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Weekends at Olive View
presented by
The Weekend Warriors
June 2013
Cast
O Gezman Abdullahi
O Saba Al-Hashimi
O Ashvin Kamath
O Sewon Oum
O Steven Reinecke
O Geoffrey Tso
O Adviser: Dr. Soma Wali
Case
45 yo F with ESRD, DM, HTN, HLD presenting
with anasarca and hyperkalemia. Admitted for
initiation of dialysis… on a Friday afternoon…
Challenges
O Getting non-emergent IR procedures over the
weekend does not happen at OVMC.
O Patients often stay in hospital unnecessarily for 2-
3 days awaiting procedures.
O As result, patients may undergo extra invasive
procedures (ie temporary dialsysis access while
awaiting permacath)
Purpose
O Identify key services not available over the
weekend that result in unnecessary hospital
stays.
O Identify challenges in implementing these
services that are lacking over the weekend.
Study Design
O Cross-sectional study
O Survey of housestaff on inpatient medicine for 3
weeks in January 2013
O Data collection from existing databases from
Utilization Review, “Dr Balingit service”, and
related departments
Survey
1. Over the past weekend, what is the total number of
patients that stayed in-house without medical need?
What is the total number of days?
2. Over the past weekend, what is the total number of
patients that stayed in-house without medical need
due to home health issues? What is the total number
of days?
3. Over the past weekend, what is the total number of
patients that stayed in-house without medical need
due to interventional radiology? What is the total
number of days?
Survey
4. Over the past weekend, what is the total number of
patients that stayed in-house without medical need due to
PICC line placement? What is the total number of days?
5. Over the past weekend, what is the total number of
patients that stayed in-house without medical need due to
PT/OT? What is the total number of days?
6. Over the past weekend, what is the total number of
patients that stayed in-house without medical need due to
cardiac stress test? What is the total number of days?
7. Other reasons?
Results
Services
Home health
Number of patients
Number of total days stayed
6
11
15
35
PICC line placement
8
27
PT/OT
5
5
Placement Issues
4
32
Stress test
12
32
Cardiac MRI
1
2
LHC
2
4
Pacemaker placement
1
4
TTE
3
9
TEE
1
2
AFB sputum results
2
2
IR
Costs to Olive View
O Cost of hospital stay: $2200/day
O Accounting for fixed costs such as
salaries and variable costs such as
medications, costs of ancillaries to
operate a bed at Olive View.
O OV gets approximately $1,500/day in
reimbursement for Medi-Cal recipients.
Costs to Olive View
O Cost of running one IR room (salaries and other costs as
of 2009)
O Radiology tech salary: $4,116.55 to $5,399.09 per
month.
O RN II salary: $5,614.00 to $8,178.53 per month
O Interventional radiologist salary:
O Dr. Au: $268,568 base, $45,190 overtime,
$41,339 additional compensation, total $355,097.
O Dr. Lee: $263,926 base, $15,817 overtime,
$70,809 additional compensation, total $350,551.
Cost Analysis
O For an unnecessary stay of 3 days, the cost to
Olive View is as much as $6600 per patient.
O According to survey, 15 pts stayed awaiting IR
procedures over span of 3 weekends
O Thus considering an avg of 5 pts/weekend, will
cost $33,000 for hospitalization
Cost Analysis
O Cost of running IR lab for one weekend (two days):
O Radiology tech: $359.92
O RN: $545.24
O IR attending: $1945.74
O The cost of running the IR lab turns out to be ONLY
$2850.90!!!
O Over the 3 weekends surveyed, 15 patients stayed a
total of 35 unnecessary days, costing $77,000
O Operating IR suite for 3 weekends, would cost
$8552.70
O The hospital would have saved $68447.30!!!!!!
O If the data can be extrapolated, annual saving for 52
weekends would potentially be 1.1 million dollars!!!!
Goals
O Presentation of findings to QI, IR department
O Challenges faced by IR department
O Establishment of IR services over the weekend
O Future goal: Establishment of other ancillary
services over weekend such as: PICC line
placement, Social work, Stress tests, MRI, etc.
Thank you!
O Preguntas???
Welcome to the Olive View Family
Interns!!