Hospital Savings Research Articles

PSU5 ECONOMIC IMPACT OF PULMONARY ARTERY CATHETER UTILIZATION AMONG CARDIAC SURGERY PATIENTS: PERSPECTIVES FOR AN ACUTE CARE HOSPITAL AND AN INTEGRATED PAYER-PROVIDER HEALTH SYSTEM

A recent study demonstrated pulmonary artery catheter (PAC) use surrounding cardiac surgery is associated with a significant decrease in the incidence of new onset heart failure (HF) and respiratory failure (RF), while bacteremia and urinary infection complication rates significantly increased, as compared to patients that did not receive a PAC. We evaluated the economic impact of perioperative monitoring PAC utilization for adult cardiac procedures to support decision-making regarding PAC adoption for an acute care hospital and an integrated payer-provider health system. An Excel-based model was created to estimate the annualized savings for a US acute care hospital utilizing a monitoring PAC perioperatively for cardiac procedures during the index visit. A second model for an integrated payer-provider included costs for the index visit and for treatment of persistent index visit-related HF and RF complications over the following year (excluding patients with history of these conditions). Complication rates, costs, and healthcare utilization inputs were extracted from literature and a national database. Scenario analyses with varying surgical volume and PAC adoption rates were performed, as were one-way and probabilistic sensitivity analyses. For an acute care hospital, base-case (500 cardiac surgeries/year, 34% PAC adoption) annualized savings for the index visit totaled US$61,806 vs. no PAC utilization. Scenario analyses with cardiac surgical volumes of 100 and 1,500 procedures/year resulted in estimated savings of US$12,361 and US$185,418, respectively. Increased PAC adoption rates (75% and 95%) were associated with increased savings: US$134,751 and US$170,685, respectively, for 500 procedures/year. HF and RF treatment costs had the largest impact on savings. For an integrated payer-provider, base-case (3,845 cardiac surgeries/year, 34% PAC adoption) resulted in estimated savings of US$596,637 for the index visit and treatment of related complications over the following year. Monitoring PAC utilization for adult cardiac surgeries generates significant savings for acute care hospitals and integrated payer-provider systems.

2450. A data-driven model of the economic burden of healthcare-associated infections as impacted by use of comprehensive genomic analysis of bacteria

BackgroundEach year, nearly 2 million patients contract and are affected by healthcare-associated infections (HAIs) in the United States alone, resulting in nearly 100K deaths. According to the Centers for Disease Control and Prevention (CDC), more patients die from HAIs in the United States per year than all breast and prostate cancer cases combined (National Vital Statistics Report, 2016). In addition to the mortality burden, the financial impact of HAIs within the hospital ecosystem is estimated to total between $28–45 billion. However, no economic model has demonstrated how early effective identification and mitigation of infection clusters can result in cost savings for hospitals until now.MethodsAs there is no publicly available data for infection cluster rates, we based our analysis on anonymized real-world retrospective data spanning 18 months (November 2016 to June 2018) from two US-based academic tertiary hospitals with a combined total of about 1,700 beds, then normalized to 800 beds. A cloud-computing platform (Philips IntelliSpace Epidemiology) was used for whole-genome sequence analysis and cluster identification. We determined that an average 800-bed facility would have an occurrence of 46 genetically related infectious clusters involving 2 or more patients (mean of 7.9, median of 3), affecting 180 patients in total.ResultsGiven the average HAI treatment cost of $24,512 (average costs rescaled from literature to 2019 USD using PPI data), this represents a total cost of $4,412,160. If these clusters could have been limited to 2 patients, an additional 96 infections might have been prevented, representing a potentially avoidable economic burden of $2,353,152 for this 800-bed institution. Our data show that a 20% reduction in transmissions would drive a 3% overall reduction in HAIs, but results in savings of over $450,000.ConclusionActive, genomic-based surveillance can inform timely and precise preventative steps to help lower the size of infectious clusters. This health economic modeling shows that such measures can result in significant cost savings. As such, it recommends that prompt, dynamic detection of infectious clusters via genomics and active surveillance offers a relevant and timely strategy for cost savings within the healthcare ecosystem. Disclosures All authors: No reported disclosures.

Is Length of Stay Influenced by the Weekday On Which Lumbar Surgery is Performed?

Reducing length of stay (LOS) in a safe manner has the potential to save significant costs for the care of patients undergoing elective lumbar spine surgery. Due to the relative absence on weekends of staff required for discharging patients to rehabilitation or nursing facilities, we hypothesize that patients undergoing lumbar surgery later in the week have a longer LOS than their counterparts. To analyze the effect of day of the week for lumbar surgery on LOS. Patients undergoing surgery for lumbar degenerative disease were prospectively enrolled in the multicenter quality and outcomes database registry. A multivariable proportional odds regression model was built with LOS as the outcome of interest and patient and surgical variables as covariates. A total of 11 897 patients were analyzed. Among those discharged home, the regression analysis demonstrated significantly higher odds of longer LOS for patients undergoing surgery on Friday as compared to Monday (P<.001). Among those discharged to a facility, there were significantly higher odds of longer LOS for patients undergoing surgery on Wednesday (P<.001), Thursday (P<.001), and Friday (P=.002) as compared to Monday. The findings of this study suggest that lumbar patients undergoing fusions and those discharged to a facility have longer LOS when surgery is later in the week. Scheduling these patients for surgery earlier in the week and ensuring adequate resources for patient disposition on weekends may lead to LOS reduction and cost savings for hospitals, payers, and patients alike.

545 Converting Inpatient Consults to Directly Scheduled Outpatient Procedures

INTRODUCTION: Hospitalized patients undergo many tests which can reveal medical issues unrelated to their primary reason for hospitalization. This can lead to consultant evaluations which are necessary, although often not urgent. We evaluated one institution's practice of hospitalized patients requiring non-urgent gastroenterology (GI) procedures. The standard was for patients to either have an inpatient procedure or follow up in clinic after discharge to be scheduled for a procedure, often weeks to months after the initial hospitalization. We instituted a new protocol for scheduling hospitalized patients directly for outpatient procedures within two weeks of discharge. METHODS: A protocol was developed for GI fellows consulting on inpatients with incidentally discovered heme positive stool or non-life threatening anemia at New York-Presbyterian Queens Hospital to evaluate the urgency of a GI procedure. If non-urgent, the fellow notified the patient navigators who then reviewed the pre-procedure instructions with the patient and scheduled the procedure for within two weeks of discharge. Patients returned for their procedure and subsequently were seen in the clinic for follow up. RESULTS: 17 patients were included with 6 procedures completed. Of the 11 patients whose procedures were not completed, 7 were “no shows”, 3 had medical contraindications and 1 insurance authorization was not obtained. On average, each inpatient procedure directly costs the hospital $1,200. Conversely, each outpatient procedure yields $800. In sum, this protocol resulted in approximately $25,200 in total savings/credit for the institution. CONCLUSION: Incidental medical problems discovered during a patient's hospitalization can have downstream effects including additional procedures. Without a system to timely complete these procedures outpatient, there is pressure to do so inpatient. This can decrease patient satisfaction, increase length of stay, strain the endoscopy unit, and cause financial loss. We instituted a protocol to ensure hospitalized patients requiring non-urgent GI procedures were directly scheduled for that procedure within two weeks of discharge without the delay of a clinic visit before scheduling. This lead to 17 procedures avoided in the hospital, a direct hospital savings of over $25,000. Hurdles included patients lost to follow up and delays with insurance pre-authorization. With continued refinement, we hope to improve this process to create a better system for patients, providers, and the hospital.

Deregulation and productivity in healthcare

Deregulation and the related rise in competition are generally believed to spur productivity growth. This relationship is one of the main arguments used for the liberalization of healthcare industry. But the exceptional nature of healthcare markets, the presence of asymmetric information and physician-induced demand casts doubt on whether this also holds for the provision of care. Using the healthcare reform of 2006 in the Netherlands, we evaluated how productivity changed when the market was opened to competition. Our results indicate that improvements in productivity were smaller after products were transferred to the liberalized-segment (by 9.5 and 6.6% in 2008 and 2009), suggesting a negative relationship between competition and productivity in healthcare. Our paper also shows that higher levels of productivity gains were reached using hospital budget financing compared to open competition. Competition in healthcare provision has several advantages, such as moderating the growth in product prices and improving patient-choice, but it is more susceptible to physician-induced demand. Meanwhile, budget financing has the advantage of boosting productivity, but the resulting economic gains are generally assumed by the provider. Therefore, we conclude that competition could be socially optimal if volumes and treatment activity could be effectively controlled, and likewise that budgets could be optimal if hospital savings earned through productivity gains could be passed on to society.

Protocols for early discharging of premature infants: an empirical assessment on safety and savings.

Background Preterm newborns may be discharged when clinical conditions are stable. Several criteria for early discharge have been proposed in the literature. This study carried out the first quantitative comparison of their impact in terms of hospitalization savings, safety and costs. Methods This study was based on the clinical histories of 213 premature infants born in the Neonatal Intensive Care Unit of Padova University Hospital between 2013 and 2014. Seventeen early discharge criteria were drawn from the literature and retrospectively applied to these data, and computation of hospitalization savings, safety and costs implied by each criterion was carried out. Results Among the criteria considered, average gains ranged from 1.1 to 10.3 hospital days and between 0.3 and 1.1 fewer infections per discharged infant. Criteria that led to saving more hospital days had higher cost-effectiveness in terms of crisis and infection, and they spared infants from more infections. However, episodes of apnea and bradycardia were detected after the potential early discharge date for all criteria, with a mean number of episodes numbering between 0.3 and 1.4. Conclusion The results highlight a clear trade-off between days saved and health risks for infants, with potential consequences for health care costs.

PCV21 PHARMACOECONOMIC ANALYSIS OF SOTALOL LOADING: COMPARISON OF 1-DAY INPATIENT LOADING OF IV SOTLOL COMPARED TO THE STANDARD 3-DAY LOADING PROTOCOL

Atrial fibrillation (Afib) is the most common arrhythmia. If untreated, it can lead to severe complications, including heart failure, stroke and death. Some common anti-arrhythmia medications, including sotalol, require in-hospital monitoring during drug initiation. IV sotalol has become commercially available in the US and may shorten drug initiation, potentially reducing resource utilization. A quantitative analysis comparing costs for a 3-day and 1-day initiation of oral and IV sotalol, respectively, was performed. A budget impact model (BIM) was created to estimate changing hospital costs, savings and revenue. The target patient population was defined as those who had either a primary or secondary Afib diagnosis and received a 3-day, in-patient initiation of oral sotalol. Data from Cerner Health Facts, a large US electronic health records database, and additional published sources were leveraged to identify the cost of administering medication, patient monitoring, room and board as well as total average CMS payments ($9,200) to the hospital. Hospital savings and revenue were estimated per-patient and based on hospital bed size of 300-500 beds. The overall cost of initiating drug therapy, per-patient, on oral sotalol was estimated at $7,000 compared to $4,100 for IV sotalol. Cost of drug acquisition and dispensing of oral sotalol was relatively low ($650) compared to IV sotalol ($1,700), however, the increased hospital length of stay contributed to the overall cost of oral therapy ($5,600 for oral sotalol vs $1,800 for IV sotalol). The hospital revenue per patient on oral and IV sotalol was $2,200 and $5,100 respectively. Furthermore, we estimated that a 300-500 bed hospital could save up to $60,000/year by converting only 10% of its patients to IV sotalol. Our BIM suggests that initiation with IV sotalol has the potential to lower overall hospital costs and increase hospital savings compared to oral sotalol.

PIN40 POST-OPERATIVE ANTIBIOTIC COST PROJECT: DISCONTINUATION OF ANTIMICROBIAL PROPHYLAXIS AFTER SURGICAL INCISION CLOSURE

Preoperative Antibiotic (ABX) prophylaxis (PPX) reduces the likelihood of post-operative surgical site infection (SSI). In 2017, national guidelines were changed to recommend no post-operative ABX PPX for clean and clean-contaminated surgeries. Inappropriate use of post-operative ABX PPX provides no added clinical benefit and has been linked to direct patient harm, including allergic reactions (including anaphylaxis), bacterial resistance, and Clostridioides difficile infection. Guideline adherence could result in both improved patient outcomes and overall cost-savings to health systems. We analyzed existing economic and clinical evidence to quantify the potential direct medical cost consequences of inappropriate post-operative ABX PPX in clean and clean-contaminated surgeries compared to no post-operative ABX PPX use. A decision tree model of expected costs for each ABX strategy was created based on review of the existing literature. A U.S. hospital costing perspective was used (all costs updated to 2018 US$). The time horizon for adverse outcomes was 48-72 hours after surgical incision closure. Currently, nearly all such surgeries typically receive at least 24 hours of antibiotic post-operatively. The most common post-operative ABX regimens; cefazolin, clindamycin, vancomycin, ciprofloxacin/levofloxacin, were compared to NO post-operative ABX PPX administered. The analysis included post-surgical expected costs for drugs, drug-related adverse events and other treatment complications. The expected medical costs per patient are: for cefazolin -- $6141, clindamycin -- $7949, vancomycin -- $6550, ciprofloxacin $14597, and NO ABX agent -- $1978. The NO post-operative ABX strategy saves an average per patient cost of $6,832. U.S. data show approximately 12 million inpatient clean and clean-contaminated surgeries annually. The potential annual savings in reduced hospital costs alone could thus exceed $76 billion. Full guideline adherence with NO post-operative prophylaxis will generate substantial hospital savings for clean and clean-contaminated surgeries, in addition to improving health outcomes and reducing risk of bacterial drug resistance.

A Supervised Pattern Analysis of the Length of Stay for Hip Replacement Admissions.

Hip replacement is the most common surgical procedure among Medicare patients in the US and worldwide. The hospital length of stay (LOS) for hip replacement admissions is therefore important to be controlled, contributing to savings for hospitals. This study combined medical claims and hospital structure and service data to examine LOS fluctuations and trends, and admission distribution patterns, during weekdays, for hip replacement cases. The study furthermore examined associations of these patterns with the LOS performance. Most hospitals were found to admit hip replacement cases at the start of the week (Monday through Wednesday). There is an upward LOS trend as we approach late weekday admissions. Multiple linear regression analysis showed that LOS weekday inconsistencies, a large proportion of hip replacement admissions on Thursday and Friday, the government ownership status, the bed size, and the critical access status are associated with an increased LOS. On the other hand, the rate of hip replacement admissions over total ones, and the hospital being accredited, are associated with a lower LOS. Findings stress out the need for hospitals to maintain an effective and balanced distribution of hip replacement admissions, evenly during the week, and the need for standardized case management, to avoid practice variability and, therefore, LOS fluctuations for their hip replacement cases.

The Impact of Custom Contracting and the Infomediary Role of Healthcare GPOs

Manufacturers and distributors of expensive implants and other medical supplies often require buyers to sign non‐disclosure agreements treating all information concerning negotiated prices as trade secrets. Such agreements make it difficult for hospitals to obtain accurate pricing benchmarks. To save on procurement costs and to obtain pricing information, most hospitals in the United States join group purchasing organizations (GPOs). GPOs are believed to lower procurement costs by aggregating hospitals’ demand. Whether GPOs indeed add value to the healthcare supply chain and produce actual savings for hospitals are debated policy issues, as evidenced by the ongoing discussions on the topic in the US Congress. Some hospitals procure using GPO contracts, and some try to improve on prices available via GPO contracts, negotiating custom contracts directly with the GPO vendors. Using a game‐theoretic model, we prove that GPOs that operate independently and allow for custom contracting limit the benefit of demand aggregation to smaller hospitals only. The larger hospitals gain primarily from using the GPO as an infomediary to obtain critical pricing information benchmarks. Our results further explain why the introduction of custom contracting lowers the value of access to this pricing information for the hospitals, and how the savings through custom contracting can be misleading. We reveal how GPO vendors can exploit information asymmetry about their prices and earn even higher profits, and why, contrary to the industry's belief, the resulting savings are never higher for any hospital, not even for the larger ones when the GPOs allow custom contracting.

Staphylococcus aureus: A predominant cause of surgical site infections in a rural healthcare setup of Uttarakhand.

Introduction:Surgical site infections (SSIs) represent the second most common type of healthcare-associated infections and remain a relatively common postoperative complication and the most common reason for readmission after surgery. SSIs have dire implications for the surgeon, patient, and institution which often require prolonged treatment, impose an economic burden and double the risk of patient mortality. Staphylococcus aureus is currently the most common cause of SSIs causing as many as 37% of cases of SSIs in community hospitals with methicillin-resistant S. aureus (MRSA) of particular concern.Materials and Methods:This cross-sectional study was conducted from January 2014 to December 2014 in a rural tertiary care hospital of Pauri Garhwal district of Uttarakhand state, India. Samples were collected using sterile cotton swabs from 269 patients clinically diagnosed with SSIs and were processed as per standard microbiological techniques. Antimicrobial susceptibility testing was done using a modified Kirby-Bauer disc diffusion method.Results:Out of 1294 patients, 269 (20.8%) were found to have SSIs and samples were collected from them. Out of a total of 269 samples, 258 (95.9%) yielded bacterial growth and 267 bacterial isolates were obtained. S. aureus (45.3%) was the commonest organism followed by Escherichia coli (13.9%), Pseudomonas aeruginosa (6.7%), and Proteus species (4.9%). Antimicrobial profile of S. aureus revealed maximum sensitivity to rifampicin, linezolid, teicoplanin, vancomycin, and amikacin whereas ampicillin, cefazolin, and gentamicin were found to be least sensitive.Conclusion:S. aureus played a predominant role in the etiology of SSIs in this hospital with MRSA being a major concern as the treatment options for such resistant strains are limited. Reduction in SSI rates can lead to both better clinical outcomes for patients and cost savings for hospitals. Adherence to strict infection control measures, maintenance of proper hand hygiene and optimal preoperative, intraoperative, and postoperative patient care can surely reduce the incidence of SSIs. A multifaceted approach involving the surgical team, microbiologist, and the infection control team is required to provide quality surgical services.

2022. Modeling Improved Patient Management and Hospital Savings with SeptiCyte LAB in the Diagnosis of Sepsis at ICU Admission

BackgroundThe ability to accurately diagnose sepsis at ICU admission is key to effective clinical management, patient safety, and efficient hospital resource utilization. Most tests used for sepsis diagnosis, including pathogen detection and host-based biomarker approaches, are lacking in either sensitivity or specificity, resulting in a clinical assumption of sepsis, patient overtreatment with antimicrobials, and hospital or ICU admission as a precaution. SeptiCyte LAB is the only FDA-cleared test that analyzes the patient’s own host transcriptional response in systemically inflamed patients, to discriminate between infectious and non-infectious underlying causes.MethodsThe SeptiCyte LAB test was validated in a multi-site prospective trial in the ICU (N = 447). Test performance and length of stay in both the ICU and hospital were recorded. Length of stay associated with initial diagnoses was directly recorded, and a model was created in which costs/savings due to the added deployment of the SeptiCyte LAB assay, in comparison to the standard of care, was projected. Assumptions for the timing of antimicrobial de-escalation and hospital stay costs were drawn from published literature. Assumptions for changes in clinical management were based on required minimum negative and positive predictive values.ResultsThe estimated savings due to reduced length of stay per patient, as a consequence of the information generated by SeptiCyte LAB was found to be approximately $1,600 in the ICU, and an estimated $900 on the ward. Matched procalcitonin results from the same trial and exclusively used for de-escalation as specified by the manufacturer resulted in per-patient savings of $80.ConclusionModeling of a rapid and accurate diagnosis sepsis diagnostic (SeptiCyte LAB) at ICU admission projects significant savings and improvements in patient management.Disclosures L. Mchugh, Immunexpress: Employee, Salary.

Case study results: fault detection in air-handling units in buildings

ABSTRACT The building sector of the U.S. currently consumes over 40% of the U.S. primary energy supply. This paper presents analytical methods embodied within useful software tools to quickly identify and evaluate selected building system faults that cause large building energy inefficiencies. These contributions are particularly unique in their treatment of models and the careful consideration of user interests in fault evaluation. As a first step to developing this general framework for fault detection, first-order faults such as simultaneous heating and cooling and imbalanced airflows within several large air-handling units were targeted. Savings of around $22,500 were predicted when the fault of simultaneous heating and cooling occurred over an entire month in an air handler. An example of the potential energy savings in a large hospital that has been monitored. Yearly savings of around $24,000 were predicted by correcting the operation of the circulation pump in an air-handler heat recovery loop. User testing and experiments show that embracing uncertainty within HVAC fault detection and evaluation is not only paramount to judicious fault inference but it is also central to gaining the trust and buy-in of system users who ultimately can apply fault detection information to actually fix and improve building operations.

PIN24 - ESTIMATION OF HOSPITAL COST SAVINGS ASSOCIATED WITH HYPOTENSION REDUCTION IN SEPTIC INTENSIVE CARE UNIT PATIENTS IN US HOSPITALS

Emerging data shows an association between hypotension during ICU stay with death and acute kidney injury (AKI). This analysis estimates the cost-savings per ICU patient that can accrue to US hospitals as a result of improved outcomes associated with hypotension reduction in sepsis. In our economic analysis we estimated patient-level costs and the budget impact associated with hypotension reduction in septic ICU patients from the hospital perspective. The reduction in the probabilities of AKI and death were sourced from a prior EMR analysis in which hypotension exposure was defined by time-weighted average mean arterial pressure (TWA-MAP) and cumulative time in hours below 65 mmHg thresholds. Cost savings for each of the separate outcomes in sepsis was estimated from the current published literature. All dollars were adjusted to reflect 2018 costs. Scenario analyses and Monte Carlo simulations were performed to test the robustness of the model. We ran six simulations (10,000 trials each) comparing 5, 10, 15, 20, 25 and 30 unit improvement in TWA-MAP to reach a baseline of 65 mmHg. Mean savings for the hospital associated with hypotension control ranged from $736 (5 unit change) to $6,648 (30 unit change) per patient. In each case, the 95% confidence interval exceeded $0. If causal, a 15 unit improvement in TWA-MAP from 50 to 65 (baseline) would yield expected saving of $3,137 (95% CI: $228-$9,472) per patient. Sensitivity analyses identified the rate of AKI, death and the cost of sepsis to have the greatest influence on hospital savings. As the US healthcare system moves toward pay for performance, well managed hospitals become very sensitive to cost control. In our study, hypotension reduction was shown to reduce hospitalization cost for septic ICU patients, with even a 5 unit improvement in hypotension control yielding substantial per patient cost savings.

Relevance or performance: potential savings associated with verification of prior results before performing microbiology analysis

ObjectiveIn an era of rising healthcare expenditures, it is critical to find ways to decrease cost. The objective of this study is to evaluate the number of repeated tests and the associated cost savings in a university-affiliated hospital. MethodsThe following 7 microbiology analysis were assessed for nonrepeat testing: HCV antibody, HBV core antibody, CMV IgG, rubella IgG, Treponema pallidum antibodies, Clostridioides difficile toxin detection, and vancomycin-resistant enterococci PCR. Presence of a prior positive result leads to the cancellation of subsequent orders. ResultsPercentages of not repeated test ranged from 0.1% to 21.4%. Rubella IgG had the highest proportion of unnecessary repeat testing. Total cost savings were estimated at $33,627 for 2016. ConclusionUnnecessary repeated microbiologic test can account for a non-negligible part of total volume test. Use of an automated software to detect unnecessary repeated microbiologic test through laboratory information system can generate important savings.

Does a Reduction in Readmissions Result in Net Savings for Most Hospitals? An Examination of Medicare's Hospital Readmissions Reduction Program.

This study aimed (1) to estimate the impact of an incremental reduction in excess readmissions on a hospital's Medicare reimbursement revenue, for hospitals subject to penalties under the Medicare's Hospital Readmissions Reduction Program and (2) to evaluate the economic case for an investment in a readmission reduction program. For 2,465 hospitals with excess readmissions in the Fiscal Year 2016 Hospital Compare data set, we (1) used the Hospital Readmissions Reduction Program statute to estimate hospital-specific Medicare reimbursement gains per an avoided readmission and (2) carried out a pro forma analysis of investment in a broad-scale readmission reduction program under conservative assumptions regarding program effectiveness and using program costs from earlier studies. For an average hospital, avoiding one excess readmission would result in reimbursement gains of $10,000 to $58,000 for Medicare discharges. The economic case for investments in a readmission reduction effort was strong overall, with the possible exception of hospitals with low excess readmissions.

HCAHPS scores as a surrogate for quality does not correlate with TQIP quality measures at a level 1 trauma center

The Trauma Quality Improvement Program was designed by the American College of Surgeons to measure quality benchmarks across American College of Surgeons-certified trauma centers. The Hospital Consumer Assessment of Healthcare Providers and Systems survey was developed to report patient satisfaction with inpatient care and has been used as a surrogate for quality of care by the Affordable Care Act. The purpose of this study was to determine the correlation of hospitals' Hospital Consumer Assessment of Healthcare Providers and Systems data to the Trauma Quality Improvement Program quality analysis. A retrospective review of available Trauma Quality Improvement Program and Hospital Consumer Assessment of Healthcare Providers and Systems results from an American College of Surgeons level 1 trauma center 2016-2017 was performed. Trauma Quality Improvement Program and Hospital Consumer Assessment of Healthcare Providers and Systems data were represented as either above, at, or below the mean of national data and were analyzed using the Fisher exact test. Hospital Consumer Assessment of Healthcare Providers and Systems scores from wards participating in care of trauma patients were summarized by perceived level of quality. Trauma Quality Improvement Program data for risk-adjusted mortality were included in analysis for all trauma admissions. The Fisher exact test was used to analyze contingency tables of data and was found to support the null hypothesis (P = .1109). Overall Hospital Consumer Assessment of Healthcare Providers and Systems rating is most significant for hospitals because it is a global view of patient satisfaction and is used to determine a portion of hospital reimbursement. It is believed that higher patient satisfaction is correlated with lower readmission rates and improved outcomes, thus resulting in cost savings for hospitals. However, it appears that overall Hospital Consumer Assessment of Healthcare Providers and Systems rating does not correlate with measured outcomes in terms of risk-adjusted mortality for trauma admissions. It is suggested from these data that trauma patients be considered independently from other hospitalizations and that Hospital Consumer Assessment of Healthcare Providers and Systems may not be an appropriate tool to determine reimbursement for trauma admission.

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.

Cost analysis of Omega-3 supplementation in critically ill patients with sepsis

Nutritional supplement of omega-3 fatty acids have been proposed to improve clinical outcomes in critically ill patients. While previous work have demonstrated that omega-3 supplementation in patients with sepsis is associated with reduced ICU and hospital length of stay, the financial impact of this intervention is unknown. Perform a cost analysis to evaluate the impact of omega-3 supplementation on ICU and hospital costs. We extracted data related to ICU and hospital length of stay from the individual studies reported in a recent systematic review. The Cochrane Collaboration tool was used to assess the risk of bias in these studies. Average daily ICU and hospital costs per patient were obtained from a cost study by Kahn etal. We estimated the ICU and hospital costs by multiplying the mean length of stay by the average daily cost per patient in ICU or Hospital. Adjustments for inflation were made according to the USD annual consumer price index. We calculated the difference between the direct variable cost of patients with omega-3 supplementation and patients without omega-3 supplementation. 95% confidence intervals were estimated using bootstrap re-sampling procedures with 1000 iterations. A total of 12 RCT involving 925 patients were included in this cost analysis. Septic patients supplemented with omega-3 had both lower mean ICU costs ($15,274 vs. $18,172) resulting in $2897 in ICU savings per patient and overall hospital costs ($17,088 vs. $19,778), resulting in $2690 in hospital savings per patient. Sensitivity analyses were conducted to investigate the impact of different study methods on the LOS. The results were still consistent with the overall findings. Patients with sepsis who received omega-3 supplementation had significantly shorter LOS in the ICU and hospital, and were associated with lower direct variable costs than control patients. The 12 RCTs used in this analysis had a high risk of bias. Large-scaled, high-quality, multi-centered RCTs on the effectiveness of this intervention is recommended to improve the quality of the existing evidence.

Reducing cost and improving operating room efficiency: examination of surgical instrument processing

BackgroundOperating room efficiency can be compromised because of surgical instrument processing delays. We observed that many instruments in a standardized tray were not routinely used during thyroid and parathyroid surgery at our institution. Our objective was to create a streamlined instrument tray to optimize operative efficiency and cost. Materials and methodsHead and neck surgical instrument trays were evaluated by operating room team leaders. Instruments were identified as either necessary or unnecessary based on use during thyroidectomies and parathyroidectomies. The operating room preparation time, tray weights, number of trays, and number of instruments were recorded for the original and new surgical trays. Cost savings were calculated using estimated reprocessing cost of $0.51 per instrument. ResultsThree of 13 head and neck trays were converted to thyroidectomy and parathyroidectomy trays. The starting head and neck surgical set was reduced from two trays with 98 total instruments to one tray with 36 instruments. Tray weight decreased from 27 pounds to 10 pounds. Tray preparation time decreased from 8 min to 3 min. The new tray saved $31.62 ($49.98 to $18.36) per operation in reprocessing costs. Projected annual savings with hospitalwide implementation is over $28,000.00 for instrument processing alone. Unmeasured hospital savings include decreased instrument wear and replacement frequency, quicker operating room setup, and decreased decontamination costs. ConclusionsOptimizing surgical trays can reduce cost, physical strain, preparation time, decontamination time, and processing times, and streamlining trays is an effective strategy for hospitals to reduce costs and increase operating room efficiency.