ABSTRACT
Implementation of a quality improvement bundle for peri-operative management of emergency laparotomy (ELPQuIC) improved mortality in a previous study. We used data from one site that participated in that study to examine whether it was associated with the cost of care. We collected data from 396 patients: 144 before, 144 during and 108 after implementation of the bundle. We estimated costs incurred using previously published methodology based on the time the patient spent in hospital, in the operating theatre and in critical care. Duration of stay in hospital and critical care did not differ between time periods, p = 0.14 and p = 0.28, respectively. The costs per patient and per survivor did not differ between the time periods, p = 0.87 and p = 0.17, respectively. Costs were similar for patients aged < 80 years vs. ≥ 80 years. Implementation of a quality improvement bundle for emergency laparotomy has the capacity to save lives without increasing hospital costs.
Subject(s)
Critical Pathways/economics , Health Care Costs/statistics & numerical data , Laparotomy/economics , Laparotomy/standards , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Critical Care/economics , Critical Pathways/standards , Emergencies , England , Health Services Research/methods , Humans , Kaplan-Meier Estimate , Length of Stay/statistics & numerical data , Middle Aged , Perioperative Care/economics , Perioperative Care/standards , Quality Improvement , Young AdultABSTRACT
OBJECTIVE: To collect and analyse data from the published literature concerning the rare condition necrotising otitis externa, in order to formulate a prognostic scoring model based on signs and symptoms. DESIGN: Retrospective data collection from published literature, and binary logistic regression analysis of the effect on outcome of identified signs and symptoms. RESULTS: Six factors were identified as prognostic of a poorer outcome, including facial nerve involvement, additional cranial nerve involvement, non-cranial nerve neurological involvement, extensive granulations (or oedema) in the external auditory canal, bilateral symptoms and aspergillus species as the causative organism. A four-point scoring model based on these findings is presented. CONCLUSIONS: A novel, systematic method of data analysis was utilised to construct a prognostic scoring model for necrotising otitis externa. This will better equip clinicians to treat this potentially fatal condition.
