The effect of a bundle intervention for ambulatory otorhinolaryngology procedures on same-day case cancellation rate and associated costs.

Cancellations within 24 h of planned elective surgical procedures reduce operating theatre efficiency, add unnecessary costs and negatively affect patient experience. We implemented a bundle intervention that aimed to reduce same-day case cancellations. This consisted of communication tools to improve patient engagement and new screening instruments (automated estimation of ASA physical status and case cancellation risk score plus four screening questions) to identify patients in advance (ideally before case booking) who needed comprehensive pre-operative risk stratification. We studied patients scheduled for ambulatory surgery with the otorhinolaryngology service at a single centre from April 2021 to December 2022. Multivariable logistic regression and interrupted time-series analyses were used to analyse the effects of this intervention on case cancellations within 24 h and costs. We analysed 1548 consecutive scheduled cases. Cancellation within 24 h occurred in 114 of 929 (12.3%) cases pre-intervention and 52 of 619 (8.4%) cases post-intervention. The cancellation rate decreased by 2.7% (95%CI 1.6-3.7%, p < 0.01) during the first month, followed by a monthly decrease of 0.2% (95%CI 0.1-0.4%, p < 0.01). This resulted in an estimated $150,200 (£118,755; €138,370) or 35.3% cost saving (p < 0.01). Median (IQR [range]) number of days between case scheduling and day of surgery decreased from 34 (21-61 [0-288]) pre-intervention to 31 (20-51 [1-250]) post-intervention (p < 0.01). Patient engagement via the electronic health record patient portal or text messaging increased from 75.9% at baseline to 90.8% (p < 0.01) post-intervention. The primary reason for case cancellation was patients' missed appointment on the day of surgery, which decreased from 7.2% pre-intervention to 4.5% post-intervention (p = 0.03). An anaesthetist-driven, clinical informatics-based bundle intervention decreases same-day case cancellation rate and associated costs in patients scheduled for ambulatory otorhinolaryngology surgery.

Asthma and clinical outcomes of COVID-19 in a community setting.

OBJECTIVES: The association between asthma and COVID-19 mortality remains inconclusive. We examined the association between asthma and clinical outcomes of patients with COVID-19. STUDY DESIGN: A case-control study based on a surveillance cohort in Harris County, Texas. METHODS: Using the data of 21,765 patients who reported having at least one chronic health condition, we investigated the association between asthma and COVID-19 severity, characterized primarily by hospitalization and death. Unconditional logistic regression models were used to estimate the multivariable odds ratio (mOR) and its 95 % confidence interval (CI) of COVID-19 severity associated with asthma and other chronic lung diseases, adjusting for demographic and other comorbidities. A P-value < 0.005 was considered statistically significant after correcting multiple testing. RESULTS: In total, 3034 patients (13.9 %) had asthma, and 774 (3.56 %) had other chronic lung diseases. The case death rate among patients with asthma and other chronic lung diseases was 0.75 % and 19.0 %, respectively. Compared to patients without the respective conditions, patients with asthma had lower odds of death (mOR = 0.44, 95 % CI: 0.27-0.69), while patients with other chronic lung diseases had higher odds of hospitalization (mOR = 2.02, 95 % CI: 1.68-2.42) and death (mOR = 1.95, 95 % CI: 1.52-2.49) (P-values < 0.005). Risk factors for COVID-19 mortality included older age, male gender, diabetes, obesity, hypertension, cardiovascular disease, active cancer, and chronic kidney disease. CONCLUSIONS: The public health surveillance data suggested that preexisting asthma was inversely associated with COVID-19 mortality.

Succeeding beyond the Year 2000: how to rise to the challenges of the new millennium. Interview by Jill L. Sherer.

Are you ready to take your organization into the 21st century? Do you fully grasp the implications of current and emerging trends in the field? Healthcare Executive talked with six healthcare experts and asked them what they saw as the greatest challenge for both executives and their organizations in the new millennium. Although the experts' opinions vary, their responses emphasize the importance of repairing old relationships and building new partnerships between those working in healthcare organizations, as well as bringing a consumer focus back to healthcare delivery.

Hemophilia and extracorporeal shock wave lithotripsy: a case report.

We report renal calculi fragmentation in a hemophiliac patient through the use of extracorporeal shock wave lithotripsy. The Dornier Human Model III lithotriptor was used with the patient under general anesthesia and high frequency intermittent positive pressure ventilation was delivered via a Siemen-Elema 900-D Ventilator. The pathological features and clinical course are discussed.

Positioning marketing in the hospital's power structure.

Although hospitals are increasingly recognizing the importance of marketing, many have difficulty assimilating what has been primarily an industrial concern into a health care environment. The author explains the function of marketing in health care, the outlook and expectations of a good marketing executive, and why hospital management and the medical staff may have difficulty accepting marketing and the expectations of the marketing executive.

Marketing strategies, or, it wouldn't be competition without competitors.

Predicting that in an environment of limited resources, the hospital's competitive strategy will assume greater importance, the author reviews the relationship of positioning to market success. He also discussed how such strategies as differentiation, overall cost leadership, and market focus can be applied to hospitals.