Time-Driven Activity-Based Costing Comparison of Stereotactic Radiosurgery to Multiple Brain Lesions Using Single-Isocenter Versus Multiple-Isocenter Technique.

PURPOSE: Stereotactic radiosurgery (SRS) historically has been used to treat multiple brain lesions using a multiple-isocenter technique-frequently associated with significant complexity in treatment planning and long treatment times. Recently, given innovations in planning algorithms, patients with multiple brain lesions may now be treated with a single-isocenter technique using fewer total arcs and less time spent during image guidance (though with stricter image guided radiation therapy tolerances). This study used time-driven activity-based costing to determine the difference in cost to a provider for delivering SRS to multiple brain lesions using single-isocenter versus multiple-isocenter techniques. METHODS AND MATERIALS: Process maps, consisting of discrete steps, were created for each phase of the SRS care cycle and were based on interviews with department personnel. Actual treatment times (including image guidance) were extracted from treatment record and verify software. Additional sources of data to determine costs included salary/benefit data of personnel and average list price/maintenance costs for equipment. RESULTS: Data were collected for 22 patients who underwent single-isocenter SRS (mean lesions treated, 5.2; mean treatment time, 30.2 minutes) and 51 patients who underwent multiple-isocenter SRS (mean lesions treated, 4.4; mean treatment time, 75.2 minutes). Treatment time for multiple-isocenter SRS varied substantially with increasing number of lesions (11.8 minutes/lesion; P < .001), but to a much lesser degree in single-isocenter SRS (1.8 minutes/lesion; P = .029). The resulting cost savings from single-isocenter SRS based on number of lesions treated ranged from $296 to $3878 for 2 to 10 lesions treated. The 2-mm planning treatment volume margin used with single-isocenter SRS resulted in a mean 43% increase of total volume treated compared with a 1-mm planning treatment volume expansion. CONCLUSIONS: In a comparison of time-driven activity-based costing assessment of single-isocenter versus multiple-isocenter SRS for multiple brain lesions, single-isocenter SRS appears to save time and resources for as few as 2 lesions, with incremental benefits for additional lesions treated.

Improving efficiency, securing savings.

The NHS in England could save £1 bn annually if all NHS acute Trustsachieved the median level of estates and facilities running costs, the second (and 'final') report by Lord Carter and his team into the 'productivity and efficiency' of acute NHS Trusts across England, published on 5 February,suggests. As HEJ, editor, Jonathan Baillie reports, Lord Carter's team'songoing recent discussions with senior personnel working in a range of disciplines at 32 NHS Trusts--which followed dialogue with an initial 22 Trusts--identified 'unwarranted variation' in the use of resources ranging from staff to land and buildings on such a scale that effectively addressing this 'variation' could, the DH-commissioned team says, potentially reduce by £5 bn annually the NHS in England's costs.

The role of an effective AP explained.

As one of the largest consumers of electricity in the country, the NHS is exceeding its reserved capacities and putting further strain on al already stretched electrical supply network, says Kevin Furey, Electrical Portfolio manager at Eastwood Park. Here he examines the issues facing the NHS in maintaining sufficient and sage electrical supplies that will also cope with the service's needs for the future.

Energy efficiency could cut NHS costs by £400m.

With the growing influence of digital applications in building maintenance, and the considerable pressures on NHS budgets, the Building Engineering Services Association (BESA), examines some of the latest digital advances, and the potential cost savings for the health sector by harnessing them. One key focus is the SFG20 maintenance standard owned and maintained by the Association -'the UK's leading professional body for building and engineering services contractors' -which is about to be expanded again 'to provide comprehensive support for healthcare facilities by incorporating a Healthcare Functional Set developed in collaboration with IHEEM'. The new 'module' will be launched at this month's Healthcare Estates event.

Maximising your asset, minimizing the cost.

Standby generators are an essential piece of life-critical in every hospital. While acknowledging, however, that the generators represent a large capital investment, and that maintaining them in reliable running order 'represents a necessary, but significant expense', Leigh Preece, service director of Power Electrics Generators - one of the UK's leading names in the supply and maintenance of standby generation equipment - explains that there are ways for users both to amortise their outlay, and, in the process, to cut their overall electricity costs by 15-20%.

Small investments, huge savings.

Writing on behalf of the Building & Engineering Services Association (B&ES), Ewen Rose, an experienced journalist specialising in building engineering services, reports on a number of presentations at October's IHEEM Healthcare Estates 2014 conference where the focus was very much on how healthcare estates and facilities and healthcare engineering teams can save energy and cut carbon emissions through more efficient monitoring, and, if necessary, subsequent adjustment, of key HVAC plant. Among the key conclusions were that basic energy efficiency measures could 'shave millions of pounds from NHS estates' running costs', and that hospitals and other healthcare buildings face both 'an air-conditioning legal crisis', and a growing threat from outdoor air pollution.

[Challenges Analysis and Strategic Consideration on Medical Equipment Maintenance].

Expounding the status of the current domestic medical equipment maintenance management, and puting forward the strategic thinking of medical maintenance for the challenges of equipment maintenance management in the hospital. This discussion can be performed to control the maintenance costs of hospital effectively, increase the income and social benefits of the hospital.

Be aware of the Adjusted Treatment Index.

The authors of the interim report relating to the Review of Operational Productivity in NHS providers, published in June of this year, are, as many will know, developing a set of Adjusted Treatment Index (ATI) metrics, and are also to publish a model of their interpretation of what an estates department should look like in terms of its operational productivity and cost. This article argues that the underlying reason for the past failures was the creation of static 'point-value' metrics similar to the ATIs proposed, and that this can only be overcome by designing and populating a series of non-linear dynamic simulation models with feedback control of an organisation's estate in relation to its asset base and condition with respect to time, together with the resultant financial capital and revenue consequences. It concludes by calling on IHEEM's Council to urgently make representation to the authors of the June 2015 report, and suggests that the Institute's members be fully involved in the design, testing, and interpretation, of the estates model and ATIs. IHEEM's Technology Platforms are ideally placed to play a central role in this.

A proper strategy for combating mould.

managing director of Mycologia & Mould Worx, MSc, B.(Env. Sci.), TAE40110, examines the topic of mould exposure in healthcare facilities, and the associated duty of care for hospital facility managers and engineers. The article, published here in slightly adapted form, also focuses on the need for additional training of key personnel on the risks associated with exposure to environmental microbial contamination.

CHP project brings substantial savings.

With the NHS having committed to reduce its carbon footprint by 10% by 2015, Alan Newman, a partner at building services engineers, Troup Bywaters + Anders (TB+A), describes how, with the company's expertise and help, customer, the East and North Hertfordshire NHS Trust, 'surpassed the targets two years in advance'. As he explains, the key element of an ambitious carbon reduction scheme that won the 2013 IHEEM Healthcare Estates Sustainability Award (HEJ - November 2013) was a new combined heat and power-based energy centre at the Trust's Lister Hospital in Stevenage.

[Organization of mechanical ventilation in French Intensive care units]. / Organisation de la ventilation artificielle dans les unités de réanimation en France.

OBJECTIVES: To clarify the procedures related to mechanical ventilation in the intensive care unit setting: allocation of ventilators, team education, maintenance and reference documents. STUDY DESIGN: Declarative survey. METHODS: Between September and December 2010, we assessed the assignment and types of ventilators (ICU ventilators, temporary repair ventilators, non-invasive ventilators [NIV], and transportation ventilators), medical and nurse education, maintenance of the ventilators, presence of reference documents. Results are expressed in median/range and proportions. RESULTS: Among the 62 participating ICUs, a median of 15 ventilators/ICU (range 1-50) was reported with more than one trademark in 47 (76%) units. Specific ventilators were used for NIV in 22 (35%) units, temporary repair in 49 (79%) and transportation in all the units. Nurse education courses were given by ICU physicians in 54 (87%) units or by a company in 29 (47%) units. Medical education courses were made by ICU senior physicians in 55 (89%) units or by a company in 21 (34%) units. These courses were organized occasionally in 24 (39%) ICU and bi-annually in 16 (26%) units. Maintenance procedures were made by the ICU staff in 39 (63%) units, dedicated staff (17 [27%]) or bioengineering technicians (14 [23%] ICU). Reference documents were written for maintenance procedures in 48 (77%) units, ventilator setup in 22 (35%) units and ventilator dysfunction in 20 (32%) ICU. CONCLUSIONS: This first survey shows disparate distribution of ventilators and practices among French ICU. Education and understanding of the proper use of ventilators are key issues for security improvement.