Valuable Cost Savings Research Articles

385. HOSPITAL COSTS OF POSTOPERATIVE ADVERSE EVENTS FOLLOWING ESOPHAGECTOMY: RESULTS FROM 10 CANADIAN INSTITUTIONS

Abstract Background Surgical resection plays a central role in the multimodal curative intent management of esophageal cancer. Despite advances in peri-operative care, 60% of patients undergoing esophagectomy experience postoperative adverse events (AEs), if AEs are prospectively collected by surgeons. We recently performed a systematic review documenting the published index hospital costs of AEs, yet the overall costs of AEs in Canadian esophageal centres remains unknown. Methods Between 2017–2021, prospectively collected data from 10 Canadian esophageal centres were included. Volumes of esophagectomy, incidence of postoperative AEs (anastomotic leak (AL), pneumonia, respiratory failure), graded using the Ottawa TM&M system [ottawatmm.org], and obtained from 2 Canadian Association of Thoracic Surgeons (CATS) National Positive Deviance Seminars were included. Using literature-derived index hospitalization costs of AEs, estimates of annual costs were obtained (2023 Cdn$). Results Data from 795 esophagectomies performed in Canada between 2017–2019 revealed an average AL rate of 15% (8.7–22%). This led to an estimated yearly hospital cost of $6.63 M. Additional data from 863 esophagectomies performed between 2018–2021 revealed an average yearly pneumonia rate of 10.2% (2.4–20.3%)., with an estimated cost of $1.44 M, and respiratory failure (requiring ICU admission) of 7.8% (0–13.8%), with an estimated cost of $1.83 M. When all 10 centres are combined, these 3 AEs equate to over $9.9 M in hospital expenditures/year. A 1% reduction/year in the 3 AEs would lead to a cost-savings of $816,738. Conclusion Our analysis of only 3 post-operative AEs highlights the staggering costs to hospitals across Canada individually, and collectively, and emphasizes the need to support value-based QI research. Direct financial support from hospitals to support value-based QI in esophageal surgery has the potential to simultaneously improve care and provide valuable cost savings.

Heat losses in applied smouldering systems: Sensitivity analysis via analytical modelling

As applied smouldering systems gain popularity for a variety of energy conversion purposes, there is a strong interest in optimizing the reactor design to support robust smouldering. Heat losses play a critical role in the energy balance of smouldering systems, and therefore have strong implications toward understanding propagation limits and reactor design. Heat losses in an applied smouldering system were approximated by adapting the analytical model from Kuznetsov (1996), originally developed for unsteady local thermal non-equilibrium heat transfer in a porous cylinder, to simulate the cooling zone trailing the smouldering front. The analytical model was adapted to a smouldering system by solving on a domain that lengthens as the cooling zone expands at the rate of the smouldering velocity. The results are incorporated into a global energy balance on the smouldering system, thereby providing an inexpensive and rapid method to estimate the system energy efficiency. Confidence in the analytical model was provided by demonstrating its predictions compare well with existing experimental and numerical estimates of heat losses from similar smouldering systems. The model was then used to quantify the sensitivity of the heat losses to two key reactor design parameters: radius and insulation quality. The system energy efficiency was shown to be highly sensitive to improved insulation and increased radius up to ~0.1 m (i.e., laboratory-sized reactors). However, this sensitivity diminished with size. Beyond 0.4 m radius, the predicted system energy efficiency was high (~85-95%) and relatively insensitive to reactor radius and insulation quality. Therefore, commercial, batch treatment smouldering reactors do not need to be larger than 0.4 m in radius to protect against heat losses and maximize their energy efficiency. This threshold design radius is considerably less than used in current reactors and therefore can provide valuable cost savings.

Modern Technologies for Micro-drilling of the Fuel Injector Nozzle used in Motor Vehicles - A Review of the Literature

To cope with the pollution norms and an improvement of the combustion of the internal combustion engines, high-quality holes with diameters smaller than 145 µm are needed for the manufacture of fuel injection nozzles. The current practice of using drilling by electro-discharge machining of fuel injection nozzles is limited in terms of the size of the hole it can efficiently produce and the time required for drilling. In addition, the cost of the tool is high. This paper presents an investigation into a sequential laser and electro-discharge micro-drilling technique for the manufacture of fuel injection nozzles. A pilot hole drilled with a laser is removed by electrodischarge. It was found that this hybrid process eliminated the problems of reformed and heat-affected areas usually associated with the laser drilling process. The new process has allowed a reduction in total drilling time compared to standard electro-discharge machining drilling, as less material is removed from the electro-discharge machining. The quality of the holes is as good as direct electro-discharge machining drilling. This technique has allowed valuable cost savings and increased production capacity for the manufacture of the fuel injector nozzle.

The impact of changing reflexive to clinician-ordered Clostridioides difficile polymerase chain reaction (PCR) testing for indeterminate cases: Cost savings without associated adverse events.

To evaluate changing Clostridioides difficile infection (CDI) testing among inpatients with indeterminate enzyme immunoassay (EIA) results (antigen+/toxin-) from reflexive polymerase chain reaction (PCR) testing to clinician-ordered PCR testing. Multicenter, before-and-after, quasi-experimental study. Four large urban tertiary-care hospitals. We evaluated two 6-month periods before and after an intervention. The primary study outcome was the change in the number of CDI diagnoses between periods. Secondary outcomes included the number of PCR tests performed, adverse events, and healthcare cost savings. In total, 500 EIA-indeterminate C. difficile test results were evaluated: 281 before the intervention and 219 thereafter. CDI was diagnosed by PCR among EIA-indeterminate cases in 182 in the preintervention period versus 94 patients in the postintervention period (48% reduction; P < .01). PCR testing was performed in 99.6% of indeterminate cases (280 of 281; 1 not performed due to an inhibitor) in the preintervention period versus 66% (144 of 219) in the postintervention period (34% reduction; P < .01). We observed no differences between study periods in 30-day all-cause (P = .96), GI-related (P = .93), or C. difficile (P = .47) readmissions, nor in 30-day C. difficile infections (P > .99). No patient without a PCR test in the postintervention period and not treated was later diagnosed with CDI. Each reflexive PCR test not performed led to a cost savings of $4,498 per patient. Applying diagnostic stewardship to C. difficile PCR testing in the inpatient setting led to significant reductions in both testing and cases. Changing the C. difficile PCR testing algorithm for EIA-indeterminate cases from reflexive to clinician-required ordering resulted in valuable cost savings without associated adverse events.

2342. Elimination of Reflexive C. difficile PCR Testing Among Inpatients Resulted in Cost Savings Without Adverse Events

BackgroundDiagnosis of C. difficile infection is imperfect and various algorithms have been proposed. While PCR is sensitive for detecting toxin-carrying C. difficile, it leads to overdiagnoses resulting in antibiotic overuse and potentially unnecessary healthcare costs.MethodsWe performed a study of C. difficile cases after changing the testing protocol from reflexive vs. physician-requested PCR in cases of indeterminant EIA testing (antigen +, toxin −). The study was conducted among inpatient adults at four large hospitals in the southern California area and evaluated two 6-month periods: pre-intervention: (September 5, 2016–March 5, 2017) and post-intervention (3/6/2017–9/6/2017). Only the first C. difficile test during a period per patient was evaluated. Primary outcome was change in number of C. difficile diagnoses. Secondary outcomes included adverse events (missed cases of C. difficile and 30-day readmissions) and cost savings (accounting for PCR, isolation, and treatment costs).ResultsA total of 500 EIA indeterminant C. difficile test results were evaluated, 281 pre- and 219 post-intervention. There were no statistically significant differences in demographics, laboratory values (WBC, Cr), or hospital site between the study periods. A PCR was performed in 99.6% (280/281; one not performed due to an inhibitor) and 66% (144/219) in the pre- vs. post-intervention periods (P < 0.01); the PCR was positive in 65% (n = 182 and n = 94, respectively) in both periods. The change in testing strategy resulted in a 49% reduction in PCR testing and 48% fewer C. difficile cases. There were no differences between study periods in 30-day readmissions for all-cause (P = 0.96), GI-related illness (P = 0.93) or C. difficile (P = 0.47), nor in new or recurrent C. difficile cases (P > 0.99). No patient without a PCR and not treated was later diagnosed with C. difficile infection. Each reflexive PCR avoided led to a cost savings of $4,384/patient.ConclusionDiagnostic stewardship is an emerging area that can potentially reduce overdiagnosis and overtreatment of a variety of infectious diseases. Our study showed that changing C. difficile PCR testing among EIA-indeterminant cases from reflexive to requiring a physician order resulted in valuable cost savings without associated adverse events.Disclosures All authors: No reported disclosures.

Effects of shielding gas control: welded joint properties in GMAW process optimization

One function of shielding gases used in welding processes, such as hydrogen (H2), oxygen (O2), carbon dioxide (CO2), nitrogen (N2), helium (He), argon (Ar) and their mixtures, is protection of the weld pool against harmful contamination that could generate defects. In addition to this primary function, shielding gases significantly affect the shape of the weld, weld geometry, seam appearance, metallurgical and mechanical properties, welding speed, metal transfer, arc stability or beam and fume emissions. The shielding gas is thus a key factor in determining weld joint properties and welding process efficiency. As welding processes have become enhanced and welding research has advanced, different combinations of shielding gas mixtures have become available under a wide variety of trademarks, each claiming to offer the best efficiency. The shielding gas flow rate in GMAW welding is usually set according to empirical experiment. The flow generally remains unchanged throughout the entire welding process and is set at maximum values of the welding parameters so that there is sufficient gas cover. This setting means, however, that unnecessarily large quantities of shielding gas may be consumed in other phases of the welding process. In view of constantly increasing prices and shortfalls in helium supply, there is a need to optimize the use of shielding gas. Consequently, an ability to closely monitor the shielding gas blend and reduce waste can provide valuable cost savings. This paper examines the effects of shielding gas mixtures and their components, presents a cross-comparison of shielding effects in fusion welding and suggests guidelines for adaptive controllability of shielding gas in advanced adaptive fusion welding. The study reviews scientific case studies and experiments from the point of view of the effect of the shielding gas on the process efficiency and process outcome. The study considers shielding gases for welding of both ferrous metals (i.e. carbon steels, stainless steels, high-strength steels) and non-ferrous metals (i.e. aluminium and its alloys, nickel and its alloys and copper and its alloys). Appropriate choice of shielding gas and use of an optimum flow rate results in better quality in terms of increased productivity, reduced gas consumption and improved weld geometry properties, microstructure and mechanical properties. Although some blends can be used effectively in many different processes, other blends appear process-dependent; they produce far poorer results when utilized in non-appropriate processes. Particle image velocimetry (PIV) and Schlieren techniques can be used for visual sensing of gas flow during fusing welding. Moreover, an adaptive alternative gas supply can improve welding performance and weld quality and reduce harmful fume emission.

A Grey Theory Based Multiple Attribute Approach for R&D Project Portfolio Selection

In this paper, the research and development (R&D) project portfolio selection problem is introduced as a multiple attribute decision making problem. Recognizing and modeling the project interdependencies provide valuable cost savings and other greater benefits to organizations. Therefore, besides conventional attributes like cost and outcome, different type of interdependencies are also considered as attributes. Since the decision makers’ preferences on the project alternatives or attributes are uncertain, a grey theory based method is proposed to cope with the uncertainty. correspondingly, the preferences and ratings of the attributes are described by linguistic variables, which are further expressed as grey numbers. Consequently, a ranking order of the projects is done using grey possibility degree and is used to determine the portfolio. To explore, an illustration is done by a case study. The methodology proposed here is shown to be an efficient approach to solve the R&D project portfolio selection problem.

Evaluating the clinical and economic burden of healthcare-associated infections during hospitalization for surgery in France

Over 4 million patients suffer nosocomial infections annually in the European Union. This study aimed to estimate the healthcare burden associated with healthcare-associated infections (HAIs) following surgery in France, and explore the potential impact of infection control strategies and interventions on the clinical and economic burden of disease. Data on the frequency of HAIs were gathered from the 2010 Programme de Médicalisation des Systèmes d'Information (PMSI), and cost data were taken from the 2009 Echelle Nationale de Coûts à Méthodologie Commune (ENCC). It was estimated that 3% of surgical procedures performed in 2010 in France resulted in infection, resulting in an annual cost of €57 892 715. Patients experiencing a HAI had a significantly increased mortality risk (4.15-fold) and an increased length of hospital stay (threefold). Scenario analysis in which HAI incidence following surgery was reduced by 8% (based on a study of the effectiveness of triclosan-coated sutures), suggested that, annually, 20 205 hospital days and €4 588 519 could be saved. Analyses of 20% and 30% reductions in incidence (based on an estimate of the number of preventable nosocomial infections) suggested that annual savings of €11 548 057 and €17 334 696, respectively, could be made. New infection control interventions which reduce HAI incidence during hospitalization for surgery have the potential to provide valuable cost savings to healthcare providers.

Using the analytic network process (ANP) to determine method of waste energy recovery from engine

There are many ways to recover engine waste energy. But which way is the most suitable or feasible ways in future? This is belongs to a multi-criteria decision-making (MCDM) process. Existing methods for project selection does not reflect interdependencies of criteria and candidate methods. Consideration of criteria interdependencies enables valuable cost savings and great benefits to engine and environment. When these problems are evaluated, it is necessary to collect group opinion because the interdependence relationship among criteria is known and it is very important to consider the criteria for the problem solving and decision-making. In order to collect group opinions for interdependent project problems, expert interviews are conducted. Analytic network process (ANP) is applied for measurement of the dependency among the strategic factors, which can help engineer determine their decisions. (1) It is found that thermoelectricity technology is the most suitable method to recovery waste energy in future and the ANP technique is useful as a decision judgment tool.

When the government actively faces the burden of osteoporosis: the Italian experience

EPIDEMIOLOGY AND COSTS OF FRAGILITY FRACTURES IN ITALY: The problem of osteoporosis is emerging as growing phenomenon, with an enormous impact on quality of life and on health expenses. As a consequence, a reduction in the social and health impact of bone fragility would be associated with an improved quality of life of all elderly citizens and with valuable cost savings at the health system level. OSTEOPOROSIS: EVOLUTION OF THE CONCEPT IN ITALY: In the last 20years, there have been enormous advances in the knowledge of diagnostic and therapeutic options and thus we would be in the position of starting effective therapies in at risk populations. However, this not always happens. NEW APPROACHES TO THE FRAGILITY FRACTURES BY THE ITALIAN GOVERNMENT: In this paper we offer to the reader the possibility to know the history of osteoporosis, its diagnosis and its therapy in Italy, a country where life expectancy is one of the highest in the world. THE FUTURE OF OSTEOPOROSIS IN ITALY: We hope that the example of Italy would serve as an inspiration to those countries where the history of osteoporosis only recently began.

Maintenance Strategy Evaluation Using ANP and Goal Programming

An optimal maintenance strategy mix is necessary for increasing availability and reliability levels of production facilities without significantly increasing operational costs. The selection of maintenance strategies is a typical Multiple Criteria Decision-Making (MCDM) problem with conflicting goals. Consideration of interdependence among the criteria and alternative policies for maintenance strategy provides valuable cost savings and greater benefits for any hybrid flow systems. For any decision maker, it is convenient to prioritize the criteria of MCDM problems and goals of goal programming problems in fuzzy terms. This paper presents an integrated approach for maintenance policy selection, using fuzzy Analytic Network Process (ANP) within a Goal Programming, based on fuzzy preemptive priority where goal hierarchies are specified in different levels of fuzzy importance. To overcome the criticism of inconsistency, unbalanced scale of judgments and uncertainty in the pair-wise comparison process, criteria weights are determined using modified fuzzy LLSM method.

Sequential Laser and EDM Micro-drilling for Next Generation Fuel Injection Nozzle Manufacture

High quality holes of diameters less than 145 μm are required for the manufacture of next generation diesel fuel injection nozzles for improved combustion efficiency and reduction of emission to the environment. The current practice of using electro-discharge machining (EDM) drilling of fuel injection nozzles is limited in terms of the hole size it can produce effectively and the length of time needed to drill. In addition, the tooling cost is high. This paper reports on an investigation into a sequential laser and EDM micro-drilling technique for the manufacture of next generation fuel injection nozzles. A laser-drilled pilot hole is rimmed out by EDM drilling. It was found that this hybrid process has eliminated the problems of recast and heat affected zones typically associated with the laser drilling process. The new process has enabled a 70% reduction in total drilling time compared to standard EDM drilling as less material is removed by the EDM. The quality of the holes is as good as direct EDM drilling, thus eliminating the need for re-certification of the drilling process. Various combinations of laser/EDM drilling conditions have been examined. Optimum diameters for the pilot hole and the EDM electrode have been identified for a particular diameter of fuel injection nozzle, giving the minimum total drilling time and the best quality holes. A special system was designed to enable the alignment of nozzles to be controlled to within ± 20 μm. The technique has enabled valuable cost savings and increase in production capacity for next generation fuel injection nozzle manufacture.

An integrated approach for interdependent information system project selection

Information System (IS) project selection problems are Multi-Criteria Decision Making (MCDM) problems. Prior research for IS project selection does not reflect interdependencies among criteria and candidate projects. To consider project interdependent property provides valuable cost savings and greater benefits to organizations. Although goal programming incorporates multiple objectives and arrives at an optimal solution, its major drawback is that the decision maker(s) must specify goals and priorities a priori. In order to overcome this problem, group discussion is needed. In this paper, we suggested an integrated approach for interdependent IS project selection problems using Delphi, Analytic Network Process concept and Zero–One Goal Programming. The application of the proposed methodology is illustrated through an example.

Using analytic network process and goal programming for interdependent information system project selection

Information system (IS) project selection problems are multi-criteria decision-making (MCDM) problem. Existing methods for IS project selection does not reflect interdependencies among criteria and candidate projects. Considering these interdependencies among criteria provides valuable cost savings and greater benefits to organizations. When we evaluate project problems, we need to collect a group opinion because to know the interdependence relationship among criteria and criteria in considered project problems is very important. In order to collect group opinion for interdependent project problem, we use expert interview. In this paper, we suggest an improved IS project selection methodology which reflect interdependencies among evaluation criteria and candidate projects using analytic network process (ANP) within a zero–one goal programming (ZOGP) model. Scope and purpose When information system (IS) projects are selected from a suggested competing projects they are evaluated according to different criteria. Prior research neglected an important aspect of information technology, namely the interdependencies that exist among IS projects. When we select IS project in organization, to select IS project through recognizing and modeling these project interdependencies provides valuable cost savings to organizations. Among the proposed methodologies of multi-criteria decision making (MCDM), goal programming (GP) is widely used for IS project selection. Although GP incorporates multiple objectives and arrives at an optimal solution, its major drawback is dependent on the judgment of decision maker(s). In order to provide a systematic approach to set priorities among multi-criteria and trade-off among objectives, analytic network process (ANP) is suggested to be applied prior to GP formulation. In this paper, we present a methodology using analytic network process and zero–one goal programming (ZOGP) for IS projects selection problems that have multiple criteria and interdependence property.

Cost comparison of zuclopenthixol acetate and haloperidol

This prospective, sequential study compared the costs of using haloperidol or zuclopenthixol acetate for rapid tranquillisation. In the first phase, all 16 patients admitted to our psychiatric intensive care unit requiring rapid tranquillisation received haloperidol; in the second phase, all 26 such patients received zuclopenthixol acetate. Mean overall costs per patient were substantially lower in the zuclopenthixol acetate group than the haloperidol group, mainly because special nursing was used much less in the zuclopenthixol acetate group. All nursing staff preferred to use zuclopenthixol acetate rather than haloperidol. Zuclopenthixol acetate could potentially reduce the need for special nursing and produce valuable cost savings.

A decision model for interdependent information system project selection

Existing methods for information system (IS) project selection neglect an important aspect of information technology, namely the interdependencies that exist among various IS applications (projects). Recognizing and modeling these project interdependencies provides valuable cost savings and greater benefits to organizations. In this paper, an IS project selection model is developed that identifies and models benefit, resource and technical interdependencies among candidate projects. The proposed model is formulated as a nonlinear 0–1 programming problem and represents a significant addition to existing IS, capital budgeting and R&D project selection models. The model is converted, using linearization techniques, and tested (validated) by applying it to real-world IS project selection data. By comparing the performance of this model with existing project selection models, the contribution of this model is highlighted.

Resource consumption in psychiatric intensive care: The cost of aggression

The coils of operating a psychiatric intensive care unit (PICU) were recorded for a six-month period. There were 110 admissions and 99 discharges. Mean length of stay was 12.3 days. Total costs were £346,516 over the study period, £283.56 per patient-day. Fixed costs comprised 93% of the total, inducing nursing staff ($169,447), overheads ($77,017), medical staff ($48,819), hotel costs (£24,160) and miscellaneous (£1,750). Variable costs included special nursing, (£19,405), treatment of major self-harm (£3,024), drugs (£1,707) and staff time to manage aggressive incidents (£1,188). Reduction of the incidence of aggression could result in valuable cost savings.

The Effect of Reusing Ground Flash and Scrap Rubber in Parent Compound

Abstract We have described a method of grinding flash and scrap product to such a particle size that it may be added back into parent compound with minimal reduction in properties. At the same time, this method affords valuable cost savings.