Assuntos
Assistência Ambulatorial/métodos , Derrame Pleural/terapia , Assistência Ambulatorial/economia , Análise Custo-Benefício , Gerenciamento Clínico , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviços de Saúde/economia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Derrame Pleural/economia , Medicina Estatal , Reino UnidoRESUMO
BACKGROUND: Correct coding is essential for accurate reimbursement for clinical activity. Published data confirm that significant aberrations in coding occur, leading to considerable financial inaccuracies especially in interventional procedures such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Previous data reported a 15% coding error for EBUS-TBNA in a U.K. service. OBJECTIVES: We hypothesised that greater physician involvement with coders would reduce EBUS-TBNA coding errors and financial disparity. METHODS: The study was done as a prospective cohort study in the tertiary EBUS-TBNA service in Bristol. 165 consecutive patients between October 2009 and March 2012 underwent EBUS-TBNA for evaluation of unexplained mediastinal adenopathy on computed tomography. The chief coder was prospectively electronically informed of all procedures and cross-checked on a prospective database and by Trust Informatics. Cost and coding analysis was performed using the 2010-2011 tariffs. RESULTS: All 165 procedures (100%) were coded correctly as verified by Trust Informatics. This compares favourably with the 14.4% coding inaccuracy rate for EBUS-TBNA in a previous U.K. prospective cohort study [odds ratio 201.1 (1.1-357.5), p = 0.006]. Projected income loss was GBP 40,000 per year in the previous study, compared to a GBP 492,195 income here with no coding-attributable loss in revenue. CONCLUSIONS: Greater physician engagement with coders prevents coding errors and financial losses which can be significant especially in interventional specialties. The intervention can be as cheap, quick and simple as a prospective email to the coding team with cross-checks by Trust Informatics and against a procedural database. We suggest that all specialties should engage more with their coders using such a simple intervention to prevent revenue losses.
Assuntos
Codificação Clínica , Redução de Custos/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/economia , Papel do Médico , Codificação Clínica/economia , Codificação Clínica/métodos , Codificação Clínica/estatística & dados numéricos , Serviços de Diagnóstico/economia , Custos Diretos de Serviços , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/estatística & dados numéricos , Humanos , Doenças Linfáticas/diagnóstico , Doenças do Mediastino/diagnóstico , Melhoria de Qualidade , Reino UnidoRESUMO
Convex probe endobronchial ultrasound is an evolving technology allowing real-time transbronchial needle aspiration used for lung cancer staging and diagnosis of cancer or unexplained mediastinal or hilar lymphadenopathy. This article focuses on setting up a service, pitfalls and training issues.
Assuntos
Biópsia por Agulha Fina/métodos , Broncoscopia/métodos , Carcinoma Pulmonar de Células não Pequenas/patologia , Endossonografia/métodos , Neoplasias Pulmonares/patologia , Neoplasias do Mediastino/patologia , Biópsia por Agulha Fina/economia , Biópsia por Agulha Fina/instrumentação , Broncoscopia/economia , Broncoscopia/instrumentação , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Análise Custo-Benefício , Endossonografia/economia , Endossonografia/instrumentação , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Doenças Linfáticas/diagnóstico por imagem , Doenças Linfáticas/patologia , Neoplasias do Mediastino/diagnóstico por imagem , Mediastino/diagnóstico por imagem , Mediastino/patologia , Estadiamento de NeoplasiasAssuntos
Biópsia/economia , Neoplasias Brônquicas/patologia , Broncoscopia/economia , Criocirurgia/economia , Custos Hospitalares , Biópsia/instrumentação , Biópsia/métodos , Broncoscópios/economia , Análise Custo-Benefício , Criocirurgia/instrumentação , Inglaterra , Humanos , Modelos Econômicos , Valor Preditivo dos Testes , Instrumentos Cirúrgicos/economiaRESUMO
Medical pleuroscopy (MP) offers a safe and minimally invasive tool for interventional pulmonologists. It allows diagnosis of unexplained effusion, while at the same time allowing drainage and pleurodesis. It can also help in the diagnosis of diffuse interstitial disease or associated peripheral lung abnormality in the presence of effusion. It can have a therapeutic role in pneumothorax and hyperhidrosis or chronic pancreatic pain. This article reviews the technical aspects and range of applications of MP.
Assuntos
Doenças Pleurais/cirurgia , Toracoscopia , Humanos , Hiperidrose/cirurgia , Doenças Pulmonares Intersticiais/diagnóstico , Derrame Pleural/diagnóstico , Derrame Pleural/cirurgia , Pneumotórax/cirurgia , Toracoscopia/economia , Toracoscopia/métodos , Tuberculose Pleural/cirurgiaRESUMO
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) offers a minimally invasive option for staging the mediastinum in suspect lung cancer but also in the diagnosis of mediastinal lesions accessible from the airway. This review is aimed at centres considering establishing an EBUS service that may not be so familiar with the technique. It focuses primarily on technical aspects of EBUS-TBNA, training issues, cost considerations, indications, advantages and disadvantages compared with other mediastinal sampling techniques as well as some reference to its performance in clinical studies. In summary, EBUS-TBNA is primarily used for staging non-small cell lung cancer, especially for bulky mediastinal disease and discrete N2 or N3 disease on CT, but also used for the diagnosis of unexplained mediastinal lymphadenopathy. For radical treatment staging, mediastinoscopy is still used at many centres and negative EBUS-TBNA results should be corroborated by mediastinoscopy. In the future, EBUS-TBNA may be used for staging the radiologically normal mediastinum and in re-staging. It is a procedure that can be taught with ease by an experienced operator, has numerous advantages over mediastinoscopy and is potentially cost saving by reducing the number of mediastinoscopies and associated peri-operative support required.
Assuntos
Biópsia por Agulha/métodos , Broncoscopia/métodos , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Ultrassonografia de Intervenção/métodos , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/economia , Perda Sanguínea Cirúrgica/prevenção & controle , Broncoscopia/efeitos adversos , Broncoscopia/economia , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Humanos , Neoplasias Pulmonares/diagnóstico , Linfonodos/patologia , Metástase Linfática , Mediastinoscopia , Estadiamento de Neoplasias , Ultrassonografia de Intervenção/efeitos adversos , Ultrassonografia de Intervenção/economiaRESUMO
Postgraduate medical training has changed. There is a significant reduction in hours of experience and training time due to the European Working Time Directive, a relative lag in substantive consultant post expansion and a resulting 'bulge' of trainees joining the specialist register having attained a Certificate of Completion of Training (CCT). Until the necessary expansion takes place, it is therefore less likely that all post-CCT trainees will immediately acquire substantive positions. Traditional historical alternatives for career progression at this point have been a locum consultancy, a period of research or an overseas fellowship. This article discusses the pros and cons of another more controversial alternative: a post-CCT fellowship.
Assuntos
Escolha da Profissão , Certificação/organização & administração , Educação de Pós-Graduação em Medicina/organização & administração , Bolsas de Estudo/organização & administração , Seleção de Pessoal , Humanos , Reino UnidoRESUMO
PURPOSE OF REVIEW: There is increasing awareness of minimally invasive endoscopic techniques for mediastinal staging in lung cancer. Traditionally, cervical mediastinoscopy has been utilized. Endobronchial ultrasound-guided fine needle aspiration (EBUS) has recently emerged as a potential alternative. RECENT FINDINGS: EBUS has sensitivity for lung cancer which is at least equivalent (if not superior) to cervical mediastinoscopy. However, cervical mediastinoscopy remains superior to EBUS and other techniques in its high negative predictive value. More recent data suggest EBUS may have a role in presurgical staging of radiologically normal subcentimetre nodes and its negative predictive value may be equivalent to surgical staging. Ongoing comparative studies between EBUS and cervical mediastinoscopy may well clarify relative performance and cost analyses. SUMMARY: Currently, insufficient data are present to recommend replacing cervical mediastinoscopy with EBUS for lung cancer staging; the negative predictive value of EBUS requires validation. However, EBUS can be recommended for initial staging as a minimally invasive option provided negative results are followed by cervical mediastinoscopy. This would also allow cervical mediastinoscopy to be reserved for re-staging. Conventional transbronchial needle aspiration has a limited role only as a first-line staging procedure but may aid diagnosis. In the future, EBUS may have a role in presurgical staging of the radiologically normal mediastinum and re-staging if prior staging is done by cervical mediastinoscopy.