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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!!