Consolidation of pathology services in England: have savings been achieved?

BACKGROUND: During the last decade, pathology services in England have undergone profound changes with an extensive consolidation of laboratories. This has been driven by some national reviews forecasting a national reduction of costs by £250-£500 million ($315-$630 million) a year as a result. The main aim of this paper is to describe the financial impact of such consolidation, with a specific focus on the forecasted savings. A secondary aim is to describe the development of private sector involvement in laboratory services in a traditionally publicly funded healthcare system and the development of pathology staff size. METHODS: In the English scenario, the majority of hospitals and laboratories are publicly funded and a survey was sent as Freedom of Information request to all directors of pathology. A descriptive comparison of savings among consolidated and non-consolidated pathology services was made by using the pathology budgets in two different periods (2015 versus 2010), adjusted by inflation and increased activity. RESULTS: The hub-and-spoke model has been implemented as part of the consolidation process of pathology services in England. Consolidated pathology networks have achieved higher savings compared to non-consolidated single laboratories. There has been an increased role of private providers and savings were achieved with negligible personnel redundancies. CONCLUSIONS: Consolidated units have on average achieved larger cost savings than non-consolidated units but further analysis with stronger research design is required to independently evaluate the impact of pathology consolidation on both savings and quality.

A pilot study to assess the effectiveness and cost of routine universal use of peracetic acid sporicidal wipes in a real clinical environment.

BACKGROUND: Peracetic acid sporicidal wipes have been shown to be an effective disinfectant, but in controlled test environments. Their high cost may restrict use. AIMS: This pilot study investigated the efficacy and compared the costs of routine universal use of peracetic acid sporicidal wipes versus sporicidal quaternary ammonium compound and alcohol wipes in the disinfection of a hospital environment. METHODS: The routine universal use of peracetic acid wipes (Clinell Sporicidal; GAMA Healthcare Ltd, London, UK) was allocated to a study ward, whereas the control ward continued with the use of quaternary ammonium compound wipes (Tuffie 5; Vernacare, Bolton, UK) and alcohol wipes (PDI Sani-Cloth 70; PDI, Flint, UK). Twenty high-touch areas in the 2 wards were sampled for the presence of indicator organisms. The weekly detection rates of indicator organisms and weekly healthcare associated infection (HCAI) rates in the 2 wards were compared and examined for decreasing trends over the trial period. RESULTS: The detection rates of indicator organisms and HCAI rates were not significantly different in the 2 wards, and did not decrease significantly over the trial period. However, the peracetic acid wipes seem to be more effective against gram-negative organisms but at a significantly higher cost. CONCLUSIONS: Further prospective studies are needed to assess the cost-effectiveness of peracetic acid wipes.

ß-lactam allergy: clinical implications and costs.

BACKGROUND: ß-lactam allergy is the most commonly reported medication allergy and it remains a key issue in antibiotic prescribing. A detailed and accurate history taking play a key role in preventing potentially serious clinical incidents and it may contribute in reducing costs. METHODS: Data were collected for patients with a documented penicillin allergy on their drug chart during a six month period. Sources included the inpatient drug charts and medical notes. Adherence to hospital guidelines was audited and costs of treatments were calculated. RESULTS: 94 patients with a history of penicillin allergy were included. Compliance with the hospital antibiotic policy was 81% and 52% of cases had a description of the reaction documented. The mean additional cost per patient was £89.29 (excluding VAT). CONCLUSIONS: It is important to maintain a high level of vigilance and constantly educate all healthcare professionals involved in prescribing and dispensing antibiotics in order to avoid the unnecessary use of non-penicillin-based antibiotics and associated cost implication.