PURPOSE: As health care costs rise, continuous quality improvement and increased efficiency are crucial to reduce costs while providing high-quality care. Time-driven activity-based costing (TDABC) can help identify inefficiencies in processes of cancer care delivery. This study measured the process performance of Port-a-Cath placement in an outpatient cancer surgery center by using TDABC to evaluate patient care process. METHODS: Data were collected from the Anesthesia Information Management System database and OneConnect electronic health record (EHR) for Port-a-Cath cases performed throughout four phases: preintervention (phase I), postintervention, stabilization, and pre–new EHR (phases II and III), and post–new EHR (phase IV). TDABC methods were used to map and calculate process times and costs. RESULTS: Comparing all phases, as measured with TDABC methodology, a decrease in post-anesthesia care unit (PACU) length of stay (LOS) was identified (83 minutes v 67 minutes; P < .05). The decrease in PACU LOS correlated with increased efficiency and decreasing process costs and PACU nurse resource use by fast tracking patients for Port-a-Cath placement. Port-a-Cath placement success and the functionality of ports remained the same as patient experience improved. CONCLUSION: TDABC can be used to evaluate processes of care delivery to patients with cancer and to quantify changes made to those processes. Patients’ PACU LOS decreased on the basis of the 2013 Port-a-Cath process improvement initiative and after implementation of a new EHR, over the course of 3 years, as quantified by TDABC. TDABC use can lead to improved efficiencies in patient care delivery that are quantifiable and measurable.
in which a short lecture and a live demonstration were given, followed by hands-on practice by the participants. The participants were trained on cannula cricothyrotomy with Melker conversion, jet oxygenation through cannula cricothyrotomy, and scalpelebougie cricothyrotomy. All participants were given a preand post-training survey form to complete. Ethics approval was not required as advised by the institutional review board.Fifty-four anaesthetists participated in the refresher training with years of anaesthetic experience from fewer than five to more than 10. Only one person had previously performed an emergency front-of-neck access. We evaluated their confidence in performing the various CICO techniques before and after the training, on a scale of 1 (not confident at all) to 5 (extremely confident). The results are illustrated in Figure 6. Feedback was favourable and the participants were keen for such CICO refresher sessions to be conducted regularly.Although CICO crises are rare, it is crucial that anaesthetists maintain the knowledge, decision-making, and procedural skill sets to perform emergency cricothyroidotomies quickly and safely. Moving forward, we aim to enhance the training using different airway models to simulate difficult airway anatomy, and to integrate it with simulation software providing real-time dynamic changes in oxygen saturation to make the scenarios more realistic.
Takotsubo Cardiomyopathy (TC) is a reversible, stress-induced, non-ischemic cardiomyopathy associated with temporary weakness of the myocardium and midventricular or apical ballooning [1,2]. Angina, ST abnormalities, elevated troponins, ventricular asynergy, CHF, and decreased EF are all components of TC. The unique finding is that they occur on the absence of CAD [3]. In this case series with IRB approval we report three cases of post-operative cardiac symptoms that all resulted in a diagnosis of TC.
Pertinent Past Medical History:Tobacco use and hiatal hernia with controlled GERD In the post-anesthesia care unit (PACU), she developed severe chest pressure 9/10. The 12-lead electrocardiogram did not show any ST-T changes. Anti-acids were given to treat any reflux. Subsequently, her pain decreased to 3/10. However, cardiac enzymes were still sent and the troponin came back at 0.67. A cardiology consult was called. Symptomatic medical management was immediately implemented.The patient remained stable overnight with sustained chest pressure 2/10.
Pt#363 year old female with ovarian carcinoma presents for a port-acath (PAC) insertion.Pre-operatice echocardiogram revealed an EF of 60-65%, and normal left ventricular wall motion.
Pertinent Past Medical History:
Pt #257 year old female with a multinodular goiter, presents for total thyroidectomy.
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