A break-even analysis of major ear surgery.

OBJECTIVES: To determine variables which affect cost and profit for major ear surgery and perform a break-even analysis. DESIGN: Retrospective financial analysis. SETTING: UK teaching hospital. PARTICIPANTS: Patients who underwent major ear surgery under general anaesthesia performed by the senior author in main theatre over a 2-year period between dates of 07 September 2010 and 07 September 2012. MAIN OUTCOME MEASURES: Income, cost and profit for each major ear patient spell. Variables that affect major ear surgery profitability. RESULTS: Seventy-six patients met inclusion criteria. Wide variation in earnings, with a median net loss of £-1345.50 was observed. Income was relatively uniform across all patient spells; however, theatre time of major ear surgery at a cost of £953.24 per hour varied between patients and was the main determinant of cost and profit for the patient spell. Bivariate linear regression of earnings on theatre time identified 94% of variation in earnings was due to variation in theatre time (r = -0.969; P < 0.0001) and derived a break-even time for major ear surgery of 110.6 min. Theatre time was dependent on complexity of procedure and number of OPCS4 procedures performed, with a significant increase in theatre time when three or more procedures were performed during major ear surgery (P = 0.015). CONCLUSION: For major ear surgery to either break-even or return a profit, total theatre time should not exceed 110 min and 36 s.

The role of the vestibular assessment.

OBJECTIVE: To evaluate the role of vestibular assessment in the management of the dizzy patient. MATERIALS AND METHODS: A retrospective review of case notes and vestibular assessment reports of 100 consecutive patients referred for vestibular assessment. RESULTS: Sixty of the 100 patients had an abnormal vestibular assessment. Eleven patients had benign paroxysmal positional vertigo as the sole diagnosis, of whom nine had not had a Dix-Hallpike manoeuvre performed before referral. Of patients referred for vestibular rehabilitation, 76 per cent had an abnormal electrophysiological assessment. After vestibular assessment, 35 patients were discharged with no further follow-up appointments in the ENT department. CONCLUSIONS: All patients should have a Dix-Hallpike manoeuvre performed prior to referral for vestibular assessment. The majority of our patients undergoing vestibular rehabilitation had abnormal test results, although a significant number did not. Prior to referral, it is worth considering the implication of a 'normal' and 'abnormal' result for the management of the patient. Careful consideration should be given to the development of dedicated dizziness clinics run by practitioners with a specialist interest in balance disorders, in order to ensure appropriate requests for vestibular assessment.

Job context, selection decision outcome, and the perceived fairness of selection tests: biodata as an illustrative case.

S. W. Gilliland (1993) has proposed a model of perceived selection system fairness to help understand applicants' prehire and posthire behavior. The present study aimed to verify and extend his framework by investigating the role of job context in the formation of fairness perceptions of biodata. A sample of 255 students (108 men, 147 women) completed an operational biodata instrument, believing that it would be used to hire persons for either international, local, or unspecified entry-level managerial positions. Participants were then presented with outcome information (selected or rejected for further consideration). Consistent support was found for the research hypotheses derived from the Gilliland model. Participants' perceptions of the fairness and job relatedness of biodata were affected by the selection context and decision outcome. The importance of considering selection context in assessments of perceived test fairness is discussed.

Utilization management affects health care practices at Walter Reed Army Medical Center: analytical methods applied to decrease length of stay and assign appropriate level of care.

The Department of Defense has embraced utilization management (UM) as an important tool to control and possibly decrease medical costs. Budgetary withholds have been taken by the Office of the Assistant Secretary of Defense (Health Affairs) to encourage the military services to implement UM programs. In response, Walter Reed Army Medical Center implemented a UM program along with other initiatives to effect changes in the delivery of inpatient care. This paper describes this UM program and other organizational initiatives, such as the introduction of new levels of care in an attempt to effect reductions in length of stay and unnecessary admissions. We demonstrate the use of a diversity of databases and analytical methods to quantify improved utilization and management of resources. The initiatives described significantly reduced hospital length of stay and inappropriate inpatient days. Without solid command and clinical leadership support and empowerment of the professional staffs, these significant changes and improvements could not have occurred.