Analysis of Cost Variation in Endourological Procedures throughout the United States Using a National Database.

INTRODUCTION: We examined geographic variations in the direct costs of endourological procedures, including percutaneous nephrolithotomy, shock wave lithotripsy and retrograde intrarenal surgery/ureteroscopy, as well as the impact of hospital factors on costs using Vizient™, a national clinical database. METHODS: We performed statistical analysis on 44,379 cases (percutaneous nephrolithotomy in 8,395, shock wave lithotripsy in 12,979 and retrograde intrarenal surgery/ureteroscopy in 23,005) from 2015 to 2018 augmented with information from the 2017 American Hospital Directory to determine the impact of hospital factors on the direct costs of endourological procedures across American Urological Association geographic sections. RESULTS: We found a mean±SD direct cost of $5,040±$1,578 for percutaneous nephrolithotomy, $1,994±$642 for shock wave lithotripsy and $2,291±$1,077 for retrograde intrarenal surgery/ureteroscopy nationally. The South Central region had the highest costs for shock wave lithotripsy (mean±SD $3,022±$815), while the Western region had the highest costs for percutaneous nephrolithotomy and retrograde intrarenal surgery/ureteroscopy ($5,610±$1,460 and $3,207±$1,338, respectively). The Northeastern region had the lowest mean±SD costs for percutaneous nephrolithotomy ($4,368±$1,613), shock wave lithotripsy ($927±$234) and retrograde intrarenal surgery/ureteroscopy ($1,824±$1,238). For percutaneous nephrolithotomy and retrograde intrarenal surgery/ureteroscopy high volume institutions had greater costs compared to low volume institutions ($5,318 vs $5,092, p <0.01 and $2,579 vs $2,246, p <0.01, respectively). This finding was not replicated for shock wave lithotripsy ($2,096 vs $2,119, p=0.9). CONCLUSIONS: Significant geographic variation exists regarding direct costs of endourological procedures, with higher volume hospital systems having greater costs for percutaneous nephrolithotomy and retrograde intrarenal surgery/ureteroscopy regardless of location.

Maintaining quality care during a nursing shortage using licensed practical nurses in acute care.

Implications of an aging registered nurse workforce, coupled with an inadequate supply of new nurses, presented a unique challenge for the nurse executive in an acute care hospital. This article presents one possible solution: reintroduction of licensed practical nurses to the patient care setting. It describes a pilot project initiated to answer the following question: Is there a change in quality of patient care or staff satisfaction when the nursing care delivery system adds a licensed practical nurse to the registered nurse and patient care assistant care pairs? It also describes the driving forces behind this practice change and presents focus group discussions, the implementation process, and conclusions and recommendations.

Assessing costs of aerosol therapy.

The large economic burden of asthma accentuates the need for economically sound treatment. Numerous studies report that the outcomes produced by nebulizers are equivalent to the outcomes produced by MDI/spacers in selected patients. Studies show that MDI/spacer use will probably result in substantial cost savings to hospitals. Although some patients will not be able to achieve the same outcomes with MDI/spacers as with nebulizers, Bowton et al and Orens et al showed that a large percentage of patients could be converted to the less costly MDI/spacer therapy without negative repercussions. Observation of current treatment practice indicates that hospitals have yet to capitalize on the economic benefits of replacing nebulizers with MDI/spacers. For example, original data from MARC indicate that only 5% of adults who present to an academic ED with acute asthma receive at least one beta agonist treatment via MDI. Studies that improve upon existing cost analyses may convince hospitals of the untapped savings potential. Investigation of barriers to MDI/spacer conversion, along with a compilation of successful strategies for this conversion, would be helpful. Taken together, such research could lead to increased beta agonist delivery via MDI/spacer and probable savings to the health care system.