Economic Analysis of AbClo, a Novel Abdominal Fascia Closure Device, for Patients With an Open Abdomen Following Trauma or Acute Abdominal Surgery.

BACKGROUND: Open Abdomen (OA) cases represent a significant surgical and resource challenge. AbClo is a novel non-invasive abdominal fascial closure device that engages lateral components of the abdominal wall muscles to support gradual approximation of the fascia and reduce the fascial gap. The study objective was to assess the economic implications of AbClo compared to negative pressure wound therapy (NPWT) alone on OA management. METHODS: We conducted a cost-minimization analysis using a decision tree comparing the use of the AbClo device to NPWT alone among patients with midline laparotomy for trauma or acute abdominal surgery who were ineligible for primary fascial closure. The time horizon was limited to the length of the inpatient hospital stay, and costs were considered from the perspective of the US Medicare payer. Clinical effectiveness data for AbClo was obtained from a randomized clinical trial. Cost data was obtained from the published literature. Probabilistic and deterministic sensitivity analyses were performed. The primary outcome was incremental cost. RESULTS: The mean cumulative costs per patient were $76 582 for those treated with NPWT alone and $70,582 for those in the group treated with the AbClo device. Compared to NPWT alone, AbClo was associated with lower incremental costs of -$6012 (95% CI -$19 449 to +$1996). The probability that AbClo was cost-savings compared to NPWT alone was 94%. CONCLUSIONS: The use of AbClo is an economically attractive strategy for management of OA in in patients with midline laparotomy for trauma or acute abdominal surgery who were ineligible for primary fascial closure.

Skin Tear Management: A Multidisciplinary Education Project.

OBJECTIVE: To identify the number of skin tears present at the authors' facility and evaluate a multidisciplinary educational intervention to support treatment of skin tears. METHODS: The authors determined the prevalence of skin tears from an analysis of a wound audit dataset at Baycrest Health Sciences and compared it with the literature to inform the aims of the educational intervention. They developed an educational module and presented it to physicians and students at separate in-person sessions and to clinical care staff at a virtual session. Participants completed an evaluation survey after the education sessions to assess their knowledge and confidence with skin tear management and obtain their feedback about the session. RESULTS: The prevalence of skin tears at Baycrest hospital was 5.6%, which was low compared with the values reported in the literature. For the 10 studies reviewed, the median prevalence was 8.8% (range, 3.0%-22.1%). A total of 7 physicians, 12 students, and 7 clinical care staff completed the evaluation survey. All of the physicians (100%), 43% of students, and 57% of clinical care staff could classify an image of a skin tear; 86% of physicians, 33% of students, and 43% of clinical care staff identified the correct skin tear complications; and 71% of physicians, 0% of the students, and 29% of clinical care staff selected the appropriate dressing. Participants reported moderate to considerable increases in knowledge and confidence in skin tear management. CONCLUSIONS: This method of multidisciplinary teaching on skin tears was well received and useful in enhancing knowledge and confidence in identifying and treating skin tears.

Expedited Cross-Training: An Approach to Help Mitigate Nurse Staffing Shortages.

Cross-training of nurses is an approach used by hospitals to mitigate anticipated nurse staffing shortages. This article provides professional practice nurse educators guidance on how to plan, implement, and evaluate expedited cross-training that integrate the principles of just-in-time training. Sixty-one nurses in a postacute care hospital setting were cross-trained over the course of 8 weeks using a six-step method.