Hypothetical Hospital Research Articles

Food for future: The impact of menu design on vegetarian food choice and menu satisfaction in a hypothetical hospital setting

Daily food choices do not only affect our health but also the environment in important ways. Food choice architecture can help to nudge people towards more healthy and sustainable food options. The current research explores the influence of menu design strategies on food choices and satisfaction in a hypothetical hospital setting. Specifically, we systematically tested the effect of vegetarian option availability, menu category framing, and health recommendation inclusion on hypothetical food choice and satisfaction, conducting two large online studies representative of the German adult population that consumes meat at least once a week (Study 1: N = 991; Study 2: N = 989). Both studies were based on a menu from a German university hospital. Results revealed that increasing the availability of vegetarian options increased vegetarian food choices. Neutral menu descriptions had no impact, whereas health recommendations that were presented in form of a visual appeal slightly increased vegetarian dish choices. Importantly, the research also considered menu satisfaction, revealing no main effects of availability, framing and health recommendation. Only when a health recommendation was added to a menu with high availability of vegetarian options, satisfaction was decreased. The findings suggest that menu design elements could modestly influence food choices and satisfaction among meat-eaters in healthcare settings, warranting further investigation with hospital patients.

Multi-stage and multi-objective design optimization for improving resilience of base-isolated hospital buildings

The hospital is a critical infrastructure for treating the injured after the earthquake. The hospital is a complex system composed of structure, non-structural components, and medical equipment that are located on different floors, have different importance and seismic performance, and need different control objectives, enhancing any component could improve the hospital's functionality. It is imperative to economically and rationally choose enhancement measures to minimize initial functionality losses and improve hospital resilience. This study provides a hospital functional evaluation method that takes into account the physical dimension of the damage to the structure, non-structural components and medical equipment, as well as the organizational dimension of the treatment process of earthquake casualties. Bayesian networks and discrete event simulation methods are used to calculate the availability probability of medical rooms and the functional indicator of the number of earthquake casualties that can be treated. Then, a two-stage and multi-objective functionality improvement method was proposed to improve hospital functionality. The first stage is the design optimization of the isolation system with the objectives of minimizing the functionality loss and displacement of the isolation layer. The second stage optimizing the enhancement strategies for non-structural components and medical equipment aims at minimizing the functionality loss and enhancement budget. The proposed method uses a fast and elitist non-dominated sorting genetic algorithm (NSGA-II) approach to optimize the design of the isolation system and the enhancement of non-structural components and medical equipment. The method is applied to a hypothetical hospital to highlight the proposed method's capability of improving the hospital's functionality.

What is a star worth to Medicare beneficiaries? A discrete choice experiment of hospital quality ratings.

Hospital quality ratings are widely available to help Medicare beneficiaries make an informed choice about where to receive care. However, how beneficiaries' trade-off between different quality domains (clinical outcomes, patient experience, safety, efficiency) and other considerations (out-of-pocket cost, travel distance) is not well understood. We sought to study how beneficiaries make trade-offs when choosing a hypothetical hospital. We administered an online survey that included a discrete choice experiment to a nationally representative sample of 1025 Medicare beneficiaries. On average, beneficiaries were willing to pay $1698 more for a hospital with a 1-star higher rating on clinical outcomes. This was over twice the value of the patient experience ($691) and safety ($615) domains and nearly 8 times the value of the efficiency domain ($218). We also found that the value of a 1-star improvement depends not only on the quality domain but also the baseline level of performance of the hospital. Generally, it is more valuable for low-performing hospitals to achieve average performance than for average hospitals to achieve excellence.

Prevention of surgical site infections: a personal odyssey

Prevention of surgical site infections: a personal odyssey

Interpretability, credibility, and usability of hospital-specific template matching versus regression-based hospital performance assessments; a multiple methods study

BackgroundHospital-specific template matching (HS-TM) is a newer method of hospital performance assessment.ObjectiveTo assess the interpretability, credibility, and usability of HS-TM-based vs. regression-based performance assessments.Research designWe surveyed hospital leaders (January-May 2021) and completed follow-up semi-structured interviews. Surveys included four hypothetical performance assessment vignettes, with method (HS-TM, regression) and hospital mortality randomized.SubjectsNationwide Veterans Affairs Chiefs of Staff, Medicine, and Hospital Medicine.MeasuresCorrect interpretation; self-rated confidence in interpretation; and self-rated trust in assessment (via survey). Concerns about credibility and main uses (via thematic analysis of interview transcripts).ResultsIn total, 84 participants completed 295 survey vignettes. Respondents correctly interpreted 81.8% HS-TM vs. 56.5% regression assessments, p < 0.001. Respondents “trusted the results” for 70.9% HS-TM vs. 58.2% regression assessments, p = 0.03. Nine concerns about credibility were identified: inadequate capture of case-mix and/or illness severity; inability to account for specialized programs (e.g., transplant center); comparison to geographically disparate hospitals; equating mortality with quality; lack of criterion standards; low power; comparison to dissimilar hospitals; generation of rankings; and lack of transparency. Five concerns were equally relevant to both methods, one more pertinent to HS-TM, and three more pertinent to regression. Assessments were mainly used to trigger further quality evaluation (a “check oil light”) and motivate behavior change.ConclusionsHS-TM-based performance assessments were more interpretable and more credible to VA hospital leaders than regression-based assessments. However, leaders had a similar set of concerns related to credibility for both methods and felt both were best used as a screen for further evaluation.

Advantages in Management and Remote Monitoring of Intravenous Therapy: Exploratory Survey and Economic Evaluation of Gravity-Based Infusions in Finland

IntroductionIntravenous infusion therapy is a common and challenging invasive treatment procedure in hospital wards. Administration mistakes can have serious, even life-threatening, consequences. The Monidor solution was developed to help nurses administer gravity-based infusions and monitor them remotely, to avoid complications and reduce workload. Its real-world effects and economic consequences were unknown.MethodsAn exploratory survey was carried out to estimate the potential impact of the Monidor solution on events and nurse time use. At the end of their shift, nurses estimated effects in terms of routine room visits avoided, prevention of complications, and impact on nurse time requirements. Linear regression was applied to estimate predictors of time freed. A health economic model was developed to evaluate economic consequences and to calculate the net return on investment for a hypothetical hospital ward. A 1-month time horizon was used, and discounting was not applied.ResultsA total of 216 responses were obtained from 6 Finnish hospitals, from a total of 15 wards, and 56.3% of nurses found that the Monidor solution freed nurse time, while < 3.5% experienced additional time requirements. Per nurse shift, the Monidor solution avoided on average 2.064 routine room visits, helped detect end of infusion 1.340 times, and led to 5.045 min of time freed. One routine visit avoided was associated with 2.453 min of time freed in the linear regression. In the conservative setting, the freed monthly capacity in the hypothetical ward amounted to €1270.90 per month (year 2021), yielding a return on investment of 2.63. Uncertainty of linear regression coefficient values was identified as a driver of uncertainty in sensitivity analysis, with return on investment ranging from 1.55 to 3.71.ConclusionsThe study demonstrated that management and remote monitoring with the Monidor solution frees nurse time and reduces routine activities associated with gravity-based intravenous infusions. These findings could be confirmed in a comparative empirical study.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02093-6.

Using Discrete Choice Methodology to Explore the Impact of Patient Room Window Design on Hospital Choice.

Evidence-based design has been fundamental to designing healthcare environments for patient outcomes and experience, yet few studies have studied how design factors drive patient choice. 652 patients who recently received care at hospitals across the United States were administered an online discrete choice survey to investigate the factors playing into their choice between hypothetical hospitals. Discrete choice models are widely used to model patient preferences among treatment alternatives, but few studies have utilized this approach to investigate healthcare design alternatives. In the current study, respondents were asked to choose between hypothetical hospitals that differed in patient room design, window features of the room, appointment availability, distance from home, insurance coverage, and HCAHPS ratings. The results demonstrate that patient room design that allowed unobscured access to daylight and views through windows, in-network insurance coverage, closer distance from home, and one-star higher patient experience rating increased the likelihood of a patient's hospital choice. The study broadly explores discrete choice model's applicability to healthcare design and its ability to quantify patient perceptions with a metric meaningful for hospital administrators.

Evaluating the Costs of Nurse Burnout-Attributed Turnover: A Markov Modeling Approach.

Burnout is a public health crisis that impacts 1 in 3 registered nurses in the United States and the safe provision of patient care. This study sought to understand the cost of nurse burnout-attributed turnover using hypothetical hospital scenarios. A cost-consequence analysis with a Markov model structure was used to assess nurse burnout-attributed turnover costs under the following scenarios: (1) a hospital with "status quo" nurse burnout prevalence and (2) a hospital with a "burnout reduction program" and decreased nurse burnout prevalence. The model evaluated turnover costs from a hospital payer perspective and modeled a cohort of nurses who were new to a hospital. The outcome measures were defined as years in burnout among the nurse cohort and years retained/employed in the hospital. Data inputs derived from the health services literature base. The expected model results demonstrated that at status quo, a hospital spends an expected $16,736 per nurse per year employed on nurse burnout-attributed turnover costs. In a hospital with a burnout reduction program, such costs were $11,592 per nurse per year employed. Nurses spent more time in burnout under the status quo scenario compared with the burnout reduction scenario (1.5 versus 1.1 y of employment) as well as less time employed at the hospital (2.9 versus 3.5 y of employment). Given that status quo costs of burnout are higher than those in a hospital that invests in a nurse burnout reduction program, hospitals should strongly consider proactively supporting programs that reduce nurse burnout prevalence and associated costs.

Impact of the subcutaneous formulations of trastuzumab and rituximab on efficiency and resource optimization in Spanish hospitals: H-Excelencia study

BackgroundSubcutaneous (SC) versus intravenous (IV) administration is advantageous in terms of patient convenience and hospital efficiency. This study aimed to compare the effect of optimizing the processes involved in SC versus IV administration of rituximab and trastuzumab on hospital capacity and service quality.MethodsThis cross-sectional resource utilization study interviewed oncologists, hematologists, nurses, and pharmacists from 10 hospitals in Spain to estimate changes in processes associated with conversion from IV to SC rituximab and trastuzumab, based on clinical experience and healthcare use from administrative databases.ResultsEfficient use of SC formulations increased the monthly capacity for parenteral administration by 3.35% (potentially increasable by 5.75% with maximum possible conversion according to the product label). The weekly capacity for hospital pharmacy treatment preparation increased by 7.13% due to conversion to SC formulation and by 9.33% due to transferring SC preparation to the cancer treatment unit (potentially increasable by 12.16 and 14.10%, respectively). Monthly hospital time decreased by 33% with trastuzumab and 47% with rituximab. In a hypothetical hospital, in which all processes for efficient use of SC rituximab and/or trastuzumab were implemented and all eligible patients received SC formulations, the estimated monthly capacity for preparation and administration increased by 23.1% and estimated hospital times were reduced by 60–66%.ConclusionsConversion of trastuzumab and rituximab to SC administration could improve the efficiency of hospitals and optimize internal resource management processes, potentially increasing care capacity and improving the quality of care by reducing time spent by patients at hospitals.

Children's Hospitals: We Get What We Pay For.

* Abbreviations: FCH — : freestanding children’s hospital HDDI — : hospital diversity of diagnosis index NCH — : nonchildren’s hospital NFCH — : nonfreestanding children’s hospital In 2016, the US spent $3.34 trillion on health care, with almost one-third of it allocated to hospitalizations1; of that total, $47.7 billion was for pediatric hospitalizations.2 As hospitalization expenditures continue to increase, much attention is understandably focused on how to identify the drivers of these high-cost events, in particular, on what explains the considerable variation in hospitalization costs among different hospitals caring for similar conditions. On one hand, we know that certain patient characteristics are associated with more expensive care. We have learned, for example, that children with documented high-risk social conditions have longer lengths of stay3 and those children hospitalized from low-income zip codes also incur higher costs for common pediatric conditions compared with children from high-income zip codes.4 But these variations in patient features are not enough themselves to account for the cost differences observed among different hospitals. In this issue of Pediatrics, Berry et al5 offer another insight into the phenomenon of hospital cost variation. Beginning with the premise that hospitals that care for a greater variety of conditions likely incur a higher set of fixed costs, the authors invoke a novel instrument, the hospital diversity of diagnosis index (HDDI), … Address correspondence to Andrew D. Racine, MD, PhD, Montefiore Health System, 111 E 210th St, Bronx, NY 10467. E-mail: aracine{at}montefiore.org

Modelling of hypothetical SARS-CoV-2 point-of-care tests on admission to hospital from A&E: rapid cost-effectiveness analysis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease 2019. At the time of writing (October 2020), the number of cases of COVID-19 had been approaching 38 million and more than 1 million deaths were attributable to it. SARS-CoV-2 appears to be highly transmissible and could rapidly spread in hospital wards. The work undertaken aimed to estimate the clinical effectiveness and cost-effectiveness of viral detection point-of-care tests for detecting SARS-CoV-2 compared with laboratory-based tests. A further objective was to assess occupancy levels in hospital areas, such as waiting bays, before allocation to an appropriate bay. The perspective was that of the UK NHS in 2020. The setting was a hypothetical hospital with an accident and emergency department. An individual patient model was constructed that simulated the spread of disease and mortality within the hospital and recorded occupancy levels. Thirty-two strategies involving different hypothetical SARS-CoV-2 tests were modelled. Recently published desirable and acceptable target product profiles for SARS-CoV-2 point-of-care tests were modelled. Incremental analyses were undertaken using both incremental cost-effectiveness ratios and net monetary benefits, and key patient outcomes, such as death and intensive care unit care, caused directly by COVID-19 were recorded. A SARS-CoV-2 point-of-care test with a desirable target product profile appears to have a relatively small number of infections, a low occupancy level within the waiting bays, and a high net monetary benefit. However, if hospital laboratory testing can produce results in 6 hours, then the benefits of point-of-care tests may be reduced. The acceptable target product profiles performed less well and had lower net monetary benefits than both a laboratory-based test with a 24-hour turnaround time and strategies using data from currently available SARS-CoV-2 point-of-care tests. The desirable and acceptable point-of-care test target product profiles had lower requirement for patients to be in waiting bays before being allocated to an appropriate bay than laboratory-based tests, which may be of high importance in some hospitals. Tests that appeared more cost-effective also had better patient outcomes. There is considerable uncertainty in the values for key parameters within the model, although calibration was undertaken in an attempt to mitigate this. The example hospital simulated will also not match those of decision-makers deciding on the clinical effectiveness and cost-effectiveness of introducing SARS-CoV-2 point-of-care tests. Given these limitations, the results should be taken as indicative rather than definitive, particularly cost-effectiveness results when the relative cost per SARS-CoV-2 point-of-care test is uncertain. Should a SARS-CoV-2 point-of-care test with a desirable target product profile become available, this appears promising, particularly when the reduction on the requirements for waiting bays before allocation to a SARS-CoV-2-infected bay, or a non-SARS-CoV-2-infected bay, is considered. The results produced should be informative to decision-makers who can identify the results most pertinent to their specific circumstances. More accurate results could be obtained when there is more certainty on the diagnostic accuracy of, and the reduction in time to test result associated with, SARS-CoV-2 point-of-care tests, and on the impact of these tests on occupancy of waiting bays and isolation bays. These parameters are currently uncertain. This report was commissioned by the National Institute for Health Research (NIHR) Evidence Synthesis programme as project number 132154. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 21. See the NIHR Journals Library website for further project information.

Using Combined Tabletop and Simulation Activities to Improve Nursing Students' Attitudes About Quality Improvement: A Feasibility Study.

Nursing students' attitudes about quality improvement (QI) reflect poor understanding of its importance. In a mixed-method interventional feasibility study, students received instruction about QI processes, plus information about factors contributing to central line-associated bloodstream infection (CLABSI) rates at a hypothetical hospital. Experimental group students observed a high-fidelity simulation bedside report for a CLABSI-affected patient. Both groups independently completed tabletop QI exercises to solve the CLABSI problem and had equivalent improvement in attitudes. Joint debriefing revealed how experimental group students developed greater understanding of interrelated, system-wide contributing factors. Hybrid learning activities with tabletop and simulation positively influence students' attitudes about QI.

Cost–consequence analysis of 18F-fluciclovine for the staging of recurrent prostate cancer

ABSTRACT Background: Current detection methodologies are often unable to identify the location and extent of recurrent prostate cancer (PCa) leading potentially to ‘futile’ local therapies in the presence of metastatic disease. The use of 18 F-fluciclovine PET/CT may lead to better patient management. Objective: The aim of this study was to quantify the economic impact and cost–consequence of using 18 F-fluciclovine PET/CT in PCa recurrence. Study design: A decision analytic model based on recurrent PCa imaging guidelines. Setting: US hospital. Participants: PCa patients experiencing biochemical recurrence. Intervention: 18 F-fluciclovine PET/CT was compared to conventional imaging. Main outcome measure: Budget impact, correct diagnoses, futile treatments, and cost-consequence (cost per correct diagnosis) Results: For a hypothetical hospital serving 500,000 individuals, the model showed the use of 18 F-fluciclovine reduced ‘futile’ therapies by 19.2%. Re-imaging costs were reduced by 40.2% ($8.2 million); however, when assuming diagnostic and staging costs only, the total costs increased from $31.2 to $34.6 million (10.9%), driven by 18 F-fluciclovine imaging agent and procedure costs. The cost per ‘correct’ diagnosis declined $30,673 (46.8%). When including subsequent 5-year patient management, the cost per ‘correct’ diagnosis declined $410,206 (49.2%). Conclusion: 18 F-fluciclovine PET/CT imaging may improve the clinical management of men with recurrent PCa with minimal increase in healthcare spending.

PIN67 BUDGET IMPACT ANALYSIS OF THE IMPLEMENTATION OF A PRESURGICAL WARMING PROTOCOL TO EFFECTIVELY MANAGE SURGICAL PATIENT NORMOTHERMIA

Perform a budget impact analysis from a hospital perspective and estimate the cost savings achieved by adding a presurgical warming protocol to intra-operative warming, using a forced-air warming system to prevent inadvertent perioperative hypothermia (IPH). The one-year time horizon budget impact model is based on a new static decision-tree, modified from a model published by NICE in 2008. Based on IPH rate, the model allows a comparison of different patient temperature management strategies with associated material and adverse consequences costs. The current analysis uses IPH rates measured in a German hospital when implementing active pre-warming plus intra-operative warming versus intra-operative warming only. Adverse consequences of IPH, according to the NICE guidance, are grouped in surgical site infections (SSI), morbid cardiac events (MCE) and other complications, including the need of blood transfusions. The cost of the adverse consequences is monetized via increased length-of-stay (LOS). The model accounts for minor, intermediate and major surgery and four different age groups following German DRG-data to evaluate the relative risk for SSI and MCE. The costs of a bed-day on a surgical ward are derived from WHO estimates. The hypothermia rate from a retrospective study including 7786 patients having a surgery duration of at least 30 minutes under general anesthesia showed an IPH decrease from 12.4% to 5.1% with the introduction of active pre-warming in addition to intra-operative warming. For a hypothetical hospital conducting 1,000 surgical procedures per year (48% minor, 30% intermediate and 22% major), the implementation of pre-warming could result in total annual cost savings of 192,220€, corresponding to 60% direct costs decrease, 300 less hypothermia events and 342 days reduction in attributable LOS. The implementation of pre-warming is a cost saving intervention and should be recommended for effective management of patient normothermia.

Economic Model for Cost Containment: Evaluating the Utilization of a Touch-free Zinc Oxide in an Acute Care Hospital.

IntroductionIncontinence-associated dermatitis (IAD), the most common form of moisture-associated skin damage (MASD), puts patients at higher risk for ulceration. Treatment of MASD/IAD includes application of zinc oxide, typically applied using gloved hands directly to the area of concern. A computational model was utilized to examine a cost comparison of a touch-free zinc oxide treatment versus traditional zinc oxide for MASD/IAD.MethodsA literature search was performed using PubMed, a nursing journal database (CINAHL), and MEDLINE for publications from January 1, 2010 through November 30, 2017. Data on prevalence of MASD/IAD, average length of stay, and time to heal were extracted and utilized in the computational model. Cost per patient stay and annual total hospital costs were calculated for three and four applications of zinc oxide per patient with an averaged prevalence rate of 25% for a hypothetical hospital.ResultsThe computational model estimated a range of cost savings between $181.88 to $2,000.63 per patient stay, and $4,728.88 to $52,016.25 over a 12-month period compared to traditional zinc oxide application.ConclusionsThe computational model estimated a cost savings of up to $52,016.25 per year in a hypothetical 250-bed acute care hospital compared to traditional zinc oxide application. Future prospective studies examining clinical effectiveness and health economics of touch-free zinc oxide are necessary.

A Monte Carlo simulation estimating US hospital cost reductions associated with hypotension control in septic ICU patients

Objective: This economic analysis extends upon a recent epidemiological study to estimate the association between hypotension control and hospital costs for septic patients in US intensive care units (ICUs).Methods: A Monte Carlo simulation decision analytic model was developed that accounted for the probability of complications—acute kidney injury and mortality—in septic ICU patients and the cost of each health outcome from the hospital perspective. Probabilities of complications were calculated based on observational data from 110 US hospitals for septic ICU patients (n = 8,782) with various levels of hypotension exposure as measured by mean arterial pressure (MAP, units: mmHg). Costs for acute kidney injury (AKI) and mortality were derived from published literature. Each simulation calculated mean hospital cost reduction and 95% confidence intervals based on 10,000 trials.Results: In the base-case analysis hospital costs for a hypothetical “control” cohort (MAP of 65 mmHg) were $699 less per hospitalization (95% CI: $342–$1,116) relative to a “case” cohort (MAP of 60 mmHg). In the most extreme case considered (45 mmHg vs 65 mmHg), the associated cost reduction was $4,450 (95% CI: $2,020–$7,581). More than 99% of the simulated trials resulted in cost reductions. A conservative institution-level analysis for a hypothetical hospital (which assumes no benefit for increasing MAP above 65 mmHg) estimated a cost decline of $417 for a 5 mmHg increase in MAP per ICU septic patient. These results are applicable to the US only.Conclusions: Hypotension control (via MAP increases) for patients with sepsis in the ICU is associated with lower hospitalization cost.

Where We Walk Is What We See: Foundational Concepts and Analytical Techniques of Space Syntax.

The most difficult issue in writing a methods paper on Space Syntax is that it is not simply a method. It is a theory on which a methodology has been built. In the 40 years since introduction, both its theory and its methods have advanced, including the creation and development of computerized software. Essentially Space Syntax investigates layouts, seen in plan drawings; but this is done from mature theoretical arguments about function in those spaces. While theories of society were at the genesis of Space Syntax, it has branched into cognition, transportation, economics, and so on, and has been used to investigate buildings, cities, and regions. In the last decade or so, Space Syntax has been used in different ways to investigate healthcare facilities. This article concentrates on explaining the analytical techniques of Space Syntax. The theoretical underpinnings are minimally described-just enough for the reader to understand the basis of the methods. All examples provided are based on the same hypothetical hospital floor layout for ease of comprehension and comparison. Also, all Space Syntax concepts are italicized for identification. Since the theoretical aspects are not treated in detail, the reader is advised to pay particular attention to the citations for advanced comprehension. This cannot be overemphasized.

Economic analysis of implementing virtual reality therapy for pain among hospitalized patients

Virtual reality (VR) has emerged as a novel and effective non-pharmacologic therapy for pain, and there is growing interest to use VR in the acute hospital setting. We sought to explore the cost and effectiveness thresholds VR therapy must meet to be cost-saving as an inpatient pain management program. The result is a framework for hospital administrators to evaluate the return on investment of implementing inpatient VR programs of varying effectiveness and cost. Utilizing decision analysis software, we compared adjuvant VR therapy for pain management vs. usual care among hospitalized patients. In the VR strategy, we analyzed potential cost-savings from reductions in opioid utilization and hospital length of stay (LOS), as well as increased reimbursements from higher patient satisfaction as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The average overall hospitalization cost-savings per patient for the VR program vs. usual care was $5.39 (95% confidence interval –$11.00 to $156.17). In a probabilistic sensitivity analysis across 1000 hypothetical hospitals of varying size and staffing, VR remained cost-saving in 89.2% of trials. The VR program was cost-saving so long as it reduced LOS by ≥14.6%; the model was not sensitive to differences in opioid use or HCAHPS. We conclude that inpatient VR therapy may be cost-saving for a hospital system primarily if it reduces LOS. In isolation, cost-savings from reductions in opioid utilization and increased HCAHPS-related reimbursements are not sufficient to overcome the costs of VR.

PHP94 - Budget Impact Model of Low Chloride Balanced Intravenous Solutions in Patients with Systemic Inflammatory Response Syndrome from a Hospital Perspective in Colombia

The study aimed to assess the budget impact of increasing usage of low chloride balanced solutions (BAL) for IV fluid therapy on costs of fluids and avoidance of fluid-related adverse outcomes in patients with systemic inflammatory response syndrome (SIRS) from a hospital perspective in Colombia. An Excel®-based budget impact model was adapted to assess the impact of increased usage of BAL in SIRS patients versus current IV fluid practice on the costs of IV fluids and fluid-related complications in a hypothetical hospital with 300 beds and 47 patients with SIRS per month. Two scenarios were compared, a baseline scenario which assumed 2% of patients were treated with BAL and an alternate scenario with a BAL adoption of 5% in Year 1, 8% in Year 2, 12% in Year 3, 16% in Year 4 and 20% in Year 5. Complication frequencies of SIRS were adapted from a single observational study. Cost of IV fluids and SIRS complications (length of stay, medication, procedures, professional services and diagnostic costs) were obtained from a literature search of Colombian studies, local national tariffs and expert opinion. All values were reviewed and validated by experts. With BAL adoption increasing progressively each year, a hypothetical Colombian hospital with 300 beds and 47 SIRS patients per month would produce cumulative savings of 78 million Colombian pesos (COP) in Year 1, 235 million COP by Year 2, 495 million COP by Year 3, 860 million COP by Year 4 and 1.33 billion COP by Year 5. The adoption of BAL could produce savings for a Colombian hospital due to a reduction in SIRS-related complications and their associated costs.

Design Optimization of a Complex Polygeneration System for a Hospital

Small-scale decentralized polygeneration systems have several energetic, economic and environmental benefits. However, using multiple energy sources and providing multiple energy services can lead to complicated studies which require advanced optimization techniques for determining optimal solutions. Furthermore, several parameters can influence the design and performance of a polygeneration system. In this study, the effects of heat load, renewable generation and storage units on the optimal design and performance of a polygeneration system for a hypothetical hospital located in northern Italy are investigated. The polygeneration system shows higher performance compared to the reference system, which is based on the separate generation of heat and power. It reduces fuel consumption by 14–32%, CO2 emissions by 10–29% and annualized total cost by 7–19%, for various studied scenarios. The avoided fuel and electricity purchase of the polygeneration system has a positive impact on the economy. This, together with the environmental and energetic benefits if the renewable generation and use of storage devices, indicate the viability and competitiveness of the system.