Cost savings of performing paracentesis procedures at the bedside after simulation-based education

Jeffrey H. Barsuk*, Elaine R. Cohen, Joe Feinglass, Sarah E. Kozmic, William C. McGaghie, Daniel Ganger, Diane B. Wayne

*Corresponding author for this work

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Introduction: Paracentesis procedures are increasingly performed in interventional radiology (IR) rather than at the bedside, and there are few comparative effectiveness data on safety or cost. There is also no consensus about the need for blood product transfusions before the procedure. In a previous study, we reported that the selection of procedure location was largely discretionary and that bedside procedures had equal or better outcomes than IR procedures. Therefore, the aim of this study was to evaluate direct hospital costs of IR paracentesis procedures compared with procedures performed at the bedside by simulation-trained clinicians. Methods: We performed an observational study of paracentesis procedures on a hepatology/liver transplant floor at a tertiary care hospital from July 2008 to December 2011. We modeled hospital costs for IR facility use and transfused blood products and calculated the cost of simulation training to compare costs between IR and bedside procedures. Results: Five hundred eighty-eight patients underwent 764 paracentesis procedures (331 in IR and 433 at bedside). Fifty-one patients (15.4%) with IR procedures received platelet transfusions versus 16 patients (3.7%) with bedside procedures (P < 0.001). Forty-nine patients (14.8%) with IR procedures received fresh frozen plasma transfusions versus 24 patients (5.5%) with bedside procedures (P < 0.001). There were no clinical differences in platelet counts or coagulopathy between groups. In random-effects logistic regression, IR procedures had significantly higher likelihood of platelet (odds ratio, 6.36; 95% confidence interval, 3.28-12.35) and fresh frozen plasma (odds ratio, 3.41; 95% confidence interval, 1.95-5.95) transfusions. Total costs were $663.42 per case for IR and $134.01 per case for bedside procedures. Conclusions: Training residents to perform bedside paracentesis procedures was highly cost-effective. This approach should be considered as part of national efforts to reduce hospital costs while providing quality care.

Original languageEnglish (US)
Pages (from-to)312-318
Number of pages7
JournalSimulation in Healthcare
Volume9
Issue number5
DOIs
StatePublished - Jan 1 2014

Fingerprint

Paracentesis
Radiology
Cost Savings
savings
Education
Interventional Radiology
simulation
Costs
costs
education
Simulation
Platelets
Hospital Costs
Costs and Cost Analysis
Gastroenterology
Blood
Odds Ratio
Plasmas
Transplants
Confidence interval

Keywords

  • Blood product transfusion
  • Health care costs
  • Paracentesis
  • Simulation

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Epidemiology
  • Education
  • Modeling and Simulation
  • Medicine(all)

Cite this

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title = "Cost savings of performing paracentesis procedures at the bedside after simulation-based education",
abstract = "Introduction: Paracentesis procedures are increasingly performed in interventional radiology (IR) rather than at the bedside, and there are few comparative effectiveness data on safety or cost. There is also no consensus about the need for blood product transfusions before the procedure. In a previous study, we reported that the selection of procedure location was largely discretionary and that bedside procedures had equal or better outcomes than IR procedures. Therefore, the aim of this study was to evaluate direct hospital costs of IR paracentesis procedures compared with procedures performed at the bedside by simulation-trained clinicians. Methods: We performed an observational study of paracentesis procedures on a hepatology/liver transplant floor at a tertiary care hospital from July 2008 to December 2011. We modeled hospital costs for IR facility use and transfused blood products and calculated the cost of simulation training to compare costs between IR and bedside procedures. Results: Five hundred eighty-eight patients underwent 764 paracentesis procedures (331 in IR and 433 at bedside). Fifty-one patients (15.4{\%}) with IR procedures received platelet transfusions versus 16 patients (3.7{\%}) with bedside procedures (P < 0.001). Forty-nine patients (14.8{\%}) with IR procedures received fresh frozen plasma transfusions versus 24 patients (5.5{\%}) with bedside procedures (P < 0.001). There were no clinical differences in platelet counts or coagulopathy between groups. In random-effects logistic regression, IR procedures had significantly higher likelihood of platelet (odds ratio, 6.36; 95{\%} confidence interval, 3.28-12.35) and fresh frozen plasma (odds ratio, 3.41; 95{\%} confidence interval, 1.95-5.95) transfusions. Total costs were $663.42 per case for IR and $134.01 per case for bedside procedures. Conclusions: Training residents to perform bedside paracentesis procedures was highly cost-effective. This approach should be considered as part of national efforts to reduce hospital costs while providing quality care.",
keywords = "Blood product transfusion, Health care costs, Paracentesis, Simulation",
author = "Barsuk, {Jeffrey H.} and Cohen, {Elaine R.} and Joe Feinglass and Kozmic, {Sarah E.} and McGaghie, {William C.} and Daniel Ganger and Wayne, {Diane B.}",
year = "2014",
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language = "English (US)",
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T1 - Cost savings of performing paracentesis procedures at the bedside after simulation-based education

AU - Barsuk, Jeffrey H.

AU - Cohen, Elaine R.

AU - Feinglass, Joe

AU - Kozmic, Sarah E.

AU - McGaghie, William C.

AU - Ganger, Daniel

AU - Wayne, Diane B.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Introduction: Paracentesis procedures are increasingly performed in interventional radiology (IR) rather than at the bedside, and there are few comparative effectiveness data on safety or cost. There is also no consensus about the need for blood product transfusions before the procedure. In a previous study, we reported that the selection of procedure location was largely discretionary and that bedside procedures had equal or better outcomes than IR procedures. Therefore, the aim of this study was to evaluate direct hospital costs of IR paracentesis procedures compared with procedures performed at the bedside by simulation-trained clinicians. Methods: We performed an observational study of paracentesis procedures on a hepatology/liver transplant floor at a tertiary care hospital from July 2008 to December 2011. We modeled hospital costs for IR facility use and transfused blood products and calculated the cost of simulation training to compare costs between IR and bedside procedures. Results: Five hundred eighty-eight patients underwent 764 paracentesis procedures (331 in IR and 433 at bedside). Fifty-one patients (15.4%) with IR procedures received platelet transfusions versus 16 patients (3.7%) with bedside procedures (P < 0.001). Forty-nine patients (14.8%) with IR procedures received fresh frozen plasma transfusions versus 24 patients (5.5%) with bedside procedures (P < 0.001). There were no clinical differences in platelet counts or coagulopathy between groups. In random-effects logistic regression, IR procedures had significantly higher likelihood of platelet (odds ratio, 6.36; 95% confidence interval, 3.28-12.35) and fresh frozen plasma (odds ratio, 3.41; 95% confidence interval, 1.95-5.95) transfusions. Total costs were $663.42 per case for IR and $134.01 per case for bedside procedures. Conclusions: Training residents to perform bedside paracentesis procedures was highly cost-effective. This approach should be considered as part of national efforts to reduce hospital costs while providing quality care.

AB - Introduction: Paracentesis procedures are increasingly performed in interventional radiology (IR) rather than at the bedside, and there are few comparative effectiveness data on safety or cost. There is also no consensus about the need for blood product transfusions before the procedure. In a previous study, we reported that the selection of procedure location was largely discretionary and that bedside procedures had equal or better outcomes than IR procedures. Therefore, the aim of this study was to evaluate direct hospital costs of IR paracentesis procedures compared with procedures performed at the bedside by simulation-trained clinicians. Methods: We performed an observational study of paracentesis procedures on a hepatology/liver transplant floor at a tertiary care hospital from July 2008 to December 2011. We modeled hospital costs for IR facility use and transfused blood products and calculated the cost of simulation training to compare costs between IR and bedside procedures. Results: Five hundred eighty-eight patients underwent 764 paracentesis procedures (331 in IR and 433 at bedside). Fifty-one patients (15.4%) with IR procedures received platelet transfusions versus 16 patients (3.7%) with bedside procedures (P < 0.001). Forty-nine patients (14.8%) with IR procedures received fresh frozen plasma transfusions versus 24 patients (5.5%) with bedside procedures (P < 0.001). There were no clinical differences in platelet counts or coagulopathy between groups. In random-effects logistic regression, IR procedures had significantly higher likelihood of platelet (odds ratio, 6.36; 95% confidence interval, 3.28-12.35) and fresh frozen plasma (odds ratio, 3.41; 95% confidence interval, 1.95-5.95) transfusions. Total costs were $663.42 per case for IR and $134.01 per case for bedside procedures. Conclusions: Training residents to perform bedside paracentesis procedures was highly cost-effective. This approach should be considered as part of national efforts to reduce hospital costs while providing quality care.

KW - Blood product transfusion

KW - Health care costs

KW - Paracentesis

KW - Simulation

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