Does offering pricing information to resident physicians in the emergency department potentially reduce laboratory and radiology costs?

OBJECTIVES: The aim of this study was to establish whether price list information could reduce laboratory and radiological examination costs in emergency departments (EDs). MATERIALS AND METHODS: A prospective survey of adult (>16 years old) admissions was conducted at the ED of a university hospital in Belgium. Nine resident emergency physicians were followed for a span of 6 months, which was divided into 2-month periods: control (October and November 2011), intervention (December 2011 to January 2012), and washout (February and March 2012). Laboratory and radiological costs for each of the daily admissions were calculated during the respective periods and compared. RESULTS: A total of 3758 patients were registered: 1093 in period 1 (control), 1329 in period 2 (intervention), and 1336 in period 3 (washout). We observed significant reductions in examination costs: 10.73% (P=0.015) for laboratory and 33.66% (P<0.001) for radiological costs in period 2 versus period 1; 5.02% (P=0.014) for laboratory and 40.00% (P<0.001) for radiological costs in period 3 versus period 1. In addition, we found that laboratory examination costs increased slightly between periods 2 and 3 (+6.4%), whereas costs related to radiologic examinations continued to decrease (-10.16%); however, these differences were not statistically significant. CONCLUSION: We conclude that the distribution of price lists at EDs promotes cost awareness, which can result in significant decreases in examination costs.

Performance of the adverse drug event trigger tool and the global trigger tool for identifying adverse drug events: experience in a Belgian hospital.

BACKGROUND: Medication-related harm can be detected using the adverse drug event (ADE) trigger tool and the medication module of the Global Trigger Tool (GTT) developed by the Institute for Healthcare Improvement (IHI). In recent years, there has been some controversy on the performance of this method. In addition, there are limited data on the performance of the medication module of the GTT as compared with the ADE trigger tool. OBJECTIVES: To evaluate the performance of the ADE trigger tool and of the medication module of the GTT for identifying ADEs. METHODS: The methodology of the IHI was used. A random sample of 20 adult admissions per month was selected over a 12-month period in a teaching hospital in Belgium. The ADE trigger tool was adapted to the Belgian setting and included 20 triggers. The positive predictive value (PPV) of each trigger was calculated, as well as the proportion of ADEs that would have been identified with the medication module of the GTT as compared with the ADE trigger tool. RESULTS: A total of 200 triggers and 62 ADEs were found, representing 26 ADEs/100 admissions. Nineteen ADEs (31%) were found spontaneously without the presence of a trigger. Three triggers never occurred. The PPVs of other triggers varied from 0 to 0.67, with half of them having PPVs less than 0.20. If we had used the medication triggers included in the GTT (n = 11), we would have identified 77% of total ADEs and 67% of preventable ADEs. CONCLUSIONS: Applying the trigger tool method proposed by the IHI to a Belgian hospital led to the identification of one ADE out of 4 admissions. To increase performance, refining the list of triggers in the ADE trigger tool and in the medication module of the GTT would be needed. Recording nontriggered events should be encouraged.

[Use of a portfolio during the second cycle of medical studies in a urology department]. / Utilisation du portfolio au cours du deuxième cycle des etudes médicales dans un service d'urologie.

OBJECTIVE: To introduce the use of a portfolio (PF) as a learning and evaluation tool for hospital medical students in a urology department. METHODS: In the course of 6 consecutive 3-month sessions, 36 medical students each constituted a PF. After having chosen a urological topic, each student identified his/her learning needs and constructed a PF by collecting various types of information (books, medical articles, internet, orals, ...) with the aid of a tutor. The PF had to be established in the form of a series of questions asked by the student followed by answers provided by the information collected. The PF was scored (out of 20) and contributed to validation of the session. Students completed a satisfaction questionnaire. RESULTS: All students were validated (mean score: 14.2/20). Results of the satisfaction questionnaire showed that, although no student had previously performed a PF, 27/30 expressed the desire to establish a PF for another training attachment. This questionnaire also showed that the PF helps to improve theoretical knowledge (30/36), the needs in relation to professional practice (17/36), the ability to select data (34/36), and is a good self-learning tool (36/36). The major difficulty encountered by students concerned sorting of data (26/36) and written formulation of questions and answers (35/36). CONCLUSION: The PF appears to be a good learning and evaluation tool that can be used in surgical training attachments. It guides students in their personal study and highlights the quality of their reasoning.

Use of portfolios as a learning and assessment tool in a surgical practical session of urology during undergraduate medical training.

We chose to introduce a portfolio as a learning and assessment tool in a practical training session of urological surgery for undergraduate medical students. Our primary objectives were to develop the students' self reflexive ability in front of complex medical cases and to teach them how to identify their learning needs in a short period of time, on a specific topic. Students completed, during their training session, a portfolio on a urological topic under the constant supervision of a tutor. The students were evaluated on their portfolio's presentation with a 20-point grade grid known in advance. Even in a surgical training session, a portfolio can be a useful learning and assessment tool. It clearly encourages self-reflection and pre-professional practice.

Differential risk factors for early and later hospital readmission of older patients.

BACKGROUND AND AIMS: This study aimed at analyzing rates and factors associated with early and later readmission (0-1 month and 2-3 months after discharge, respectively) of older people after index hospitalization. METHODS: This prospective observational study was conducted in two teaching hospitals. People 70 years and over were interviewed within 48 h of emergency admission. Socio-demographic and medical factors were collected, together with functional factors including Activities of Daily Living (basis and instrumental), cognitive state, and geriatric syndromes. Medical diagnosis, length of stay, and destination were collected at discharge, and patients were followed up by phone 1 and 3 months after discharge. During these interviews, outcomes on readmission, institutionalization, need for help, and death were evaluated. RESULTS: The population of 625 patients had a mean age of 80.0 years. The rate of early readmission (01 month) was 10. 7% and the overall rate within 3 months was 23.1%. Logistic regression analysis showed that variables predicting early readmission were previous hospitalization within 3 months, a longer length of stay, and a discharge diagnosis in chapter 8 (respiratory system) and chapter 10 (genito-urinary system) of the ICD-9-CM. Variables predicting later readmission were previous hospitalization within 3 months, a discharge diagnosis in chapter 7 (circulatory system) of the ICD-9-CM, and a poor pre-admission IADL score. CONCLUSIONS: In a medicalized population of older people, several risk factors may be identified for 0-1 month and 2-3 month readmission. Besides severe morbidities at discharge, diagnoses and previous hospitalization, pre-admission IADL was an independent risk factor for 2-3 month readmission.