The Economic and Capacity Impact of Time Saved in the Operating Theatre Performing Holmium Laser Enucleation of the Prostate with MosesTM Technology vs Standard Technology

Objectives: Reducing operating theatre time can help hospitals to optimise operational efficiency and effectively allocate scarce resources. Holmium Laser Enucleation of the Prostate (HOLEP) is an established procedure for the treatment of symptoms secondary to Benign Prostatic Hyperplasia (BPH). It can be performed with Standard Technology (standard HOLEP) or MOSESTM Technology (MOLEP, Boston Scientific Corp). A recent meta-analysis demonstrated significantly reduced operative time with MOLEP vs. standard HOLEP. Our objective is to understand the potential economic impact of reducing theatre time with MOLEP vs. standard HOLEP and potential increases in operational capacity in hospitals in major European DRG-system countries, England, France, Germany and Italy. Method(s): We developed a health economic model to extrapolate theatre time savings reported in the meta-analysis to annual procedure volumes of a theoretical small (1 HOLEP/week), medium (3 HOLEP/week), and large (15 HOLEP/week) hospital. The model allows individual proportions of the time saved to feed into either theatre time cost savings or increased procedure throughput. We used national DRG tariffs and theatre cost per minute to estimate the economic impact. Result(s): Assigning all time savings to the performance of new procedures, small, medium, and large hospitals could perform up to 14, 44, and 229 additional procedures per year, respectively, increasing their procedure volume by 28-29%. In this example, potential revenue gains ranged from 32.573 (small French hospital) to 653.866 (large German hospital), for MOLEP vs. standard HOLEP. For every four procedures performed with MOLEP vs. standard HOLEP, sufficient time was saved to perform an additional procedure. Conclusion(s): Use of MOLEP saves time vs. standard HOLEP. Depending on the hospital aims, this efficiency gain can result in higher cost savings and generate additional revenue for the hospital. Aspects of operative efficiency and workflow improvements should be considered when evaluating the adoption of state-of-the-art medical technologies, especially in the post-COVID-19 pandemic era. Copyright © 2022

Cancer Experience of Care Improvement Collaboratives in the National Health Service in England

NHS England started the work described in this article with the ambition of using insight and feedback from the adult National Cancer Patient Experience Survey to grow coproduced service improvements leading to improved patient centred quality outcomes in experience for cancer patients. Based on the Institute for Healthcare Improvement’s Breakthrough Collaborative Series, the approach of the Cancer Experience of Care Improvement Collaboratives (CIC) in the English healthcare system was developed, initially with 19 NHS provider organisation teams in 2019 as a face-to-face model, then developing into two collaboratives with an additional 15 NHS provider organisation teams in Cohort 2 and 8 teams in Rare & Less Common Cancers in a virtual framework. Each cohort has reported improvements in patient experience, staff experience and team working, but more fundamentally, have been able to describe a cultural shift in the way they work, together with people, leaving a lasting impact and legacy of this work. Key learning has been recognised with the increasing emphasis on involving people with relevant lived experience as partners and colleagues in the collaborative, alongside flexibility, responsiveness and adaptability as key to enabling project teams to continue where COVID-19 pressures allowed to participate. © The Author(s), 2022.

COVID-19 related moral injury: Associations with pandemic-related perceived threat and risky and protective behaviors.

BACKGROUND: The coronavirus-2019 (COVID-19) pandemic is associated with increased potential for morally injurious events, during which individuals may experience, witness, or learn about situations that violate deeply held moral beliefs. However, it is unknown how pandemic risk and resilience factors are associated with COVID-related moral injury. METHODS: Individuals residing in the U.S. (N = 839; Mage = 37.09, SD = 11.06; 78% women; 63% White; 33% PTSD) participating in an online survey reported on COVID-19 related moral injury (modified Moral Injury Events Scale), perceived current and future threat of pandemic on life domains (social, financial, health), and COVID-19 risky and protective behaviors. Multivariate linear regressions examined associations of perceived threat and risky and protective behaviors on type of COVID-19 related moral injury (betrayal, transgression by others, self). RESULTS: Participants endorsed MI betrayal (57%, N = 482), transgression by other (59%, N = 497), and by self 17% (N = 145). Adjusting for sociodemographics, only future threat of COVID-19 to health was significantly associated with betrayal (B = 0.21, p = .001) and transgression by other (B = 0.16, p = .01), but not by self. In contrast, high frequency of risky behaviors was associated with transgressions by self (B = 0.23, p < .001). Sensitivity analyses showed PTSD did not moderate the observed effects. CONCLUSIONS: Betrayal and transgression by others was associated with greater perceived future threat of COVID-19 to health, but not financial or social domains. Stronger endorsement of transgression by self was associated with more frequently engaging in risky behaviors for contracting COVID-19. These findings may suggest the need for individual, community, and system level interventions to address COVID-19 related moral injury.

A framework for a multimodal intensive care curriculum for anesthesiologists during COVID-19

INTRODUCTION: As need outstrips intensivist supply, anesthesiologists are a natural fit to step in and serve in COVID ICU care teams. We describe an educational package designed to improve anesthesiologists' self-efficacy and willingness to work in the COVID ICU. METHODS: Over 7 days, 4 ICU trained anesthesiologists from our 958-bed quaternary care facility created a distance learning, online platform for the affiliated private practice anesthesia group. The program was developed using an iterative process with input from the anesthesiologists. The multimodal format included 13 lectures as well as 3 online interactive video sessions. Each lecture included a bulleted summary document, a PowerPoint presentation and a recorded video lecture. Material was presented using a flipped classroom approach with online material distributed first, followed by interactive sessions moderated by specialists from pulmonary, anesthesia and emergency critical care. At the end of the curriculum, a survey was sent to the 27 attending anesthesiologists identified as the initial backup staffing cohort. RESULTS: 11 out of 27 surveys were completed. 1 of the 11 did not access the content. Of the remaining 10, 90% reported that the material conferred additional benefit beyond that provided by other online COVID educational resources. All reported that the material made them feel more comfortable with recognizing major issues associated with caring for the COVID ICU patient, 80% reported a reduction in stress level and 80% felt that it improved their willingness to take care of COVID ICU patients. CONCLUSIONS: Our group was successful in quickly creating effective online COVID ICU educational materials using a combination of low tech mediums. These materials supported distance learning for a group of attending anesthesiologists from a large private practice group working in a large academic medical center. While national resources are available, our experience highlights that local resources represent an important supplement. The fact that our program was successfully implemented quickly at a large academic medical center but targeted private practice anesthesiologists, was low tech and used only materials readily available to many highlights its applicability to hospitals throughout the nation.

PMD27 Cost Comparison of Surgical Interventions to TREAT Lower Urinary TRACT Symptoms (LUTS) Secondary to Benign Prostatic Hyperplasia (BPH) in the UK, Sweden, and South Africa

Objectives: BPH is a common condition in ageing men that can negatively impact quality of life. Surgical management is indicated when medical management is no longer effective. We compared the overall cost and capacity benefit of available surgical interventions for the relief of LUTS in BPH in three countries considering the post-COVID19 “new normal”. Methods: A recently published Markov model developed from a UK NHS perspective and used in NICE MTG49 was adapted to the Swedish and South African healthcare perspectives. Patients entered the model having a surgical procedure before transitioning to one of four health states, defined by whether patients suffer from one, both or none of the long-term complications captured in the model, namely urinary incontinence or erectile dysfunction. Surgical retreatment, complications and procedure-related resource use was also considered. Surgical interventions included Water Vapor Thermal Therapy (WVTT), Photoselective Vaporization of the Prostate (PVP), Prostatic Urethral Lift (PUL), Holmium Laser Enucleation of the Prostate (HoLEP) and current standard of care, Transurethral Resection of the Prostate (TURP). Due to local practice differences, not all technologies were modelled in all geographies. Results: In the UK, using a 4-year timeline, PVP and WVTT were associated with lowest costs (£2,421 and £2,466 respectively), followed by PUL (£2,994), TURP (£3,098) and HoLEP (£3,120). In Sweden, PVP was associated with lower costs (38,638kr) than TURP (39,801kr). In South Africa, WVTT was associated with lower costs (R58,882) than TURP (R82,939). WVTT, PUL and PVP had shorter procedure times (17.5-30, 30, 49.6 minutes, respectively) compared to TURP (66-90 minutes) and did not require hospitalization. Cost reductions were driven by shorter procedure durations and length of stay. Conclusions: WVTT and PVP were the joint lowest cost interventions over 4-years. Day-case procedures are of particular relevance in a post-COVID19 landscape.