Cost Savings of Performing Paracentesis Procedures at the Bedside After Simulation-based Education
Cost Savings of Performing Paracentesis Procedures at the Bedside After Simulation-based Education
复制标题
经过模拟教育后在床边进行穿刺手术可节省成本
DOI：
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
D. Wayne
中科院分区：
文献类型：
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作者：
J. Barsuk;E. Cohen;J. Feinglass;S. Kozmic;W. McGaghie;D. Ganger;D. Wayne
穿刺术越来越多地在介入放射学（IR）而不是在床边进行，并且很少有关于安全性或成本的比较有效性数据。对于手术前是否需要输血也没有共识。在之前的研究中，我们报告了手术位置的选择在很大程度上是自由裁量的，床旁手术的结局与IR手术相同或更好。因此，本研究的目的是评价IR穿刺术的直接医院成本，并与模拟培训的临床医生在床边进行的手术进行比较。方法：我们从2008年7月至2011年12月在一家三级医院的肝病/肝移植楼层进行了一项关于穿刺术的观察性研究。我们对IR设施使用和输血的医院成本进行了建模，并计算了模拟培训的成本，以比较IR和床边程序的成本。结果588例患者共进行764次穿刺，其中IR 331次，床边433次。IR组51例（15.4%）接受血小板输注，床边操作组16例（3.7%）接受血小板输注（P < 0.001）。49例（14.8%）IR手术患者接受新鲜冷冻血浆输注，24例（5.5%）床边手术患者接受新鲜冷冻血浆输注（P < 0.001）。两组间血小板计数或凝血功能障碍无临床差异。在随机效应logistic回归中，IR程序具有显著更高的血小板（比值比，6.36; 95%置信区间，3.28-12.35）和新鲜冷冻血浆（比值比，3.41; 95%置信区间，1.95-5.95）输注的可能性。总成本为663.42美元每例IR和134.01美元每例床边程序。结论培训住院医师进行床边穿刺操作是非常划算的。这种做法应被视为国家在提供优质护理的同时降低医院成本的努力的一部分。
Introduction Paracentesis procedures are increasingly performed in interventional radiology (IR) rather than at the bedside, and there are few comparative effectiveness data on safety or cost. There is also no consensus about the need for blood product transfusions before the procedure. In a previous study, we reported that the selection of procedure location was largely discretionary and that bedside procedures had equal or better outcomes than IR procedures. Therefore, the aim of this study was to evaluate direct hospital costs of IR paracentesis procedures compared with procedures performed at the bedside by simulation-trained clinicians. Methods We performed an observational study of paracentesis procedures on a hepatology/liver transplant floor at a tertiary care hospital from July 2008 to December 2011. We modeled hospital costs for IR facility use and transfused blood products and calculated the cost of simulation training to compare costs between IR and bedside procedures. Results Five hundred eighty-eight patients underwent 764 paracentesis procedures (331 in IR and 433 at bedside). Fifty-one patients (15.4%) with IR procedures received platelet transfusions versus 16 patients (3.7%) with bedside procedures (P < 0.001). Forty-nine patients (14.8%) with IR procedures received fresh frozen plasma transfusions versus 24 patients (5.5%) with bedside procedures (P < 0.001). There were no clinical differences in platelet counts or coagulopathy between groups. In random-effects logistic regression, IR procedures had significantly higher likelihood of platelet (odds ratio, 6.36; 95% confidence interval, 3.28–12.35) and fresh frozen plasma (odds ratio, 3.41; 95% confidence interval, 1.95–5.95) transfusions. Total costs were $663.42 per case for IR and $134.01 per case for bedside procedures. Conclusions Training residents to perform bedside paracentesis procedures was highly cost-effective. This approach should be considered as part of national efforts to reduce hospital costs while providing quality care.
影响因子：
7.2
作者：
ROMANO, PS;ROOS, LL;JOLLIS, JG
通讯作者：
JOLLIS, JG
医学数据挖掘：临床数据仓库中的知识发现。
DOI：
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发表时间：
1997
期刊：
Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium
影响因子：
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作者：
Prather,JC;Lobach,DF;Goodwin,LK;Hales,JW;Hage,ML;Hammond,WE
通讯作者：
Hammond,WE
影响因子：
5.1
作者：
Sandhu, Bimaljit Singh;Sanyal, Arun J
通讯作者：
Sanyal, Arun J