Standard Operating Procedures Research Articles

Standard operating procedure for the analysis of major ions in hydrothermal fluids by ion chromatography

This standard operating procedure (SOP) describes an ion chromatography (IC) procedure for the major cations and anions in hydrothermal fluids. Hydrothermal fluids are aqueous solutions with a wide range of temperature, salinity, pH and ion species that can be used by microbial metabolism as electron donors and electron acceptors. Due to the high variability of the environmental physical-chemical parameters in these samples, we have developed this protocol taking into account the special features of the matrices analyzed. An Eco IC Metrohm system equipped with a conductivity detector was used. Calibration curves are linear in the 0.1 to 10 mg/L concentration range for cations Ca2+, Na+, K+, Mg2+, NH4 + and anions Cl-, Br-, NO3 -, NO2 -, SO4 2- , HPO4 2-.

A standard operating procedure for prehospital anaesthesia and its effect on mortality-An observational study.

Prehospital anaesthesia is a complex intervention performed for critically ill patients. To minimise complications, a standard operating procedure (SOP) outlining the process is considered valuable. We investigated the implementation of an SOP for prehospital anaesthesia in helicopter emergency medical services (HEMS). We performed a retrospective observational study of patients receiving prehospital anaesthesia by Finnish HEMS from January 2012 to August 2019. The intervention studied was the implementation of an SOP at two of the five bases during 2015-2016. Patients were stratified according to whether they were anaesthetised before, during or after implementation and the primary outcomes were 1- and 30-day mortality. Secondary outcomes included anaesthesia quality indicators. Confounding factors was assessed via logistic regression. A total of 3902 tracheal intubations were performed without an SOP, 430 during implementation and 1525 after implementation. The SOP had a significant effect on 1-day mortality during implementation with an odds ratio (OR) of 0.56, 95% confidence interval (95% CI) 0.37-0.81 and a further trend towards benefit after implementation (OR 0.84, 95% CI 0.68-1.04), but no difference in 30-day mortality (OR after implementation 1.10, 95% CI 0.92-1.30). Implementation of an SOP improved first-pass success rate from 87.3% to 96.5%, p < 0.001. Implementation of an SOP for prehospital anaesthesia was associated with a trend towards lower 1-day mortality and an improved first-pass success but did not affect 30-day mortality. Despite this, we advocate prehospital systems to consider implementation of a prehospital anaesthesia SOP as immediate performance markers improved significantly.

Optimizing the Use of Radar when the Ship is Moving in MT. Green Plus

It is believed that the high number of collisions in narrow shipping lanes is caused by the lack of skill of sailors. Therefore, this analysis aims to determine the role of Radar in preventing collisions at sea. The research approach is qualitative, and the data will be presented using descriptive analysis. The research findings indicate that the decrease in Radar function is due to the non-implementation of Standard Operating Procedures (SOPs), the officers' lack of understanding of the manual books, and damage to the scanner. The consequences of a decrease in Radar function include navigation hazards because the Radar does not function correctly, making it difficult for the watch crew to identify other ships. To optimize the use of Radar when ships are moving at night, it is necessary to regularly check, maintain and repair navigation equipment.

Non-compliance of Hospital X Employee in Implementing Standard Operational Procedures of Instrument Decontamination and Chest X-Ray Services

Good hospital management is important to maintain the safety of patients, staff and hospital visitors. Each hospital employee responsible for patient safety by carrying out work according Standard Operating Procedure (SOP) guidelines agreed by organization. This study aims to identify the casues factors and the solution for hospital employees to not comply with the SOP. This study uses a qualitative descriptive approach. Methods of data collection by conducting direct observation and interviews. Subjects in the study were determined based on purposive sampling, as many as 8 respondents consisting of the inpatient room's head, nurses and radiology officers. It is important to apply a system approach in the management of an organization. The elements included in the systems approach are planning, organizing, actuating and controlling. From those elements, there are things that not properly carried in the hospital. The existing procedures were not followed by the employees, for example, procedures regarding instrument decontamination in the inpatient room and photo reading at the radiology service. Non-compliance with this procedure is influenced by several factors, namely the staff lack of discipline and responsibility, inappropriate procedures, facilities that are not available, and there is no socialization of the procedure to hospital employees. The non-compliance of employees at X hospital was caused by procedural factors, decontamination and radiology officer's performance factors and hospital's facilities. For this reason, it is necessary to conduct periodic outreach, monitoring and evaluation of the SOP and hospital employees to improve the quality of hospital services and customer satisfaction.

Factors Causing Outpatient Long Waiting Time at Outpatient Polyclinic of X Hospital

The long waiting time at the outpatient polyclinic is challenging at various hospitals. Waiting too long at the outpatient polyclinic will decrease patient satisfaction, so hospitals must continue improving quality service. Therefore, this study aimed to discover the causes of outpatient prolonged waiting time and solutions to these problems. This research was qualitative research conducted at X Hospital in Malang. The research sample was five participants. In this study, direct interviews, FGDs, and questionnaires were used. Factors causing prolonged waiting time for outpatient services at X Hospital that were not yet effective or still exceeded the minimum standard of hospital services were obtained through observation and Focus Group Discussions (FGDs); and the three root causes compiled using a fish diagram were no online registration and online queues, no Standard Operating Procedure regulating delays in the arrival of specialists for outpatient care, and a limited number of human resources. An alternative solution to the root of the problem was the creation of a Standard Operating Procedure that specifically regulates delays in specialist doctors at the outpatient polyclinic, creating WhatsApp online registration, and increasing the number of human resources in the outpatient polyclinic registration desk.

Clinical Practice of Pre-Assembling and Storing of Extracorporeal Membrane Oxygenation Systems

According to the Extracorporeal Life Support Organization (ELSO) guidelines, pre-assembled and already primed extracorporeal membrane oxygenation (ECMO) systems can be safely stored for up to 30 days under specific conditions. This study gives a detailed overview of existing pre-assembly practices. An anonymous online survey was conducted among chief perfusionists at German ECMO centers. Forty-four of a total of 83 ECMO centers (53%) completed the survey. Thirty-three percent do not preassemble ECMO systems. Seventy-seven percent (n = 34) reported having preassembled ECMO systems readily available (30% dry preassembly/20% wet preassembly/27% wet preassembly with circulation). Half of the participating centers (50%) reported having a standard operating procedure (SOP) and the majority (57%) of chief perfusionists expressed a need for an evidence-based SOP. A maximum storage time for wet preassembled ECMO systems is established in 88% of departments. On average, wet preassembled systems are discarded after 20 days, which is below the ELSO’s safe limit of 30 days. Overall, this survey reveals a heterogeneous approach regarding the practice of provisioning preassembled ECMO systems. The demand for an evidence-based SOP for the preassembly and storing of ECMO systems becomes evident, necessitating the determination of hygienic standards, regular training, and a reliable maximum storage period.

Public Aspirations and Complaints Information System: Improving the Quality of Public Complaints in Sidrap Regency

Public assessments determine the quality of public services, so public complaints are needed to improve service quality. In making the management of public complaints more effective as expected by the government in Presidential Regulation no. 76/2013, the Sidenreng Rappang Regency Government has utilized technology, by creating. public aspirations and complaints information system (SIAPP), but until now, the complaint service is still experiencing problems. The socialization of program innovations and complaint procedures through the SIAPP program is not evenly distributed at every level of society. In addition, the SIAPP admin is less responsive in responding to public complaints. Based on this, this research was carried out to analyze the quality of public complaint services in Sidenreng Rappang Regency through the SIAPP application to support the creation of quality public services. Qualitative research methods, with a descriptive approach, were the researcher's choice. Research data was obtained through interviews, which were also strengthened from observations and literature studies. The data that has been obtained is analyzed by referring to the interactive model. The research results show that the quality of public complaints in Sidenreng Rappang Regency cannot be improved by using the SIAPP application because the standard operational procedures for SIAPP are not yet complete. Regional apparatus organizations are slow in following up on community complaints, and community data security is still weak when using the SIAPP application.

Development of standard operating procedure "Quality control of sodium chloride solution 0.9% (350 ml) for infusion (intra-pharmacy preparation) in pharmacy organizations manufacturing pharmaceuticals"

To develop a standard operating procedure (SOP) for quality control of 0.9% sodium chloride solution (350 ml) for infusion (intra-pharmacy preparation) in accordance with the requirements of the current regulatory documentation. Materials and Methods. Sodium chloride 0.9% sodium chloride solution (350 ml) for infusion (intra-pharmacy preparation) served as the object of the study. The SOP was developed taking into account the requirements of updated regulatory documents used in the field of quality control of medicines: Federal Law No. 61 dated 12.04.2010 "On Circulation of Medicines", Order of the Ministry of Health of the Russian Federation dated 22.05.2023 No. 249n, Order of the Ministry of Health of the Russian Federation dated 22.05.2023 No. 647n dated 31.08.2016, State Pharmacopoeia XV ed. and GOST R 52249-2009. Results. The main stages of the SOP in accordance with the current regulatory documentation are given, reagents, instruments and equipment required for testing are listed, mandatory and sample types of control are indicated. For this dosage form the mandatory controls will be organoleptic, written, control at release, physical and full chemical control. The methods of pH and authenticity tests are described, and the chemistry of qualitative reactions is given. For quantitative determination by the method of argentometry according to Mohr, the method of analysis is given, chemical reactions occurring during titration, the necessary calculations are made: the titer of silver nitrate solution of sodium chloride, the preliminary volume of titrant, the content of sodium chloride in the dosage form in grams. Permissible content limits are given in accordance with OFS.1.8.0001 "Medicinal preparations of pharmacy manufacture". Based on the results of the SOP development, a working instruction for quality control of sodium chloride solution 0.9% (350 ml) for infusion was drawn up. Conclusion. The presented SOP for quality control of sodium chloride solution 0.9% (350 ml) for infusion (intra-pharmacy preparation) describes the requirements for the organization and conditions of testing in assessing the quality of this dosage form and can be implemented in the work of manufacturing pharmacies as a detailed instruction for intra-pharmacy control.

Evaluasi Program Indonesia Pintar Sebagai Kebijakan Peningkatan Kesetaraan Pendidikan Dan Kurikulum

This research aims to evaluate the Smart Indonesia Program (PIP) as a policy to increase educational and curriculum equality. This research uses qualitative methods with library study techniques based on data all sourced from national journal databases. At the same time, appropriate search terms are a prerequisite for accurate data acquisition. To make search results as comprehensive and accurate as possible, the Authorb of Science core collection was selected for this study. This research uses the subject "Curriculum Management and the Smart Indonesia Program". The results of this research show that the challenge in evaluating context is the mismatch between regulations at the central and school levels (regulations of the Secretariat General of the Ministry of Education and Culture and standard operating procedures (SOP) in all schools in Indonesia. Schools must be involved in student verification and validation to determine which students will receive PIP funds so that they are truly targeted. There is no clear SOP for the data that will be submitted as a database of PIP recipients

Mitochondrial depolarization and ATP loss during high frequency nanosecond and microsecond electroporation

It is predicted that ultra-short electric field pulses (nanosecond) can selectively permeabilize intracellular structures (e.g., mitochondria) without significant effects on the outer cell plasma membrane. Such a phenomenon would have high applicability in cancer treatment and could be employed to modulate cell death type or immunogenic response. Therefore, in this study, we compare the effects of 100 µs x 8 pulses (ESOPE − European Standard Operating Procedures on Electrochemotherapy) and bursts of 100 ns pulses for modulation of the mitochondria membrane potential. We characterize the efficacies of various protocols to trigger permeabilization, depolarize mitochondria (evaluated 1 h after treatment), the extent of ATP depletion and generation of reactive oxygen species (ROS). Finally, we employ the most prominent protocols in the context of Ca2+ electrochemotherapy in vitro. We provide experimental proof that 7.5–12.5 kV/cm x 100 ns pulses can be used to modulate mitochondrial potential, however, the permeabilization of the outer membrane is still a prerequisite for depolarization. Similar to 100 µs x 8 pulses, the higher the permeabilization rate, the higher the mitochondrial depolarization. Nevertheless, 100 ns pulses result in lesser ROS generation when compared to ESOPE, even when the energy input is several-fold higher than for the microsecond procedure. At the same time, it shows that even the short 100 ns pulses can be successfully used for Ca2+ electrochemotherapy, ensuring excellent cytotoxic efficacy.

Geomorphological Structure of Landform Characteristics As A Reference for Development Recommendations in Active Volcanic and Faulting Areas, A Case Study in Kerinci Region, Jambi Province, Indonesia

Kerinci Regency is located on the western to the southwestern part of the capital city of Jambi Province, Indonesia. It has interesting geomorphological sites consisting of the physiography of the Barisan Mountain Zone associated with the Sumatran Fault System known as a volcanic-tectonic complex. Geomorphology has an important role in providing information of the landscape in an area. This paper aims to determine the geomorphological characteristics of the area which can provide information regarding disaster mitigation, the direction of land-use innovation, and infrastructure development strategies. This research uses analyses of morphographic, morphometric, morphogenetic, morphoconservation, and morphochronological aspects. Analysis of satellite images and topographic contours is a method used to determine the characteristics of drainage patterns and geological mapping. A significant result of this research is a geomorphological map of Kerinci that divides the area into several geomorphological units, namely volcanic-denudational, karst, structural, volcanic-structural, structural-denudational, and fluvial morphologies. Based on the geomorphological map, the area has a very high potential hazard consisting of volcanic structural landforms, which are Tanco Isolated Hill (TIH), Kerinci Fault Escarpment Undulation (KFEU), Kerinci Fault Escarpment Volcanic Undulation (KFEVU), structural landforms (Alang Structural Valley (ASV), Kumun Fault Hills (KFH), and Pengasih Fault Undulation (PGFU)). This map can be used to design the Standard Operating Procedures (SOP) for regional development in Kerinci.

A worldwide look into Long COVID-19 management: an END-COVID survey

BackgroundLong COVID is a heterogeneous clinical syndrome characterised by a variety of reported symptoms and signs. Its clinical management is expected to differ significantly worldwide.MethodsA survey-based study investigating Long COVID-related standard operating procedures (SOPs) has been conducted by the European Respiratory Society (ERS) END-COVID clinical research collaboration with the support of other international societies (ALAT, APSR, CHEST, ESCMID, PATS). A global analysis of the results is provided here, alongside with sub-population analysis based on continents, national income levels, type of involved healthcare professionals and inclusion or exclusion of paediatric patients.Findings1015 healthcare professionals from 110 different countries worldwide participated in this study, the majority of them being respiratory physicians (60.6%). A dedicated Long COVID programme was present in 55.4% of the investigated institutions, with hospital admission during the acute infection being the main inclusion criteria to access them. Consistent differences in Long COVID-related procedures were identified among centres, mainly regarding the multidisciplinary approach, the availability of telemedicine and psychological support, the type of requested exams and the total amount of visits in the centre.InterpretationLong COVID management shows important differences related to geographical areas and national income levels. SOPs were significantly different when centres were managed by a pulmonologist or when paediatric patients were included.FundingERS has received funding to conduct this study by AstraZeneca UK Limited, Novartis Pharma AG, F. Hoffmann-La Roche Ltd, and Boehringer Ingelheim International GmbH.

A practical guide to data management and sharing for biomedical laboratory researchers

Effective data management and sharing have become increasingly crucial in biomedical research; however, many laboratory researchers lack the necessary tools and knowledge to address this challenge. This article provides an introductory guide into research data management (RDM), and the importance of FAIR (Findable, Accessible, Interoperable, and Reusable) data-sharing principles for laboratory researchers produced by practicing scientists. We explore the advantages of implementing organized data management strategies and introduce key concepts such as data standards, data documentation, and the distinction between machine and human-readable data formats. Furthermore, we offer practical guidance for creating a data management plan and establishing efficient data workflows within the laboratory setting, suitable for labs of all sizes. This includes an examination of requirements analysis, the development of a data dictionary for routine data elements, the implementation of unique subject identifiers, and the formulation of standard operating procedures (SOPs) for seamless data flow. To aid researchers in implementing these practices, we present a simple organizational system as an illustrative example, which can be tailored to suit individual needs and research requirements.By presenting a user-friendly approach, this guide serves as an introduction to the field of RDM and offers practical tips to help researchers effortlessly meet the common data management and sharing mandates rapidly becoming prevalent in biomedical research.

Fermentation Analytical Technology (FAT): Monitoring industrial E. coli fermentations using absolute quantitative 1H NMR spectroscopy

BackgroundTo perform fast, reproducible, and absolute quantitative measurements in an automated manner has become of paramount importance when monitoring industrial processes, including fermentations. Due to its numerous advantages – including its inherent quantitative nature – Proton Nuclear Magnetic Resonance (1H NMR) spectroscopy provides an ideal tool for the time-resolved monitoring of fermentations. However, analytical conditions, including non-automated sample preparation and long relaxation times (T1) of some metabolites, can significantly lengthen the experimental time and make implementation in an industrial set up unfeasible. ResultsWe present a high throughput method based on Standard Operating Procedures (SOPs) and 1H NMR, which lays the foundation for what we call Fermentation Analytical Technology (FAT). Our method was developed for the accurate absolute quantification of metabolites produced during Escherichia coli industrial fermentations. The method includes: (1) a stopped flow system for non-invasive sample collection followed by sample quenching, (2) automatic robot-assisted sample preparation, (3) fast 1H NMR measurements, (4) metabolites quantification using multivariate curve resolution (MCR), and (5) metabolites absolute quantitation using a novel correction factor (k) to compensate for the short recycle delay (D1) employed in the 1H NMR measurements. The quantification performance was tested using two sample types: buffer solutions of chemical standards and real fermentation samples. Five metabolites – glucose, acetate, alanine, phenylalanine and betaine – were quantified. Absolute quantitation ranged between 0.64 and 3.40 mM in pure buffer, and 0.71–7.76 mM in real samples. SignificanceThe proposed method is generic and can be straight forward implemented to other types of fermentations, such as lactic acid, ethanol and acetic acid fermentations. It provides a high throughput automated solution for monitoring fermentation processes and for quality control through absolute quantification of key metabolites in fermentation broth. It can be easily implemented in an at-line industrial setting, facilitating the optimization of the manufacturing process towards higher yields and more efficient and sustainable use of resources.

Need Assessment for the Development of A Training Model for Coping Learning in Kindergarten

Coping learning is critical for fostering children's ability to cope with their problems. This study explored the issues and requirements for creating a training model for coping learning in kindergartens in Yogyakarta. Following Borg and Gall's exploration stage of the research and development approach, this research analyzed four (4) principals' and five (5) educators' input. During the exploration stage, data on coping learning was collected through observations and interviews. Interactive analysis was employed as the data analysis technique. The findings revealed some issues, specifically: 1) educators lack the necessary knowledge and skills to implement coping learning effectively, 2) the lack of a Standard Operating Procedure (SOP) for coping learning resulted in a haphazard approach to its implementation, 3) educators have limited knowledge and ability to manage children's emotional and behavioral problems, 4) insufficient coping-based learning resources, and 5) certain parenting practices prevent children from developing coping skills. The needs assessment results will then be used to create a training model, which will then be submitted for expert judgment and field testing to determine its effectiveness.

Evaluating the Performance and Practicality of a Multi-Parameter Assessment System with Design, Comparative Analysis, and Future Directions

This study introduces a developed environmental quality assessment system, detailing its hardware, software, and comparative analysis against a publicly available system. While showing larger deviations in particulate matter and air humidity parameters, the proposed system demonstrates sufficient accuracy in other environmental characteristics. It establishes a standardized operating procedure and evaluates uncertainty and quality assurance measures, ensuring reliability in environmental measurements. The system offers comprehensive capabilities, measuring parameters like total volatile organic compounds, carbon dioxide, temperature, humidity, particulate matter, noise, nitrogen oxides, sulfur oxides, ozone, and carbon monoxide, with real-time monitoring functions for detecting environmental changes. Its user-friendly interfaces, scalability, and potential integration with existing systems enhance its versatility and cost-effectiveness across diverse settings. This study underscores the need for future research to enhance accuracy, reliability, and real-time operability and explore integration with smart city initiatives and environmental management systems. Overall, the proposed system represents a promising advancement in environmental monitoring technology, facilitating comprehensive environmental quality assessment and management.

The evolution of down cow management

While improvements have been made in how non-ambulatory cattle cared for over the past 35 years, they remain a challenge to manage on farm. Cows that are down, even for several hours, are at risk of developing secondary complications, further exac­erbated by poor management and care, which impacts both their welfare and potential for recovery. Good nursing care results in better recovery rates and ensures compliance with quality assur­ance programs. Developing standard operating procedures for managing these animals, including euthanasia decision-making, is an essential step towards improving animal welfare on farm.

ESPEN guideline on nutrition and hydration in dementia – Update 2024

Background & aimsDementia is accompanied by a variety of changes that result in an increased risk of malnutrition and low-intake dehydration. This guideline update aims to give evidence-based recommendations for nutritional care of persons with dementia in order to prevent and treat these syndromes. MethodsThe previous guideline version was reviewed and expanded in accordance with the standard operating procedure for ESPEN guidelines. Based on a systematic search in three databases, strength of evidence of appropriate literature was graded by use of the SIGN system. The original recommendations were reviewed and reformulated, and new recommendations were added, which all then underwent a consensus process. Results40 recommendations for nutritional care of older persons with dementia were developed and agreed, seven at institutional level and 33 at individual level. As a prerequisite for good nutritional care, organizations caring for persons with dementia are recommended to employ sufficient qualified staff and offer attractive food and drinks with choice in a functional and appealing environment. Nutritional care should be based on a written care concept with standardized operating procedures. At the individual level, routine screening for malnutrition and dehydration, nutritional assessment and close monitoring are unquestionable. Oral nutrition may be supported by eliminating potential causes of malnutrition and dehydration, and adequate social and nursing support (including assistance, utensils, training and oral care). Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Routine use of dementia-specific ONS, ketogenic diet, omega-3 fatty acid supplementation and appetite stimulating agents is not recommended. Enteral and parenteral nutrition and hydration are temporary options in patients with mild or moderate dementia, but not in severe dementia or in the terminal phase of life. In all stages of the disease, supporting food and drink intake and maintaining or improving nutrition and hydration status requires an individualized, comprehensive approach. Due to a lack of appropriate studies, most recommendations are good practice points. ConclusionNutritional care should be an integral part of dementia management. Numerous interventions are available that should be implemented in daily practice. Future high-quality studies are needed to clarify the evidence.

Biomarkers: Their Vital Role in Understanding the Complexity of Marine Pollution Monitoring

The monitoring of marine pollution plays a pivotal role in our efforts to comprehend and mitigate its detrimental effects on marine ecosystems. Biomarkers, quantifiable biological indicators of exposure or effect, have emerged as indispensable tools in gauging the magnitude of pollution. This review delves into the multifaceted challenges associated with the use of biomarkers in marine pollution monitoring, including species-specific responses, sensitivity and specificity concerns, extraneous factors, species variability, an exclusive focus on single stressors, and limited knowledge. Discerning between pollution-induced impacts and natural fluctuations is made challenging by the inherent natural variability and confounding factors. Differences in sensitivity and specificity add complexity to the precision of pollution detection. Species-specific variations and the presence of multiple contaminants add layers of complexity to biomarker examination. Additionally, the lack of standardized operating procedures and insufficient information hinder the widespread adoption of biomarkers. Limited studies on specific stressors restrict our comprehensive understanding of pollution effects particularly in the Philippines. Further research, collaborative efforts, and the establishment of standardized protocols are imperative to enhance the precision and efficacy of biomarker-based monitoring in marine environments.

Comparative Analysis of Costing Methods for Magnetic Resonance Imaging in a Tertiary Care Teaching Hospital: An Observational Study

Abstract Background: Health-care costs, often determined through outdated methods, fail to capture the true costs of care delivery. Traditional costing methods in the health-care sector have proven insufficient, leading to potential revenue losses and increased patient out-of-pocket expenses. Activity-based costing (ABC) and time-driven ABC (TDABC) offer alternative approaches to cost calculation, aiming for a more accurate reflection of resource consumption. Methodology: This descriptive observational study was conducted in the magnetic resonance imaging (MRI) center of a tertiary care teaching hospital, focusing on a single noncontrast MRI scan costing. Direct observations and record reviews, including standard operating procedures, policy letters, financial documents, and miscellaneous records, were employed. Results: Using traditional costing, the unit cost of an MRI scan was calculated at INR 1291.51. ABC yielded a unit cost of INR 3613.77, while TDABC resulted in a unit cost of INR 2764.39. A comparison between the three costing methods revealed potential revenue losses with traditional costing. In contrast, TDABC appeared to strike a balance between financial prudence and reduced patient out-of-pocket expenses. Conclusion: The study emphasizes the significance of understanding true costs in health-care delivery. The results advocate for the adoption of TDABC as a favorable compromise, enabling the hospital to retain revenue without burdening patients with additional costs. Notably, the study highlights the necessity for a granular understanding of true costs for successful transitions from volume to value in health care.