Reduce Hospital Costs Research Articles

VENTILATOR-ASSOCIATED PNEUMONIA: DENTISTRY CONTRIBUTIONS

<h3>Objectives</h3> The aim of this study was to conduct a narrative review about the importance of oral health care in intensive care units (ICU). <h3>Study Design</h3> For the articles search, the following databases were consulted: PubMed and Scielo, using the descriptors "Pneumonia, Ventilator-Associated"; "Dentistry." The Boolean operator used was "and" through the combination: pneumonia, ventilator-associated and dentistry. The search was restricted to publications from the last 5 years. <h3>Results</h3> After the search, 88 articles were found. Oral hygiene with chlorhexidine reduces the risk of developing ventilator-associated pneumonia (VAP). Some studies also suggest that the oral hygiene protocol performance reduces the length of stay in the ICU and, consequently, reduces the costs of hospitalization. In addition, the greatest risk factor for the VAP development was the high ventilation time. <h3>Conclusions</h3> VAP is one of the most common infections and one of the biggest causes of death in the ICU. The hospital dentistry team's presence leads to a significant improvement in oral health. Thus, the implementation of oral hygiene care reduces VAP frequency; it has a positive impact on the systemic health, and it reduces hospitalization costs.

Intensive Care Based Interventions to Reduce Family Member Stress Disorders: A Systematic Review of the Literature.

BackgroundIncreasing awareness of the emotional impact of an Intensive Care Unit (ICU) hospitalization on patients and their families has led to a rise in studies seeking to mitigate Post Intensive Care Syndrome (PICS) for both groups. In efforts to decrease symptoms of anxiety and depression, ICUs have implemented a variety of programs to reduce family distress.MethodsWe conducted a systematic review of experimental studies which aimed to reduce stress related disorders in family members after the experience of having a patient admitted to the ICU. Multiple databases were searched for randomized controlled trials or nonrandomized comparative trials which targeted family members or surrogate decision makers. A total of 17 studies were identified for inclusion in the review representing 3471 participants.ResultsWe describe those interventions which we qualitatively assigned as “not passive,” or those which actively engaged the family to express themselves, as more likely to be successful in both the available pediatric and adult literature than interventions which we identified as “passive.” Studies which described active engagement of family members demonstrated comparative improvements in symptoms of depression, anxiety, and PTSD, as well as reduced hospital costs in the case of two studies.DiscussionThis review may serve to aid in the development of future interventions targeted at reducing family stress and PICS following an ICU hospitalization.

The direct and indirect effects of length of hospital stay on the costs of inpatients with stroke in Ningxia, China, between 2015 and 2020: A retrospective study using quantile regression and structural equation models.

ImportanceLength of hospital stay (LOHS) is the main cost-determining factor of hospitalization for stroke patients. However, previous analyses involving LOHS did not consider confounding or indirect factors, or the effects of other factors on LOHS and inpatient costs.ObjectiveTo investigate the direct and indirect effects of LOHS on the hospitalization costs of inpatients with ischemic and hemorrhagic stroke.Design, setting, and participantsThis was a population-based, retrospective, and observational study that analyzed data acquired from the Nationwide Inpatient Sample between 2015 and 2020 relating to ischemic and hemorrhagic stroke in Ningxia, China.Main outcomes and measuresHospitalizations were identified by the International Classification of Diseases 10th Revision (ICD-10). Inpatient costs were described by the median M (P25, P75). We used a quantile regression model to estimate the linear relationships between a group of independent variables X and the quantile of the explained variable hospitalization cost (Y). A structural equation model (SEM) was then used to investigate the direct and indirect effects of LOHS on inpatient costs.ResultsThe study included 129,444 patients with ischemic stroke and 15,525 patients with hemorrhagic stroke. The median LOHS was 10 (8–13) days for ischemic stroke and 15 (10–22) days for hemorrhagic stroke. The median M (P25, P75) of inpatient costs was $1020 (742–1545) for ischemic stroke and 2813 (1576–6191) for hemorrhagic stroke. The total effect of LOHS on inpatient costs was 0.795 in patients with ischemic stroke. The effect of yearof discharge (X4) and CCI (X8) on inpatient costs was dominated by an indirect effect through the LOHS. The indirect effect was −0.071 (84.52% of the total effect value) and 0.034 (69.39% of the total effect value), respectively. The total effect of LOHS on inpatient costs in patients with hemorrhagic stroke was 0.754. The influence of CCI on inpatient costs was dominated by an indirect effect through LOHS; the indirect effect value was −0.028 (77.78% of the total effect value). The payment type, surgery, method of discharge, and hospital level also exerted an impact on inpatient costs by direct and indirect effects through the LOHS.Conclusions and relevanceLength of hospital stay (LOHS) was identified as the main factor influencing hospitalization costs. However, other social factors were shown to indirectly influence hospitalization costs through the LOHS. Taking effective measures to further reduce hospitalization costs remains an effective way to control hospitalization costs for stroke patients.

The Efficacy of the BioFire FilmArray Gastrointestinal Panel to Reduce Hospital Costs Associated With Contact Isolation: A Pragmatic Randomized Controlled Trial.

Background: Molecular syndromic panels can rapidly detect common pathogens responsible for acute gastroenteritis in hospitalized patients. Their impact on both patient and healthcare system outcomes is uncertain compared to conventional stool testing. This randomized trial evaluates the impact of molecular testing on in-hospital resource utilization compared to conventional stool testing.Methods: Hospitalized patients with acute diarrheal illness were randomized 1:1 to either conventional or molecular stool testing with the BioFire FilmArray gastrointestinal panel (FGP). The primary outcome was the duration of contact isolation, and secondary outcomes included other in-hospital resource utilization such as diagnostic imaging and antimicrobial use.Results: A total of 156 patients were randomized. Randomization resulted in a balanced allocation of patients across all three age strata (<18, 18-69, ≥70 years old). The proportion of positive stools was 20.5% vs 29.5% in the control and FGP groups, respectively (p=0.196). The median duration of contact isolation was 51 hours (interquartile range [iqr] 66) and 69 hours (iqr 81) in the conventional and FGP groups, respectively (p=0.0513). There were no significant differences in other in-hospital resource utilization between groups.Conclusions: There were no differences in in-hospital resource utilization observed between the FGP and conventional stool testing groups.

Comparison of anal dilatation versus no dilatation with a standardized dilator in reducing pain after hemorrhoidectomy: a randomized control trial

BackgroundPost-operative pain is the main problem of hemorrhoidectomy. An adequate pain management can promote early mobilization, fast recovery, and reduce hospitalization costs. This study aimed to investigate the role of preoperative anal dilatation using a standardized anal dilator in reducing post-operative pain.MethodThis study was conducted using randomized prospective trial with a total of 40 subjects, who were divided into 2 groups. The first group received preoperative anal dilatation using a 33 mm anal dilator for 20 min, while the second group did not. The post-operative anal pain, edema, bleeding, and incontinence were observed in the first, second, and seventh day.ResultThe post-operative pain was significantly lower in the preoperative anal dilatation group for all days of observation (p < 0.05). The difference of post-operative bleeding and edema between groups were not significant. Fecal incontinence was initially significantly higher in the preoperative anal dilatation group, but the difference was insignificant at the seventh day (p = 0.500).ConclusionPreoperative anal dilatation significantly reduced post-operative pain. The side effect of fecal incontinence was only temporary until the seventh day after surgery.Trial Registration This trial was registered on Thai Clinical Trials Registry (TCTR) with TCTR identification number TCTR20220314002, on 14/03/2022 (retrospectively registered).

Elective Endovascular Treatment of Unruptured Intracranial Aneurysms.

BackgroundElective endovascular treatment (EVT) of unruptured intracranial aneurysms (UIA) is a commonly used treatment modality. However, the appropriate post-procedure management is not well-defined.MethodsThis was a single-center, retrospective review of all adults undergoing EVT of UIA performed between January 1, 2010, and March 31, 2020. Patients with any current intracranial hemorrhage or clinical symptoms severe enough to warrant emergent intervention were excluded.ResultsSixty-seven UIA were treated on 58 patients. The mean dome diameter was 6.6 mm (2-20, ±3.9), the most common parent vessel was the internal carotid artery (43.2%, 29/67), and sole flow diverter stents were the most common device used (46.2%, 31/67). Post-treatment, 43.2% (29/67) patients went to the neurocritical care unit (NCCU). The mean NCCU length of stay (LOS) was 1.07 days (range 1-4, ±0.5), and 96.6% (28/29) only spent one day in the NCCU. There were no (0%, 0/67) anesthesia-related procedural complications. One (1.5%, 1/67) intra-procedural complication was an aneurysm rupture during attempted coiling. There were five (7.4%, 5/67) post-procedural complications: two (3.0%, 2/67) groin hematomas, two (3.0%, 2/67) permanent neurologic events (left lower extremity hypoesthesia and left upper extremity hemiparesis), and one (1.5%, 1/67) temporary neurologic event (aphasia). Post-procedural complications were associated with longer hospital LOS (p=0.02), but not with longer NCCU LOS. No acute management changes occurred for the five patients that developed post-procedural complications. There were no (0%, 0/67) 30-day readmissions.ConclusionThe overall incidence of post-procedure complications was low. In the future, a possible viable way to reduce hospital costs may involve utilizing a hospital unit that could closely monitor patients but only for a short period of time post-procedure.

Laparoscopic Versus Open Pancreatoduodenectomy: Cost-Effectiveness Analysis.

Background and Objectives: The role of laparoscopy during a pancreatoduodenectomy (PD) is not clearly defined. The purpose of this study was thus to compare the cost-effectiveness between laparoscopic pancreatoduodenectomy (LPD) and open pancreatoduodenectomy (OPD). Materials and Methods: From 2010 to 2019, 140 patients underwent PD (60 LPD and 80 OPD). After 60-60 matching, the clinical-pathological characteristics, surgical technique, and type of rehabilitation were identical in both groups. Complications, R0 resection, and cost were compared. Results: Complication rates were 48% (12% Clavien-Dindo grade 3-4) in the LPD group and 64% (22% Clavien-Dindo grade 3-4) in the OPD group. The LPD group had significantly fewer pulmonary complications (6%) than the OPD group (20%) (P = .04). The oncological quality of the R0 resection did not differ between the two groups. The operating time was 312 ± 50 minutes in the OPD group and 392 ± 75 minutes in the LPD group (P < .001). The mean length of hospital stay was significantly shorter for the LPD group (13 ± 10) days compared to the OPD group (19 ± 8) days (P = .02). The average cost of total hospital stay was significantly lower for the LPD group compared to the OPD group (P = .02). Conclusions: Despite longer operative times, LPD had fewer (pulmonary) complications and reduced hospital costs.

Historical and Forecasted Changes in Utilization of Same-Day Discharge After Minimally Invasive Hysterectomy

(Abstracted from J Minim Invasive Gynecol 2022; doi: 10.1016/j.jmig.2022.03.011) In conjunction with minimally invasive hysterectomy (MIH), enhanced recovery after surgery pathways allows providers to offer same-day discharge (SDD), thereby reducing hospital cost and preventing increased adverse outcomes when compared with an overnight stay. This study was a cross-sectional analysis of studies found in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to describe changes in length of stay and SDD after MIH over the last decade and forecast anticipated utilization over the subsequent decade.

Estimated Cost-Effectiveness of Implementing a Statewide Tranexamic Acid Protocol for the Management of Suspected Hemorrhage in the Prehospital Setting

Introduction: Hemorrhage is responsible for up to 40% of all traumatic deaths. The seminal CRASH-2 trial demonstrated a reduction in overall mortality following early tranexamic acid (TXA) administration to bleeding trauma patients. Following publication of the trial results, TXA has been incorporated into many prehospital trauma protocols. However, the cost-effectiveness of widespread TXA adoption by EMS is unknown. Objective: To estimate the cost-effectiveness of statewide implementation of a TXA protocol. Methods: The North Carolina Trauma Registry was queried to identify potential TXA patients using the a priori criteria of age ≥18 years, suspected hemorrhage, penetrating or blunt injury, and prehospital blood pressure <90 mmHg and heart rate >110 bpm. Using life tables adjusted for age, sex, and race, and the absolute risk reductions in mortality with early TXA administration reported in the literature, the life-years gained were calculated for each potential life saved. Implementation costs consisted of initial stocking, training, and replacement costs. Projected reduction in hospitalization costs were based on estimates reported in the literature. Economic analyses were conducted from societal and state EMS system perspectives. To assess the robustness of the model, univariate and bivariate sensitivity analyses were performed on selected input variables. Results: Based on the TXA inclusionary criteria, 159 patients could potentially receive TXA per year. In the base-case scenario with a projected absolute mortality reduction of 3%, an additional 4.8 lives per year in NC would be saved, with an estimated 191 total life-years gained. The statewide implementation and operation cost was $305,122 in year 1, and continued operating costs were $6,042 in years 2 and 3, yielding a cost per life saved of $63,967 in year 1 and $1,267 in years 2 and 3. The cost per life-year gained was $1,595 in year 1 and $32 in years 2 and 3. Annual hospitalization costs would potentially be reduced by $1,828,072. Conclusion: Previous studies have demonstrated the clinical effectiveness of early TXA administration to patients with hemorrhage. Our modeling of the financial implications and clinical benefits of implementing a statewide TXA protocol suggests that prehospital TXA is a cost-effective treatment.

EE329 Early Albumin Infusion in Cirrhotic Patients with Spontaneous Bacterial Peritonitis (SBP) Is Associated with Reductions in Total Hospitalization Costs: A Cross-Sectional Study

SBP is a common, life-threatening complication of cirrhosis that imposes a substantial and growing healthcare cost burden. Treatment guidelines from the American Association for the Study of Liver Diseases recommend albumin administration in conjunction with antibiotics for SBP management due to albumin’s demonstrated clinical efficacy and safety. We examined the relationship between albumin infusion timing and total hospitalization cost among cirrhotic inpatients who developed SBP during hospitalization.

Therapeutic potential of silver nanoparticle-based dressing in the healing process

Introduction: The skin covers the entire surface of the human body, and is considered its largest organ. The resistance of bacteria to antibiotics represents a growing concern in wound infections, this is evidenced by the fact that wounds associated with a heavy bacterial load often present healing failures, increasing healthcare costs for the patient and healing time. Objective: To evidence through national and international literature the therapeutic potential of silver nanoparticle-based dressings in the healing process. Methodology: This is a literature review of a dissertative and explanatory nature. To theoretically support this review, the Brazilian Digital Library of Theses and Dissertations (BDTD) and the Nursing Databases (BDENF) were used. The search period was from February to April 2022, with temporal delimitation from 2017 to 2022, because these were the years that most studies on the topic of interest were obtained. The Boolean searchers (AND and OR) were used: ¬ "Nanoparticle-based dressing OR "Pressure injury" AND "Nanoprene therapy" AND "Multiprofessional team" in BDENF and BDTD, interrelated with the Boolean operators AND and OR. This study included original articles, available in full, case studies, clinical studies, randomized studies, theses and dissertations on the topic in question, published from 2016 to 2022, in English and Portuguese. As exclusion criteria, it was decided not to use articles that were not adjusted to the object of study, which ran away from the theme proposed by the authors, those that were duplicated in electronic databases, incomplete texts, unavailable in full, literature reviews, guides, technical manuals and letters to the reader. A total of 211 articles were found in the BDTD and 17 in the BDENF database, totaling 228 studies found. Of these, after applying the inclusion and exclusion criteria, 211 were excluded and 17 studies were selected because they met the study objective. Results: The AgNP-based dressing, presents great potential in pharmaceutical, therapeutic and biomedical applications, and can be applied in the composition of topical products such as ointments, gels and adhesives.Conclusion: Dressings based on silver nanoparticles (AgNP) are being widely used in biomedical sciences, being relevant to circumvent bacterial resistance to antibiotics, improving the quality of life of affected patients and consequently reducing hospital costs.

Outcomes of Expedited Discharge After Isolated Coronary Artery Bypass Grafting

Expedited discharge after coronary artery bypass grafting (CABG) has been postulated as a possible solution for reducing hospitalization costs. This study aimed to evaluate the impact of expedited postoperative discharge on readmissions and costs in patients undergoing isolated CABG. Adults (≥18 years) who underwent isolated CABG were identified using the 2016-to-2019 Nationwide Readmission Database. Patients were classified as expedited or routine, with expedited patients being discharged on or before postoperative day 4. Those who experienced perioperative complications were excluded. The Nationwide Readmissions Database. Patients ≥18 years old who underwent isolated CABG. Of an estimated 187,591 patients meeting study criteria, 37.2% (n=69,861) experienced expedited discharge. Expedited patients experienced lower index hospitalization costs ($28,543 v $34,114, p < 0.001), and were less likely to experience 30-day nonelective readmission (4.6% v 7.3%, p < 0.001) and 90-day nonelective readmission (5.6% v 8.7%, p < 0.001). After adjustment, expedited discharge remained independently associated with reduced odds of both 30-day (adjusted odds ratio [AOR]: 0.78, 95% CI: 0.71-0.85) and 90-day (AOR: 0.80, 95% CI: 0.74-0.87) nonelective readmission. In addition, expedited discharge was associated with an incremental decrease in index hospitalization costs (β: -5,661, 95% CI: -5,894 to -5,429). Expedited discharge immensely decreases costs of care for patients undergoing isolated CABG, as well as readmission risks. Expedited discharge may be considered a strategy to both improve postoperative patient care and reduce hospitalization costs within the United States healthcare system.

Patient and economic impact of implementing a paediatric sepsis pathway in emergency departments in Queensland, Australia

We examined systems-level costs before and after the implementation of an emergency department paediatric sepsis screening, recognition and treatment pathway. Aggregated hospital admissions for all children aged < 18y with a diagnosis code of sepsis upon admission in Queensland, Australia were compared for 16 participating and 32 non-participating hospitals before and after pathway implementation. Monte Carlo simulation was used to generate uncertainty intervals. Policy impacts were estimated using difference-in-difference analysis comparing observed and expected results. We compared 1055 patient episodes before (77.6% in-pathway) and 1504 after (80.5% in-pathway) implementation. Reductions were likely for non-intensive length of stay (− 20.8 h [− 36.1, − 8.0]) but not intensive care (–9.4 h [− 24.4, 5.0]). Non-pathway utilisation was likely unchanged for interhospital transfers (+ 3.2% [− 5.0%, 11.4%]), non-intensive (− 4.5 h [− 19.0, 9.8]) and intensive (+ 7.7 h, [− 20.9, 37.7]) care length of stay. After difference-in-difference adjustment, estimated savings were 596 [277, 942] non-intensive and 172 [148, 222] intensive care days. The program was cost-saving in 63.4% of simulations, with a mean value of $97,019 [− $857,273, $1,654,925] over 24 months. A paediatric sepsis pathway in Queensland emergency departments was associated with potential reductions in hospital utilisation and costs.

Comparative evaluation of dexamethasone and clonidine as an adjuvant to ropivacaine in supraclavicular block

Background/Aim: Enhancing the intensity of block by using adjuvant is the mainstay now a days in various regional block for surgery. Our primary objective was to compare the dexamethasone and clonidine as adjuvant to ropivacaine in supraclavicular block. Supraclavicular brachial plexus block provides excellent perioperative analgesia in upper extremity surgeries. Various adjuvants can be added to local anesthetics to enhance the effect of block. The main objective in the management of postoperative pain is minimizing the dose of analgesic to reduce side effects and provide adequate analgesia, shorten hospital stay, reduce hospital cost, and increase patient satisfaction. Methodology: One hundred twenty patients going for elective upper limb surgery of ASA grade I &amp; ASA II in the age group 18 – 60 years were divided in the two groups of 60 each. Groups 1 were given Ropivacaine 0.5% 30 ml with 8 mg Dexamethasone, and Groups II were given Ropivacaine 0.5% 30 ml with 75 mcg Clonidine for supraclavicular block using peripheral nerve stimulator. Onset of sensory and motor block, duration of motor block, duration of analgesia, number of rescue analgesia, sedation score, post-operative pain and adverse effects were observed.

Timing of Tracheostomy in Patients with Intracerebral Haemorrhage: A Propensity-Matched Analysis.

Although early tracheostomy (ET) is recommended for patients with severe stroke, the optimal timing of tracheostomy for patients with intracerebral haemorrhage (ICH) remains controversial. This study aimed to explore the clinical characteristics, risk factors and timing of tracheostomy in patients after tracheal intubation using a propensity-matched analysis. We conducted a retrospective database search and assessed 267 consecutive patients who underwent endotracheal intubation (175 of whom underwent tracheostomy) and ICH between July 2017 and June 2021. A logistic regression model was applied to identify the critical factors influencing the decision for tracheostomy by comparing factors in a tracheostomy group and a nontracheostomy group. Patients were divided into an early (≤5 days) or a late (>5 days) group according to the median time of tracheostomy. Propensity score matching was performed to adjust for possible confounders and investigate differences in outcomes between ET and late tracheostomy (LT). Among the 267 enrolled patients with ICH and endotracheal intubation, 65.5% received tracheostomy during hospitalisation, and 52.6% received ET. The independent risk factors for tracheostomy included National Institute of Health Stroke Scale (NIHSS) (odds ratio [OR]: 1.179; 95% confidence interval [CI]: 1.028-1.351; P = 0.018), aspiration (OR: 2.171; 95% CI: 1.054-4.471; P = 0.035) and infiltrates (OR: 2.149; 95% CI: 1.088-4.242; P = 0.028). Using propensity matching, we found that ET was associated with fewer antibiotic-using days (15 vs. 18; P < 0.001) and sedativeusing days (6 vs. 8; P < 0.001), shorter intensive care unit (ICU) Length of Study (LOS) (9 vs. 12; P < 0.05) and reduced in-ICU costs (3.59 vs. 7.4; P < 0.001) and total hospital costs (8.26 vs. 11.28, respectively; P < 0.001). Muscle relaxants (31.8% vs. 60.6%) were used less frequently in patients with ET (P = 0.001). However, there were no differences between the ET and LT groups in terms of modified Rankin Scale (mRS) (4 vs. 4; P = 0.932), in-general-ward costs (4.74 vs. 4.37; P = 0.052), mechanical ventilation days (6 vs. 6; P = 0.961) and hospital LOS (23 vs. 23; P = 0.735) as well as the incidences of ventilator-associated pneumonia (28.8% vs. 37.9%; P = 0.268), tracheostomyrelated complications (16.7% vs. 19.7%; P = 0.652), respiratory failure (24.2% vs. 31.8%; P = 0.333), all-cause deaths (15.2% vs. 16.7%; P = 0.812) and pneumonia (77.3% vs. 87.9%; P = 0.108). We recommend ET for high-risk patients with ICH. Although ET cannot reduce inhospital mortality or improve patient prognosis, it may help reduce hospital costs and ICU LOS as well as the use of antibiotics, sedatives and muscle relaxants.

Implantación de un programa de Geriatría de enlace coordinado con Atención Primaria en 60 centros sociosanitarios del área asistencial noroeste de la Comunidad de Madrid

ObjectiveTo describe interventions included in the implementation of a multidisciplinary Geriatrics Program that gives support to nursing homes, in coordination with Primary Care and Public Health, in collaboration with other hospital departments. MethodsAn observational descriptive study was conducted in an area that includes 60 nursing homes with nearly 4600 residents from June 1 st, 2020 to October 1 st, 2021. The program consists of different interventions including Telemedicine and support of a Geriatric Consultation Liaison Team. An estimation of avoided costs through these interventions was carried out. ResultsThe activity recorded was 11502 telephone calls, 2247 e-mails, 313 visits to these centres in where 4085 patients underwent comprehensive geriatric assessment. During this period of time 442 patients received intravenous therapy in their nursing homes, including 7541 different types of medication which 5850 of them were antibiotics. According to the Diagnosis-related-Group (DRG) of the patients that received intravenous treatment in their nursing homes, was estimated a cost reduction of 1,500,00€ and a total of 2800 days of hospital stay avoided. In the group of 198 patients that received video consultation was estimated reduction of costs of 37,026€. A hospital multidisciplinary care team focused on the nursing home patients was created. ConclusionsThis program improves continuity of nursing homes patients care and to enhance communication and coordination among Primary Care, Hospitals and Public Health services and secondarily, reducing hospital costs.

RSDM-AHSnet: Designing a robust stochastic dynamic model to allocating health service network under disturbance situations with limited capacity using algorithms NSGA-II and PSO

In the present study, health services networks were classified into low-level hospitals (provision of public health services) and high-level hospitals (providing specialized health services), which are at risk of being disrupted. They refer the patients to high-level hospitals for inpatient visits or emergencies by ambulance. In the present case, patients are divided into two categories: high priority (the category in which immediate service delivery is needed) and low priority. A stochastic robust dynamic mathematical model for location and allocation of health network regarding limited capacity and disturbance is developed to reduce the total costs and include the basic features of a real problem such as limited capacity. Regarding limited capacity for hospitals, the health network needs redefinition of different layers in the disturbance situation. In this study, we reduce the total costs by reducing hospital costs and costs such as transportation and service to patients. Two metaheuristic algorithms consisting of Non-dominated Sorting Genetic Algorithm II (NSGA-II) and Particle Swarm Optimization (PSO) have been applied to solve the model. Taguchi method design minimizes the cost of parameter tuning, including the level of factors related to the proposed. The results showed the method's applicability for large-scale problems that could evaluate different tools for decision-makers to select effective management strategies in constructing a dependable and robust healthcare network. For example, the total cost is minimized in conditions considered in the genetic algorithm, the population parameter at the highest level, 150, the intersection parameters, and the probability of mutation at the lowest level, 0.7 and 0.1.

Reconfiguration from emergency to urgent elective neurosurgery for glioblastoma patients improves length of stay, surgical adjunct use, and extent of resective surgery.

BackgroundGlioblastoma (GB) is the most common intrinsic brain cancer and is notorious for its aggressive nature. Despite widespread research and optimization of clinical management, the improvement in overall survival has been limited. The aim of this study was to characterize the impact of service reconfiguration on GB outcomes in a single centre.MethodsPatients with a histopathological confirmation of a diagnosis of GB between 01/01/2014 and 31/12/2019 were retrospectively identified. Demographic and tumour characteristics, survival, treatment (surgical and oncological), admission status, use of surgical adjunct (5-aminolevulinic acid, intra-operative neuro-monitoring), the length of stay, extent of resection, and surgical complications were recorded from the hospital databases.ResultsFrom August 2018 the neurosurgical oncology service was reconfigured to manage high-grade tumours on an urgent outpatient basis by surgeons specializing in oncology. We demonstrate that these changes resulted in an increase in elective admissions, greater use of intra-operative adjuncts resulting in the improved extent of tumour resection, and a reduction in median length of stay and associated cost-savings.ConclusionsOptimizing neuro-oncology patient management through service reconfiguration resulted in increased use of intra-operative adjuncts, improved surgical outcomes, and reduced hospital costs. These changes also have the potential to improve survival and disease-free progression for patients with GB.

Length of Stay and Hospital Cost Reductions After Implementing Bedside Percutaneous Ultrasound Gastrostomy (PUG) in a Critical Care Unit.

Background: Critical care patients receive 50% of gastrostomy tubes placed in the United States. Several gastrostomy placement methods exist, however care processes remain variable and often lack health system cost effectiveness. No data exists on efficiency or cost impact of performing bedside percutaneous ultrasound gastrostomy (PUG) on patients with ventilator-dependent respiratory failure. This study's objective was to determine if implementing bedside PUG would positively impact efficiency and cost outcomes in intensive care unit (ICU) patients compared to usual care gastrostomy. Design and Methods: This is a retrospective cohort study of patients with ventilator-dependent respiratory failure who received a gastrostomy consult or procedure in the ICU. Patients received PUG or usual care gastrostomy, determined by the presiding attending's skillset, and both groups were compared across patients' demographics, clinical characteristics and outcomes. Primary outcomes were length of stay (LOS) and total hospital costs. Results: A total of 88 patients were included in the analysis, 45 patients in the PUG group and 43 in the usual care gastrostomy group. No differences were observed in demographic and clinical characteristics. Patients who received PUG had a significantly shorter mean ICULOS and hospital LOS, with reductions of 5.0 and 8.7 days, respectively. Total hospital costs were significantly reduced in the PUG group, with a cost savings of US $26,621 per patient. No differences in mortality or discharge disposition were observed. PUG patients received concomitant percutaneous dilatation tracheostomy (PDT) and PUG ("TPUG") 70% of the time, whereas no usual care patients received concomitant procedures. Off-hour procedures occurred in 53.3% of PUG and 4.6% of usual care gastrostomy. Conclusions: This study demonstrates bedside PUG leads to decreased LOS and total hospital costs in patients with ventilator-dependent respiratory failure. Hospital costs were significantly reduced with a per patient savings of $26,621 compared to usual care gastrostomy.

Palliative Care Consultation in the Intensive Care Unit Reduces Hospital Costs: A Cost-Analysis.

Palliative care aims to improve or maintain quality of life for patients with life-limiting or life-threatening diseases. Limited research shows that palliative care is associated with reduced intensive care unit length of stay and use of high-cost resources. This was an observational, non-experimental comparison group study on all patients 18 years or older admitted to any intensive care unit (ICU) at Memorial Hermann - Texas Medical Center for 7 to 30 days from August 2013 to December 2015. Length of stay (LOS) and hospital costs were compared between the treatment group of patients with palliative care in the ICU and the control group of patients with usual care in the ICU. To adjust for confounding of the palliative care consultation on LOS and hospital cost, an inverse probability of treatment weighted method was conducted. Generalized linear models using gamma distribution and log link were estimated. All costs were converted to 2015 US dollars. Mean LOS was 13 days and mean total hospital costs were USD 58,378. In adjusted and weighted analysis, LOS for the treatment group was 8% longer compared to the control group. The mean total hospital cost was estimated to decrease by 21% for the treatment group versus the control group. We found a reduction of USD 33,783 in hospital costs per patient who died in the hospital and reduction of USD 9113 per patient discharged alive. Palliative care consultation was associated with a reduction in the total cost of hospital care for patients with life-limiting or life-threatening diseases.