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Cost-Effective Emergency Dept. Practices

Cost-Effective Emergency Dept. Practices. Cost-Cutting Measures that Sustain Quality Care Robert W. Kottman, MD, FACEP. Migraine Headache Drugs. Imitrex (sumatriptan) Cost 6 mg subQ $48.61 60 % return with headache in 24 hours Demerol 100 mg IM $ 1.92

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Cost-Effective Emergency Dept. Practices

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  1. Cost-Effective Emergency Dept. Practices Cost-Cutting Measures that Sustain Quality Care Robert W. Kottman, MD, FACEP

  2. Migraine Headache Drugs • Imitrex (sumatriptan) Cost • 6 mg subQ $48.61 • 60 % return with headache in 24 hours Demerol 100 mg IM $ 1.92 Phenergan 25 mg IM $ 2.27 Total Cost $ 4.19 5 pts./day (Dem+Phen.) saves daily $243.05 Annual Savings (Dem+Phen) $ 88,713.25

  3. Anti-Nausea Drugs • Zofran (ondansetron) 4 mg IV $25.64 Excellent in chemotherapy pts. • Torecan 10 mg IV $ 5.53 • Also good in chemotherapy pts. • Phenergan 25 mg IV $ 2.27 May work in some chemo pts. Savings/pt (Phenergan vs. Zofran) $23.37 5 pts/day (Phenergan rather than Zofran) $116.85 Annual Savings with Phenergan $42,650.25

  4. Anti-Convulsant Loading Dose • Cerebyx (phosphenytoin) • 1 gm IV $112.22 • Can give over 15 mins. Less phlebitis. • Dilantin (phenytoin) • 1 gm IV $ 6.66 • Give over 1 hour, vein irritation Cost savings/pt. (Dilantin vs Cerebyx) $105.66 5 pts/day—Annual Savings (Dilantin) $38,565

  5. Analgesics • Toradol 30 mg IV $ 8.30 • Good for “stone pain” (renal/biliary colic) • Increases bleeding if surgery is imminent • Morphine 6 mg IV $ 0.93 • Phenergan 25 mg IV $ 2.27 • Total Cost (Morphine + Phenergan) $3.20 • No effect on blood—savings/pt $5.10 • 10 pts./day, Annual Savings $18,615.

  6. Pyelonephritis-Inpatient Therapy • Cipro (ciprofloxacin) • 400 mg IV q12h Daily Cost $60.04 • Septra (sulfamethoxasole/trimethoprim) • 400/80 mg IV q 8h Daily Cost $15.90 • Daily savings/pt with Septra$44.14 • 5 pts./day (1 day therapy) Save $220.70 • Ave. 3 day stay-Save/pt$132.42 • 5 pts./day (3 day stay) X 365 d. $241,666

  7. Scalp Laceration Repairs • Laceration Tray $34.50 • 2 oz. Betadine $ 0.43 • Total Cost $34.93 • 10 staple skin stapler $ 7.54 • 2 oz Betadine $ 0.43 • 4x4 gauze sponge pack $ 0.47 • Total Cost$ 8.99 • $25.94 X 5/day X 365 days-Save $47,340

  8. Stool Hemoccult Tests • If done by Emergency Physician $0.52 • (at bedside, results in 30 seconds) • If done in Laboratory $2.77 • (in laboratory, results in one hour) • Cost Savings at bedside by EDP$2.25 • 50 /day---saves (daily) $112.50 • $112.50 X 365 days-annually saves $41,062

  9. Iodoform Gauze (5 yds-half-inch) • Average amount used in abscess cavity packing is 1 yard • 5 yard Bottle Cost $3.01 • If bottle is re-used at 1 yd/pt Cost/pt $0.60 • Ave. 3,650 abscesses packed/year • Cost if one bottle used/pt.$10,986 • Cost if one bottle used/5 pts.$ 2,197 • Cost Savings/year with re-use$ 8,789

  10. Skin Antiseptics • Hibiclens 4 oz. $5.04 • Betadine 2 0z. $0.43 • Cost Savings with Betadine$4.67 • 35 laceration repairs daily Betadine use, savings $4.67 X 35=$161.35 Annual Savings (Betadine) $58,892.75

  11. Latex Gloves • Latex Gloves, Sterile, size 7.5 $0.90 • Latex Gloves, Non-Sterile, Large $0.06 • Savings from Non-Sterile gloves $0.84 • Non-Sterile appropriate for pelvics, rectals, I&D of abscesses • 50 uses of N.S. vs S./day saves $42/day • Annual Savings (N.S. gloves) $15,330

  12. Cautery of Bleeding Vessels • Disposable Surgical Cautery $78.00 • 10 applicators of AgNO3 $ 2.75 • Cost Savings with AgNO3/pt $75.25 • 700 uses /year X $75.25 Save $52,675 by using AgNO3 chemical cautery rather than electrical cautery

  13. Urine Tests • Urinalysis (dipstick + Microscopic) $3.89 • Urine dipstick $2.12 • Savings of dipstick only $1.77 • 20,000 urine tests annually • 20,000 X $1.77 (Annual Savings) $35,400

  14. BNP (Beta Natriuretic Peptide) • Lab test for CHF (vs dyspnea due only to COPD) • Cost is $16.40 • Most CHF-rales, JVD, S3 gallop-no BNP is necessary • If 5 pts/day spared BNP test—daily savings is $80/day • $80/day X 365 days-annually save $29,200

  15. Overdose Pts.-Drug Screens • Urine (benzos, THC, cocaine, opiates, amphetamines, barbs, PCP) $19.00 • Serum (same drugs—sent out) $17.98 • Gastric (same drugs-sent out) $98.05 • If serum and gastric not done-save $116.03 • 2 Pts/day (only urine) saves daily $232.06 • 2 pts./day X 365 days saves/year $84,701

  16. Vasopressors • Dobutamine (500 mg in 250 ml) $142.85 • Dopamine (400 mg in 250 ml) $ 36.75 • Savings for one pt./day $106.10 • Savings by use of dopamine • Ave. of 3 days/pt on vasopressors $318.30 • If 1 new pt/day on dopamine (365 pts/year) • $318.30 X 365 days-annual save $116,179

  17. Suppression of V-tach • Amiodarone 50 mg/ml $840.34/day • Lidocaine 1% <$50.00/day (Loading dose 1 mg/kg & 24 hr. drip) If 1 Pt./day gets Amiodarone $288,350/yr If 1 pt. receives lidocaine instead $18,250 Annual savings $270,100

  18. Lumbosacral Spine X-rays • Indicated for: • Significant trauma,age>50 years, neuro deficits,Hx of cancer,unusual weight loss or fever,chronic steroid use, drug/alcohol abuse, Work Comp or litigation, suspected ankylosing spondylitis, persistent symptoms after symptomatic treatment for > 4 weeks. • Not indicated for pts. <50 years old who get back pain after exertion (lifting, bending)

  19. Lumbosacral Spine films • L-S spine X-rays (3 views) $94.40 • Average 15 patients/day with exertional back pain • Daily save-no L-S films obtained $1,416.00 • Annual savings $1,416 X 365 = $516,840

  20. Analgesics • Stadol 2 ml $73.33 • Nubain 20 mg $37.81 • Toradol 30 mg $ 8.30 • Morphine 6 mg $ 0.93 If one pt./day gets Stadol, Nubain, Toradol $43,595/year • If 3 patients got 6 mg Morphine IV $339/yr • Annual cost savings from MS $43,256

  21. Extraordinarily Expensive Drugs • Digibind 38 mg (1 vial) $ 511.31 • Crotaline antivenin (1 vial) $2,500.00 If average mild envenomation gets 4 vials, then cost is $10,000 1/3 of viper bites are “dry” If CroFab not given, savings are $10,000

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