Evaluation of Cost Reduction Measures at a State University Medical Center.

Components of a Perioperative Surgical Home (PSH), implemented at a large State University Medical Center (SUMC), have driven significant reductions in Surgical Site Infections (SSIs) and Day of Surgery (DOS) cancellations. Refined methodology for efficient and accurate assessment of these reductions was developed based on available electronic data systems and proven strategies adapted from literature. At our institution, the practice of evidence-based protocol-driven medicine has contributed to the prevention of an estimated 1073 SSIs over a 6 year period, representing avoided costs in excess of $24M. Management of logistics surrounding patients' surgeries starting in the preoperative clinic has yielded exceedingly low DOS cancellation rates (3.47% of scheduled procedures). This level of efficiency is critical given that a 1% increase in DOS cancellation rates can represent as much as a $5.6M loss of revenue to a large SUMC.

Synthesis and structure of bismuth(III)-containing noncentrosymmetric phosphates, Cs3KBi2M4(PO4)6Cl (M = Mn, Fe). Monoclinic (Cc) and tetragonal (P43) polymorphs templated by chlorine-centered Cl(Bi2Cs) acentric units.

Single crystals of three new noncentrosymmetric (NCS) phosphates, α (1) and ß (2) forms of Cs(3)KBi(2)Mn(4)(PO(4))(6)Cl and α-Cs(3)KBi(2)Fe(4)(PO(4))(6)Cl (3), were grown in a reactive CsCl/KCl molten-salt media. Their structures were determined by single-crystal X-ray diffraction methods showing that the α form crystallizes in the space group Cc (No. 9), which is in one of the 10 NCS polar crystal classes, m (2/m) while the ß form crystallizes in P4(3) (No. 78) of another polar class, 4 (4/m). The unit cell parameters of the α form can be approximately correlated with that of the ß form via the 3 × 3 orientation matrix [0.5, 0.5, 0; -0.5, 0.5, 0; 0, 0, 2 sin ß]. The structures of these otherwise complicated phosphates exhibit two types of channels with circular and elliptical windows where the Cl-centered Cl(Bi(2)Cs) acentric unit is located. The neighboring acentric units are arranged in a parallel fashion in the α form, resulting in the monoclinic (Cc) lattice, but "antiparallel" in the ß form, thus giving the tetragonal (P4(3)) unit cell. 1-3 feature the compatible M-O-P unit that contains four crystallographically independent MO(x) (x = 4, 5) polyhedra, which are connected to the Cl(Bi(2)Cs) acentric unit through one short and one long M(II)···Cl bond. The compositions of 1 and 2 consist of three Mn(2+) (d(5)) and one Mn(3+) (d(4)) per formula unit and that of 3 has three Fe(2+) (d(6)) and one Fe(3+) (d(5)). Bond valence sums reveal that, in the α phase, the trivalent site adopts distorted tetrahedral M(1)(3+)O(4) coordination and, in the ß phase, distorted trigonal-bipyramidal M(4)(3+)O(5). Thus far, the iron phase has only been isolated in the α form presumably because of little extra stabilization energy gain if the Fe(2+) d(6) ion were to occupy the M(1)O(4) site. The possible origins pertaining to the structural differences in the α and ß forms are discussed.