIs. Further research into the implications of evacuation of the most severely injured casualties to the nearest hospital while evacuating all other casualties to various hospitals in the area is needed. The challenges posed by terror-induced MCIs require consideration of a paradigm shift in trauma care. (+info)
Laparoscopic suturing and knot tying: a comparison of standard techniques to a mechanical assist device.
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BACKGROUND: Suturing and knot tying are basic skills for surgeons. Performing these tasks laparoscopically can be a tedious, time-consuming endeavor associated with much frustration. We evaluated a mechanically assisted suture and pretied knot device (Quik-Stitch) for performing the basic tasks of suturing and knot tying. METHODS: We performed a time study using 1) intracorporeal suturing and knot tying, 2) intracorporeal suturing and extracorporeal knot tying, and 3) a mechanically assisted suture and pretied knot device (Quik-Stitch). From September 2000 through March 2001, time trials were conducted using each of the different techniques. Three attending surgeons, one with much experience and 2 with less experience, and 2 chief residents, with the least experience, participated in the study. RESULTS: For the experienced surgeon, the average times for intracorporeal knot tying, extracorporeal knot tying, and knot tying with Quik-Stitch were 97.3, 103.9, and 67.7 seconds, respectively. For the less experienced surgeons, the times were 237.2, 224.3, and 92.5 seconds, respectively. For the least experienced group, the times were 265.3, 263.0, and 128.7 seconds, respectively. CONCLUSIONS: The mechanically assisted suture device and pretied knot (Quik-Stitch by PARE Surgical, Inc, Englewood, CO, USA) provides significant time-saving to surgeons regardless of experience and thus reduces operating room costs. Less experienced surgeons and surgeons in training benefited the most by the use of this device. (+info)