Pediatric inpatient hospital resource use for congenital heart defects

Background: Congenital heart defects (CHDs) occur in approximately 8 per 1000 live births. Improvements in detection and treatment have increased survival. Few national estimates of the healthcare costs for infants, children and adolescents with CHDs are available. Methods: We estimated hospital costs for hospitalizations using pediatric (0–20 years) hospital discharge data from the 2009 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) for hospitalizations with CHD diagnoses. Estimates were up‐weighted to be nationally representative. Mean costs were compared by demographic factors and presence of critical CHDs (CCHDs). Results: Up‐weighting of the KID generated an estimated 4,461,615 pediatric hospitalizations nationwide, excluding normal newborn births. The 163,980 (3.7%) pediatric hospitalizations with CHDs accounted for approximately $5.6 billion in hospital costs, representing 15.1% of costs for all pediatric hospitalizations in 2009. Approximately 17% of CHD hospitalizations had a CCHD, but it varied by age: approximately 14% of hospitalizations of infants, 30% of hospitalizations of patients aged 1 to 10 years, and 25% of hospitalizations of patients aged 11 to 20 years. Mean costs of CHD hospitalizations were higher in infancy ($36,601) than at older ages and were higher for hospitalizations with a CCHD diagnosis ($52,899). Hospitalizations with CCHDs accounted for 26.7% of all costs for CHD hospitalizations, with hypoplastic left heart syndrome, coarctation of the aorta, and tetralogy of Fallot having the highest total costs. Conclusion: Hospitalizations for children with CHDs have disproportionately high hospital costs compared with other pediatric hospitalizations, and the 17% of hospitalizations with CCHD diagnoses accounted for 27% of CHD hospital costs. Birth Defects Research (Part A) 100:934–943, 2014. © 2014 Wiley Periodicals, Inc.     

AN INQUIRY INTO THE PRINCIPLES OF NEEDS‐BASED ALLOCATION OF HEALTH CARE

The concept of need is often proposed as providing an additional or alternative criterion to cost‐effectiveness in making allocation decisions in health care. If it is to be of practical value it must be sufficiently precisely characterized to be useful to decision makers. This will require both an account of how degree of need for an intervention is to be determined and a prioritization rule that clarifies how degree of need and the cost of the intervention interact in determining the relative priority of the intervention. Three common features of health care interventions must be accommodated in a comprehensive theory of need: the probabilistic nature of prognosis (with and without the intervention); the time course of effects; and the fact that the most effective treatments often combine more than one intervention. These common features are problematic for the concept of need. We outline various approaches to prioritization on the basis of need and argue that some approaches are more promising than others.     

Response: Freedom from Pain as a Rawlsian Primary Good

In a recent article in this journal, Carl Knight and Andreas Albertsen argue that Rawlsian theories of distributive justice as applied to health and healthcare fail to accommodate both palliative care and the desirability of less painful treatments. The asserted Rawlsian focus on opportunities or capacities, as exemplified in Normal Daniels’ developments of John Rawls’ theory, results in a normative account of healthcare which is at best only indirectly sensitive to pain and so unable to account for the value of efforts of which the sole purpose is pain reduction. I argue that, far from undermining the Rawlsian project and its application to problems of health, what the authors’ argument at most amounts to is a compelling case for the inclusion of freedom from physical pain within its index of primary goods.     

The benefits of silver in hygiene, personal care and healthcare

Silver has been used for centuries as an antimicrobial agent to reduce bioburden and prevent infection. Its usage diminished when antibiotics were introduced but remained one of the most popular agents for wound infections, especially in burned patients. Incorporation of silver into a range of hygiene and healthcare applications has increased, and this has raised concerns over the development of silver resistance, toxicity, methods of testing products and evidence of efficacy. The published evidence for resistance and toxicity is limited and associated with frequent and high levels of silver used. Increasing evidence of improved antimicrobial activity of nanoparticles of silver and possible dual immunomodulatory effects are exciting. This may lead to further product development as potential alternative preservatives as some currently available preservatives have an increasing incidence of allergic reactions. Acknowledging the role of the carrier is important, and as silver is active when in solution, opens a window of opportunity in personal hygiene area. This is important in an age when multiple antibiotic–resistant bacteria are becoming prevalent.     

Effectiveness of the contingency plan for social and health care during the COVID-19 pandemic in a health district in northwestern Spain

IntroductionDuring the COVID-19 pandemic, healthcare facilities have implemented contingency plans to minimize the consequences of this pathology however, the deployment and results of these contingency plans are scarcely shared.ObjectivesTo describe the implementation of the contingency plan in the social and health care in the COVID-19 pandemic in the Public Hospital of Monforte (Lugo, Spain) and to evaluate the effectiveness of the measures included in this plan.MethodPhenomenological sampling conducted between March 10 and May 15, 2020. Evaluation qualitative assessment by an external quality improvement team of the Galician Health Service (SERGAS), based on the Practicum Direct rapid structured checklist in risk management, organizational management, and evaluation of decision making. As outcome indicators, we assessed the number of hospital admissions, number of PCRs performed, telephone attention to social and health social-healthcare patients, number of hospitalizations avoided and estimation of their direct cost.ResultsAfter assessing and managing the risks, an information security plan was developed and solutions to minimize complications in our patients derived from this pandemic. An emergency decision making team was created, as well as an employee communication mechanism for employees through standardized documents and documentation channels.ConclusionsThe adaptation of the Practicum Direct rapid model to the healthcare setting is a useful and easy-to-apply tool that allows us to identify weak points and areas for improvement in our Service and thus to strengthen patient care in all clinical areas, improving the quality of care.     

Environmental footprinting of hospitals: Organizational life cycle assessment of a Canadian hospital

Healthcare is a critical and complex service sector with direct and indirect greenhouse gas (GHG) emissions amounting to 5%–10% of the national total in developed economies like Canada and the United States. Along with a growing, albeit sporadic, set of life cycle assessment (LCA) (and “carbon footprinting”) studies of specific medical products and procedures, there is growing interest in “environmental footprinting” of hospitals. In this article, we advance this rapidly evolving area through a comprehensive organizational LCA of a 40-bed hospital in British Columbia, Canada, in its 2019 fiscal year. Our results indicate that the total environmental footprint of the hospital includes, among other things, global warming potential of 3500–5000 t CO₂ eq. (with 95% confidence). “Hotspots” in this footprint are attributable to energy and water use (and wastewater released), releases of anesthetic gases (which are potent GHGs), and the upstream production of the thousands of materials, chemicals, pharmaceuticals, and other products used in the hospital. The generalizability and comparability of these results are limited by inconsistencies across the few environmental footprinting studies of hospitals conducted to date. Nonetheless, our novel methodological approach, in which we compiled new LCA data for 200 goods and services used in healthcare—strategically selected to statistically represent the 2927 unique products in the hospital's “supply-chains”—has broad applicability in healthcare and beyond.     

Evaluating Use of the Octreotide Acetate Pen Injector in a Summative Human Factors Validation Study

ObjectiveSubcutaneous injections of octreotide acetate require chronic administration by health care providers (HCPs). We aimed to validate the safe and effective use of the octreotide acetate pen injector, its labeling, and instructions for use (IFU) by patients, caregivers, and HCPs and to mitigate use-related risks.MethodsThis summative human factors validation study enrolled adults with neuroendocrine tumors and related diarrhea or flushing, adult caregivers, and HCPs. Before simulated use, participants self-familiarized as desired. Each participant was assigned 1 injection site for administration into an injection pad. The first of 2 unaided injections assessed first use and required priming; the second assessed routine use and dose change. Participants gave subjective feedback after each injection and completed knowledge probes and reading comprehension questions after the second injection.ResultsThe study enrolled 45 participants (15 per group). Forty-two participants completed the first injection successfully by administering the dose correctly. Three participants did not dose successfully; 3 failed to prime the pen, and 1 failed to dial the correct dose. Besides dosing, 2 participants failed to remove the needle after injection. Forty-four participants completed the second injection, but 1 participant failed to dial the correct dose. No other errors were observed. Overall success rates on knowledge probes and reading comprehension questions were 99.1% and 99.6%, respectively. All participants found the IFU easy to follow and understand.ConclusionThe octreotide acetate pen injector, labeling, and IFU enabled intended users to administer subcutaneous octreotide safely and effectively. The residual risks of use are low and acceptable.     

Barriers and errors in the implementation of community psychiatry in Slovenia

Background Slovenian psychiatry is predominantly hospital based. A programme for the development of general community psychiatric services was proposed to improve access to and quality and comprehensiveness of psychiatric care according to the modern standards of delivery of psychiatric services.Aim The aim of the paper is to present the programme for developing community services that was proposed to the Slovenian government, and to describe the barriers to its implementation that were encountered, as well as the errors made by the programme authors, that contributed to the rejection of the programme last year.Conclusions There are historical, political, professional and service organisation characteristics that impede the development of community psychiatry in Slovenia. These are to be addressed through coordinated action involving primary care professionals, non-government organisations with service users and carers, the Health Insurance Agency and politicians involved in the planning of health services.     

Ethical classification of ME/CFS in the United Kingdom

Few conditions have sparked as much controversy as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Professional consensus has long suggested that the condition should be classified as psychiatric, while patients and advocacy groups have insisted it is a serious biological disease that requires medical care and research to develop it. This longstanding debate shifted in 2015, when U.S. governmental health authorities fully embraced medical classification and management. Given that some globally respected health authorities now insist that ME/CFS is a serious biological disease, this paper asks whether it can be ethical for the U.K. practice guideline now in development to characterize the condition as a mental health disorder. Following a brief history of ME/CFS controversy, I offer three arguments to show that it would be unethical for the U.K. to now characterize ME/CFS as a mental health condition, considering the relevance of that conclusion for ME/CFS guidelines elsewhere and for other contested conditions.