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https://www.readbyqxmd.com/read/28817444/strategies-for-reducing-population-surgical-costs-in-medicare-local-referrals-to-low-cost-hospitals
#1
Hari Nathan, Jyothi R Thumma, Edward C Norton, Justin B Dimick
OBJECTIVE: We sought to assess hospital cost variation for elective inpatient surgical procedures within small geographic areas. SUMMARY BACKGROUND DATA: Previous studies have documented cost variation for inpatient surgical procedures on a national basis, suggesting opportunities for savings. Cost variation within small geographic areas is more relevant to policymakers, providers, and patients, but it has not been studied. METHODS: Using Medicare payment data, we identified elderly patients undergoing 1 of 7 elective inpatient surgical procedures during 2010-2012...
August 16, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28815459/a-roadmap-for-reducing-cardiac-device-infections-a-review-of-epidemiology-pathogenesis-and-actionable-risk-factors-to-guide-the-development-of-an-infection-prevention-program-for-the-electrophysiology-laboratory
#2
REVIEW
Westyn Branch-Elliman
PURPOSE OF REVIEW: Cardiovascular implantable electronic device (CIED) infections are highly morbid, common, and costly, and rates are increasing (Sohail et al. Arch Intern Med 171(20):1821-8 2011; Voigt et al. J Am Coll Cardiol 48(3):590-1 2006). Factors that contribute to the development of CIED infections include patient factors (comorbid conditions, self-care, microbiome), procedural details (repeat procedure, contamination during procedure, appropriate pre-procedural prep, and antimicrobial use), environmental and organizational factors (patient safety culture, facility barriers, such as lack of space to store essential supplies, quality of environmental cleaning), and microbial factors (type of organism, virulence of organism)...
August 16, 2017: Current Infectious Disease Reports
https://www.readbyqxmd.com/read/28814257/discharge-interventions-and-modifiable-risk-factors-for-preventing-hospital-readmissions-in-children-with-medical-complexity
#3
John Stephens, Kelly S Kimple, Michael J Steiner, Jay G Berry
BACKGROUND: Concerns about the costs and quality of hospital care have led to increased interest in hospital readmissions in children. Children with medical complexity account for high proportions of inpatient utilization and have a higher risk of hospital readmission. OBJECTIVE: To identify studies of discharge interventions to prevent hospital readmissions in children with medical complexity. METHODS: We conducted a search to identify studies of discharge interventions...
August 16, 2017: Reviews on Recent Clinical Trials
https://www.readbyqxmd.com/read/28790295/-perioperative-management-team-in-esophageal-cancer-surgery
#4
Akihiko Okamura, Masayuki Watanabe
Esophagectomy for patients with esophageal cancer is one of the most invasive surgery. Despite advances in surgical techniques and perioperative management, both morbidity and mortality rates after esophagectomy still remains high. Recently, it was suggested that perioperative care bundle is effective for preventing postoperative complications after esophagectomy. Then, we introduced a perioperative multidisciplinary management team, which aimed at systematic perioperative care for patients undergoing esophagectomy...
July 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28790011/management-of-septic-shock-in-an-intermediate-care-unit
#5
Eric Meaudre, Cédric Nguyen, Claire Contargyris, Ambroise Montcriol, Erwan d'Aranda, Pierre Esnault, Mourad Bensalah, Bertrand Prunet, Julien Bordes, Philippe Goutorbe
BACKGROUND: While guidelines advocate goal-directed resuscitation based on timed bundles, the management of SS outside an ICU setting has been poorly studied in intermediate care units (IMCU). PATIENTS AND METHOD: We reviewed all cases of septic shock patients admitted to our IMCU between January 2013 and June 2014. The characteristics of sepsis, compliance of bundles, and outcomes were collected. The IMCU population was compared with the SS patients admitted to the ICU during the same period...
August 5, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28777122/improving-compliance-with-a-chronic-obstructive-pulmonary-disease-bundle-of-care-in-australian-emergency-departments-a-clinical-network-quality-improvement-project
#6
Anne-Maree Kelly, Jan Pannifex
OBJECTIVE: The aim of this study was to describe the impact of a clinical network-led quality improvement project on compliance with bundle of care elements (individually and as a 'bundle') for patients treated for chronic obstructive pulmonary disease exacerbations in the emergency department. PARTICIPANTS AND METHODS: A 9-month quality improvement project was performed by a modified knowledge transfer methodology with analysis before and after data collection...
August 2, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28767690/a-simplified-prevention-bundle-with-dual-hand-hygiene-audit-reduces-early-onset-ventilator-associated-pneumonia-in-cardiovascular-surgery-units-an-interrupted-time-series-analysis
#7
Kang-Cheng Su, Yu Ru Kou, Fang-Chi Lin, Chieh-Hung Wu, Jia-Yih Feng, Shiang-Fen Huang, Tao-Fen Shiung, Kwei-Chun Chung, Yu-Hsiu Tung, Kuang-Yao Yang, Shi-Chuan Chang
BACKGROUND: To investigate the effect of a simplified prevention bundle with alcohol-based, dual hand hygiene (HH) audit on the incidence of early-onset ventilation-associated pneumonia (VAP). METHODS: This 3-year, quasi-experimental study with interrupted time-series analysis was conducted in two cardiovascular surgery intensive care units in a medical center. Unaware external HH audit (eHH) performed by non-unit-based observers was a routine task before and after bundle implementation...
2017: PloS One
https://www.readbyqxmd.com/read/28762227/-chlorhexidine-bed-bath-improves-clabsi-a-meta-analysis
#8
Shu-Cing Lin, Chair-Hua Lin, Chin-Ching Yu
BACKGROUND: Central catheters are used primarily in ICU settings. Bloodstream infections in the central line of central catheters have been shown to cause longer hospital stays for patients and result in higher medical costs. PURPOSE: The present study applies a systematic review and meta-analysis to assess the effect of a 2% chlorhexidine (CHG) bed-bath on the risk of central line-associated bloodstream infections (CLABSI). METHODS: The Public Health Resource Unit of England issued the Critical Appraisal Skills Programme and evaluated the standardized crucial appraisal tools from the Joanna Briggs Institute that are used to assess methodological quality...
August 2017: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/28760398/symptomatic-clitoromegaly-case-report-of-a-clitoral-hemangioma
#9
Chandler A Kasuske, Keith A Hansen
BACKGROUND: Clitoromegaly is often a sign of an underlying disorder of sexual development. Isolated clitoromegaly may occur as a result of benign or malignant neoplasm. CASE: A 10-year-old female presented with clitoral swelling and discomfort and was noted to have a 5X2X2 centimeter, tender, cystic mass in the left periclitoral area. Ultrasound confirmed the primarily cystic nature of the lesion. At surgery the mass was carefully excised not damaging the clitoral neurovascular bundle...
July 28, 2017: Journal of Pediatric and Adolescent Gynecology
https://www.readbyqxmd.com/read/28759165/care-bundles-in-emergency-medicine-by-timothy-williamson-bilal-salman-rachael-boddy-and-matthew-cooke-foreword-by-peter-cameron-london-radcliffe-publishing-ltd-2014-144-pp-21-90-paperback
#10
REVIEW
Kathleen Cowling, Robert Dumas
No abstract text is available yet for this article.
May 27, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28754223/health-care-worker-perspectives-of-their-motivation-to-reduce-health-care-associated-infections
#11
Laura McClung, Chidi Obasi, Mary Jo Knobloch, Nasia Safdar
BACKGROUND: Health care-associated infections (HAIs) are largely preventable, but are associated with considerable health care burden. Given the significant cost of HAIs, many health care institutions have implemented bundled interventions to reduce HAIs. These complex behavioral interventions require considerable effort; however, individual behaviors and motivations crucial to successful and sustained implementation have not been adequately assessed. We evaluated health care worker motivations to reduce HAIs...
July 25, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28748651/emergent-programme-theories-of-a-national-quality-register-a-longitudinal-study-in-swedish-elderly-care
#12
Annika Nordin, Boel Andersson Gäre, Ann-Christine Andersson
RATIONALE, AIM, AND OBJECTIVE: This study aimed to explore programme theories of a national quality register. A programme theory is a bundle of assumptions underpinning how and why an improvement initiative functions. The purpose was to examine and establish programme theories of a national quality register widely used in Sweden: Senior alert. The paper reports on how programme theories among change recipients emerge in relation to the established programme theory of the initiator. METHODS: A qualitative approach and a longitudinal research design were used...
July 27, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28747588/surgical-site-infection-after-malignant-brain-tumor-resection-a-multicenter-study-for-induction-of-a-basic-care-bundle
#13
Takeo Uzuka, Hideaki Takahashi, Yoko Nakasu, Takeshi Okuda, Koichi Mitsuya, Nakamasa Hayashi, Takayuki Hirose, Hanako Kurai
Patients with malignant brain tumors are possibly at increased risk for surgical site infections (SSIs) considering the various medical situations associated with the disease. However, the actual rate of SSI after malignant brain tumor resection has not been well established, despite the potential impact of SSI on patient outcome. To investigate the incidence of SSI following malignant brain tumor surgery, we performed a retrospective study in 3 neurosurgical units. Subsequently, aiming at the reduction of incidence of SSI, we performed a prospective study using a care bundle technique in the same units...
July 26, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28746271/facial-assessment-and-injection-guide-for-botulinum-toxin-and-injectable-hyaluronic-acid-fillers-focus-on-the-upper-face
#14
Maurício de Maio, Arthur Swift, Massimo Signorini, Steven Fagien
Techniques for the administration of injectable fillers and neuromodulators for facial aesthetic rejuvenation and enhancement continue to evolve. As the number of physicians with limited experience in providing aesthetic treatments expands, the need for guidance and training from more experienced injectors has become apparent. The use of a slow, careful, and methodical injection technique is imperative in all treatment settings and for all facial areas. Constant attention to local anatomy, particularly arteries, veins, and nerve bundles, is critical for minimizing complications...
August 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28743340/-ventilator-bundle-guided-by-context-of-jci-settings-can-effectively-reduce-the-morbidity-of-ventilator-associated-pneumonia
#15
Lili Zhao, Lili Liu, Jing Chen, Caili Yang, Jianjian Nie, Minwei Zhang
OBJECTIVE: To observe the impact of improving the compliance of ventilator bundle on morbidity of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients undergoing mechanical ventilation (MV) guided by context of Joint Commission International (JCI) settings, and to study the oral care efficacy of suction tube sponge brush. METHODS: A prospective study was conducted. The patients who needed MV admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Xiamen University from January 2013 to December 2016 were enrolled...
July 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28741101/bundled-payments-in-total-joint-replacement-keeping-our-care-affordable-and-high-in-quality
#16
REVIEW
Alexander S McLawhorn, Leonard T Buller
PURPOSE OF REVIEW: The purpose of this review was to evaluate the literature regarding bundle payment reimbursement models for total joint arthroplasty (TJA). RECENT FINDINGS: From an economic standpoint, TJA are cost-effective, but they represent a substantial expense to the Centers for Medicare & Medicaid Services (CMS). Historically, fee-for-service payment models resulted in highly variable cost and quality. CMS introduced Bundled Payments for Care Improvement (BPCI) in 2012 and subsequently the Comprehensive Care for Joint Replacement (CJR) reimbursement model in 2016 to improve the value of TJA from the perspectives of both CMS and patients, by improving quality via cost control...
July 24, 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/28741014/post-resuscitation-care
#17
Sohil Pothiawala
Following return of spontaneous circulation (ROSC) after cardiac arrest, the challenge is to institute measures that ensure a higher likelihood of neurologically intact survival. Regardless of the cause of collapse, multiple organ systems may be affected secondary to post-cardiac arrest syndrome. Interventions required for post-ROSC care are bundled into a care regimen: prompt identification and treatment of the cause of cardiac arrest; and treatment of electrolyte abnormalities. It is also essential to establish definitive airway management to maintain normocapnic ventilation, prevent hyperoxia, and optimise haemodynamic management via judicious intravenous fluids and vasoactive drugs...
July 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/28739153/active-donor-management-during-the-hospital-phase-of-care-is-associated-with-more-organs-transplanted-per-donor
#18
Madhukar S Patel, Salvador De La Cruz, Mitchell B Sally, Tahnee Groat, Darren J Malinoski
BACKGROUND: Meeting donor management goals (DMGs) while caring for potential organ donors has been associated with more organs transplanted per donor (OTPD). Concern persists, however, as to whether this reflects that younger/healthier donors are more likely to meet DMGs or whether active management affects outcomes. STUDY DESIGN: A prospective observational study of all standard criteria donors (SCDs) was conducted by 10 organ procurement organizations across UNOS Regions 4, 5, and 6...
July 21, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28734109/the-cost-of-oropharyngeal-cancer-in-england-a-retrospective-hospital-data-analysis
#19
Sam T Keeping, Michael J Tempest, Stephanie J Stephens, Stuart M Carroll, Richard Simcock, Terence M Jones, Richard Shaw
OBJECTIVES: To estimate the total costs of treating head and neck cancers, specifically oropharyngeal, laryngeal and oral cavity cancer, in secondary care facilities in England during the period 2006/2007 to 2010/2011. DESIGN: Patient records were extracted from an English hospital database to estimate the number of patients treated for oropharyngeal, laryngeal and oral cavity cancer in England. Identified resource use was linked to published United Kingdom cost estimates to quantify the reimbursement of treatment through the Payment by Results system...
July 22, 2017: Clinical Otolaryngology
https://www.readbyqxmd.com/read/28733370/reliable-adherence-to-a-copd-care-bundle-mitigates-system-level-failures-and-reduces-copd-readmissions-a-system-redesign-using-improvement-science
#20
Muhammad Ahsan Zafar, Ralph J Panos, Jonathan Ko, Lisa C Otten, Anthony Gentene, Maria Guido, Katherine Clark, Caroline Lee, Jamie Robertson, Evaline A Alessandrini
BACKGROUND: Readmissions of chronic obstructive pulmonary disease (COPD) have devastating effects on patient quality-of-life, disease progression and healthcare cost. Effective interventions to reduce COPD readmissions are needed. OBJECTIVES: Reduce 30-day all-cause readmissions by (1) creating a COPD care bundle that addresses care delivery failures, (2) using improvement science to achieve 90% bundle adherence. SETTING: An 800-bed academic hospital in Ohio, USA...
July 21, 2017: BMJ Quality & Safety
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