Cost-Effective Emergency Dept. Practices

1
Cost-Effective Emergency Dept. Practices

• Cost-Cutting Measures that Sustain Quality Care
• Robert W. Kottman, MD, FACEP

2
Migraine Headache Drugs

• Imitrex (sumatriptan) Cost
• 6 mg subQ 48.61
• 60 return with headache in 24 hours
• Demerol 100 mg IM 1.92
• Phenergan 25 mg IM 2.27
• Total Cost 4.19
• 5 pts./day (DemPhen.) saves daily 243.05
• Annual Savings (DemPhen) 88,713.25

3
Anti-Nausea Drugs

• Zofran (ondansetron) 4 mg IV 25.64
• Excellent in chemotherapy pts.
• Torecan 10 mg IV 5.53
• Also good in chemotherapy pts.
• Phenergan 25 mg IV 2.27
• May work in some chemo pts.
• Savings/pt (Phenergan vs. Zofran) 23.37
• 5 pts/day (Phenergan rather than
  Zofran) 116.85
• Annual Savings with Phenergan 42,650.25

4
Anti-Convulsant Loading Dose

• Cerebyx (phosphenytoin)
• 1 gm IV 112.22
• Can give over 15 mins. Less phlebitis.
• Dilantin (phenytoin)
• 1 gm IV 6.66
• Give over 1 hour, vein irritation
• Cost savings/pt. (Dilantin vs Cerebyx) 105.66
• 5 pts/dayAnnual Savings (Dilantin) 38,565

5
Analgesics

• Toradol 30 mg IV 8.30
• Good for stone pain (renal/biliary colic)
• Increases bleeding if surgery is imminent
• Morphine 6 mg IV 0.93
• Phenergan 25 mg IV 2.27
• Total Cost (Morphine Phenergan) 3.20
• No effect on bloodsavings/pt 5.10
• 10 pts./day, Annual Savings 18,615.

6
Pyelonephritis-Inpatient Therapy

• Cipro (ciprofloxacin)
• 400 mg IV q12h Daily Cost 60.04
• Septra (sulfamethoxasole/trimethoprim)
• 400/80 mg IV q 8h Daily Cost 15.90
• Daily savings/pt with Septra 44.14
• 5 pts./day (1 day therapy) Save 220.70
• Ave. 3 day stay-Save/pt 132.42
• 5 pts./day (3 day stay) X 365 d. 241,666

7
Scalp Laceration Repairs

• Laceration Tray 34.50
• 2 oz. Betadine 0.43
• Total Cost 34.93
• 10 staple skin stapler 7.54
• 2 oz Betadine 0.43
• 4x4 gauze sponge pack 0.47
• Total Cost 8.99
• 25.94 X 5/day X 365 days-Save 47,340

8
Stool Hemoccult Tests

• If done by Emergency Physician 0.52
• (at bedside, results in 30 seconds)
• If done in Laboratory 2.77
• (in laboratory, results in one hour)
• Cost Savings at bedside by EDP 2.25
• 50 /day---saves (daily)
  112.50
• 112.50 X 365 days-annually saves 41,062

9
Iodoform Gauze (5 yds-half-inch)

• Average amount used in abscess cavity packing is
  1 yard
• 5 yard Bottle Cost 3.01
• If bottle is re-used at 1 yd/pt Cost/pt 0.60
• Ave. 3,650 abscesses packed/year
• Cost if one bottle used/pt. 10,986
• Cost if one bottle used/5 pts. 2,197
• Cost Savings/year with re-use 8,789

10
Skin Antiseptics

• Hibiclens 4 oz. 5.04
• Betadine 2 0z. 0.43
• Cost Savings with Betadine 4.67
• 35 laceration repairs daily
• Betadine use, savings 4.67 X 35161.35
• Annual Savings (Betadine) 58,892.75

11
Latex Gloves

• Latex Gloves, Sterile, size 7.5 0.90
• Latex Gloves, Non-Sterile, Large 0.06
• Savings from Non-Sterile gloves 0.84
• Non-Sterile appropriate for pelvics, rectals, ID
  of abscesses
• 50 uses of N.S. vs S./day saves 42/day
• Annual Savings (N.S. gloves) 15,330

12
Cautery of Bleeding Vessels

• Disposable Surgical Cautery 78.00
• 10 applicators of AgNO3 2.75
• Cost Savings with AgNO3/pt 75.25
• 700 uses /year X 75.25 Save 52,675 by
  using AgNO3 chemical cautery rather than
  electrical cautery

13
Urine Tests

• Urinalysis (dipstick Microscopic) 3.89
• Urine dipstick 2.12
• Savings of dipstick only 1.77
• 20,000 urine tests annually
• 20,000 X 1.77 (Annual Savings) 35,400

14
BNP (Beta Natriuretic Peptide)

• Lab test for CHF (vs dyspnea due only to COPD)
• Cost is 16.40
• Most CHF-rales, JVD, S3 gallop-no BNP is
  necessary
• If 5 pts/day spared BNP testdaily savings is
  80/day
• 80/day X 365 days-annually save 29,200

15
Overdose Pts.-Drug Screens

• Urine (benzos, THC, cocaine, opiates,
  amphetamines, barbs, PCP) 19.00
• Serum (same drugssent out) 17.98
• Gastric (same drugs-sent out) 98.05
• If serum and gastric not done-save 116.03
• 2 Pts/day (only urine) saves daily 232.06
• 2 pts./day X 365 days saves/year 84,701

16
Vasopressors

• Dobutamine (500 mg in 250 ml) 142.85
• Dopamine (400 mg in 250 ml) 36.75
• Savings for one pt./day 106.10
• Savings by use of dopamine
• Ave. of 3 days/pt on vasopressors 318.30
• If 1 new pt/day on dopamine (365 pts/year)
• 318.30 X 365 days-annual save 116,179

17
Suppression of V-tach

• Amiodarone 50 mg/ml 840.34/day
• Lidocaine 1 lt50.00/day
• (Loading dose 1 mg/kg 24 hr. drip)
• If 1 Pt./day gets Amiodarone 288,350/yr
• If 1 pt. receives lidocaine instead 18,250
• Annual savings 270,100

18
Lumbosacral Spine X-rays

• Indicated for
• Significant trauma,agegt50 years, neuro
  deficits,Hx of cancer,unusual weight loss or
  fever,chronic steroid use, drug/alcohol abuse,
  Work Comp or litigation, suspected ankylosing
  spondylitis, persistent symptoms after
  symptomatic treatment for gt 4 weeks.
• Not indicated for pts. lt50 years old who get back
  pain after exertion (lifting, bending)

19
Lumbosacral Spine films

• L-S spine X-rays (3 views) 94.40
• Average 15 patients/day with exertional back pain
• Daily save-no L-S films obtained 1,416.00
• Annual savings 1,416 X 365 516,840

20
Analgesics

• Stadol 2 ml 73.33
• Nubain 20 mg 37.81
• Toradol 30 mg 8.30
• Morphine 6 mg 0.93
• If one pt./day gets Stadol, Nubain, Toradol
  43,595/year
• If 3 patients got 6 mg Morphine IV 339/yr
• Annual cost savings from MS 43,256

21
Extraordinarily Expensive Drugs

• Digibind 38 mg (1 vial) 511.31
• Crotaline antivenin (1 vial) 2,500.00
• If average mild envenomation
  gets 4 vials, then cost is 10,000
• 1/3 of viper bites are dry
• If CroFab not given, savings are 10,000