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At least 91 records · Page 5Linked to original sources
PubMed1996

Evaluation of per-procedure equipment costs in an outpatient endoscopy center.

BACKGROUND: As disposable endoscopes become available, we need baseline costs associated with reusable instruments to make financially intelligent choices. Accordingly, we analyzed the per-use cost of several types of gastrointestinal endoscopes at our institution. METHODS: Records of 44 gastrointestinal endoscopes were analyzed. Data defined included purchase price, repair and cleaning expense (labor and materials), and number of uses. The labor cost per-use associated with endoscope cleaning was estimated by taking an average time required to clean an endoscope multiplied by the technician's salary. RESULTS: The average number of years of endoscope use varied from 4.6 to 6.9 years contingent on the type of endoscope. For flexible sigmoidoscopes, the average total cost per use was $8.35, and for colonoscopes the cost was $21.81. For gastroscopes and diagnostic and therapeutic duodenoscopes, costs were $20.99, $49.15, and $45.16, respectively. CONCLUSIONS: (1) Excluding costs associated with the procedure itself (admit-recovery, drugs, disposable equipment, and procedural personnel), total peruse scope cost ranged from a low of $8.35 for the flexible sigmoidoscope to $49.15 for the diagnostic duodenoscope. (2) The most important variables associated with per-use endoscope cost included number of uses, initial purchase price, and repair costs. (3) Techniques such as the above can be used to define per-procedure costs for a particular practitioner or institution.

Costs and Cost Analysis↗
PubMedDate not supplied

[Sterilization by ionizing radiations (author's transl)].

The first part summarizes the general characteristics of ionizing radiations and their activity on microorganisms: lethal and mutagenic effects, sensitivity conditions. Different microbial species have different sensitivities: gram negative bacteria are more sensitive (D10 approximately 5-10 Krads), bacterial spores and viruses are more resistant (D10 approximately 1 Megarads). The second part considers the main applications of radiosterilization: some are at present in full development (medical and surgical disposable equipment); others are still at the experimental stage. Practical aspects, determination of sterilizing doses and control of radiosterilization are also described.

Bacteria↗
PubMed1994

Cost-effective laparoscopic cholangiography.

Cholangiography during laparoscopic cholecystectomy is an invaluable tool for detecting occult bile duct calculi and identifying biliary tract anatomy. Attaining proficiency in cannulation of the cystic duct is an important goal for those interested in laparoscopic transcystic common duct manipulation. A variety of disposable equipment is available for this purpose, but most systems are rather costly for the patient. This report describes our experience with a technique for cholangiography that is both highly successful and inexpensive. It consists of a reusable 8" stainless steel blunt-tipped needle and trocar introducer through which a 4-French, disposable, end-hole catheter is placed into the duct and secured with a single clip. A 0.25 hydrophilic guidewire is placed through this catheter to facilitate proper catheter placement when cystic duct cannulation is difficult. Blunt-tip reusable nylon rods are placed in each trocar site to provide unobstructed visualization of the biliary tract during the fluoroscopy or filming procedures. Thirty-seven consecutive patients had successful cholangiograms during laparoscopic cholecystectomy using this technique, including the use of the guidewire in five patients, without complications. The catheter was advanced into the common duct and secured with clips to provide postoperative duct drainage in two patients with unsuspected common duct stones and very small cystic ducts until successful postoperative endoscopic retrograde cholangiopancreatography (ERCP) stone extractions were done. Three additional patients had occult common duct stones discovered during operative cholangiography. All patients were successfully treated postoperatively with ERCP sphincterotomy and stone extraction without complications. Our technique provides successful, cost-effective operative cholangiography, including cases when cystic duct cannulation is difficult.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheterization↗
PubMed1990

Infection control procedures among New Zealand general practitioners: changes since the emergence of HIV infection.

A random sample of 1000 general practitioners in New Zealand were surveyed to assess their infection control procedures in the surgery, particularly since the emergence of the human immunodeficiency virus (HIV). Forty three per cent of the sample routinely used surgical gloves for minor surgical procedures, 8% used gloves for venepuncture, and 7% for blood glucose testing. Thirty two per cent reported a change in glove use since the emergence of HIV infection. Changes in sterilization procedures were also studied. Thirty eight per cent of the sample reported increased use of disposable equipment, and 38% reported changes in the sterilization solution used. Increased time spent by equipment in the sterilizer was reported by 33% of respondents and increased use of an autoclave by 18%. In general, women were more likely to have adopted infection control procedures than men. Infection control was also more common among those doctors having the greatest number of patients requesting HIV testing.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Faulty Superset plastic catheter mounts. A cautionary tale applicable to other mass-produced disposable products.

Nine Superset (Intersurgical Ltd) single-use corrugated plastic catheter mounts were found to be faulty in a boxed batch of 75. The manufacturer's meticulous system of batch coding enabled the source of the problem to be traced quickly. Sporadic faults must be expected to occur in mass-produced disposable equipment and the unusual origin of the defect reported in these catheter mounts is testimony to the way unexpected events can prejudice the most carefully regulated quality control. It is emphasised that the user can help safeguard the community by ensuring that stock is used in strict rotation and that batch numbers are accurately reported when faults arise.

Anesthesiology↗
PubMed1991

Cutting the cost of cataract surgery--a financial audit.

We have analysed the cost of disposable equipment used during cataract surgery by eight different surgeons over a six-month period in the same hospital. By comparing the costs of single-use items used by each surgeon we highlight how significant savings can be made by change of technique (without an adverse effect on surgical outcome).

Cataract Extraction↗
PubMed2001

Variations in expenditure between adult general intensive care units in the UK.

This paper presents the findings from the second pilot study of the cost block method in 21 adult general intensive care units (ICUs). The aim of this study was to explore the possible reasons for the variation in cost identified in a previous pilot study of 11 ICUs. Data were collected for the six cost blocks for the financial year 1996/97. Multivariate analysis showed that 93% of the variation in expenditure on disposable equipment could be explained by the number of ICU beds, the number of admissions and the presence of a high-dependency unit (HDU). Ninety-two per cent of the variation in nursing staff expenditure was explained by the number of ICU beds and the presence of an HDU. Hospital type and the number of patient days explained 76% of the variation in expenditure on consultant staff. Sixty-four per cent of the variation in drug and fluid expenditure was explained by the number of patient days.

Adult↗
PubMed1995

Laparoscopic nephrectomy: initial experience and cost implications.

OBJECTIVE: To assess the results and cost implications of laparoscopic nephrectomy. PATIENTS AND METHODS: Ten patients underwent attempted laparoscopic nephrectomy and nephro-ureterectomy. The cost of the laparoscopic procedures was estimated to allow comparison with that of open surgery. RESULTS: Two patients required conversion to an open procedure, one for a colonic tear, the other for irretrievable loss of pneumoperitoneum. The median operating time for successful cases was 3 h (range 2.5-4). The mean morphine equivalent of analgesia delivered per patient was 18 mg (range 10-28). There was no mortality. Post-operative complications consisted of one case of prolonged ileus and another of chest infection. The median hospital stay of successful cases was 5 days (range 4-17), and the mean time to return to normal activity was 4 weeks (range 3-6). The cost of the procedure using re-usable instruments was approximately 2000 pounds, comprising 100 pounds for equipment. 900 pounds theatre costs and 1000 pounds for hospital stay. Using disposable equipment adds up to 900 pounds to the cost. In comparison an open nephrectomy typically costs around 2300 pounds. CONCLUSION: Laparoscopic nephrectomy is associated with lower analgesia requirements, shorter hospital stay and quicker return to work than equivalent open procedures. The cost, particularly when performed with re-usable instruments, is not prohibitive being comparable with that of open nephrectomy. With further experience it should become part of the armamentarium of urological surgeons.

Adolescent↗
PubMed1996

Cardiology. Managing equipment.

As nurses have become involved in more and more highly technological procedures and with the risk of possible litigation associated with potential cross contamination from the reuse of disposable equipment, the management and safe use of equipment are playing an increasingly important role in all spheres of cardiology and cardiac care.

Cardiology↗
PubMed2002

The benefits and problems associated with minimal access surgery.

The place of minimal access surgery (MAS) in current gynaecological practice remains controversial. As a consequence, MAS techniques have been subject to a significant amount of prospective, evidence-based assessment. The ultimate results of these comparative trials will undoubtedly have a profound impact on the future direction of our speciality. It is timely, therefore, to review the currently available data. Evidence from 2195 patients in 23 randomised clinical trials of five different treatment modalities (ectopic, ovarian cysts, myomectomy, colposuspension and hysterectomy) clearly demonstrates that uncomplicated MAS procedures produce patient friendly benefits, at least in the short term. No matter what operation is performed, the laparoscopic approach is associated with less pain, shorter hospital stay and shorter recovery. These immediate patient-orientated benefits are a generic consequence of replacing the manoeuvres of open surgery through laparotomy incisions with minimal access. These benefits must be offset against significant disadvantages. Minimal access surgery procedures always require the use of expensive, high technology equipment and usually take longer to perform. Such procedures may be more costly than current open procedures and costs will, in part, be dependent on the amount of disposable equipment employed. Patients undergoing MAS procedures may be at risk of new and/or increased risk of traditional complications. The longer-term results of most MAS procedures have not yet been determined. These potential benefits and disadvantages of MAS require that each procedure is carefully and individually assessed. This paper seeks to review the current evidence.

Evidence-Based Medicine↗
PubMed2003

Preparing for asset retirement.

Statement of Financial Accounting Standards (SFAS) No. 143 requires organizations to recognize a liability for an asset retirement obligation when it is incurred--even if that occurs far in advance of the asset's planned retirement. For example, organizations must recognize future costs associated with medical equipment disposal that carries hazardous material legal obligations.

Accounts Payable and Receivable↗
PubMed1988

Evidence for cross-infection in an outbreak of Clostridium difficile-associated diarrhoea in a surgical unit.

Environmental studies were performed in a hospital outbreak of Clostridium difficile-associated diarrhoea. Transmission was associated with the sluice room and the storage room where medical equipment was found to be contaminated with C.difficile. Typing of isolates by antibiotic-susceptibility patterns and profiles of EDTA-extracted proteins showed the presence of an "epidemic" strain common to the majority of patients and environmental sites. Control of the outbreak was achieved by improvement of environmental hygiene and use of disposable equipment.

Adult↗
PubMed1996

Economic considerations in laparoscopic surgery: disposable versus reusable instrumentation.

The subject of the economic considerations involved in using disposable versus reusable instrumentation has become a controversial issue.The economic evaluations performed purely by economists may not ap- peal to the surgeon and may not be applicable in different parts of the world. The quality of disposable instruments and their convenience in laparoscop'ic surgery is not at issue; the controversy, instead, centers on the question of the cost-effectiveness of disposable equipment. High-quality instruments enable safe, sue- cessful operations.' Some instruments are not available in reusable form and the quality of some reusable in- struments (e-g-, laparoscopic scissors) is sometimes questionable, particularly as they are periodically in need of servicing or repair. For a routine cholecystectomy, clips can be mounted on a reusable applier to ligate the cystic duct and artery. This can save considerable cost. However, disposable clips and their appliers should be available in the operating room (OR) in case of emergencies such as uncontrolled bleeding.

Journal Article↗
PubMed2000

Understanding financing options for PACS implementation. Picture archiving and communication systems.

The acquisition of expensive equipment such as picture archiving and communication systems (PACS) becomes increasingly difficult as capital budgets become tighter. Traditional ownership financing options in the form of direct purchase or financing (loan) have several limitations including technology obsolescence, higher fixed pricing, limited options for equipment disposal, and the need to tie up valuable capital. Alternative financing options, in the form of conventional lease and risk sharing arrangements, offer several theoretical advantages including technology obsolescence protection in the form of built-in upgrades, preservation of borrowing power, multiple end-of-term options, and payment flexibility (which can be directly tied to realized productivity and operational efficiency gains). These options are discussed, with emphasis on the acquisition of PACS.

Capital Financing↗