Cost analysis of one-time intravenous antibiotic doses in the emergency department.

BACKGROUND: Research shows that one-time doses of intravenous (IV) antibiotics do not improve resolution of infection. However, providers continue to use them-especially in the emergency department (ED). Very few studies have aimed to quantify the cost of this practice. OBJECTIVES: The primary objective was to evaluate the difference in average total cost of ED stay between patients who received a one-time dose of IV antibiotics in the ED before discharging on oral antibiotics and patients who were just discharged on oral antibiotics. Secondary objectives were to evaluate the differences in durations of stay between the 2 groups, as well as the differences in adverse drug effects and need for health care contact after discharge. METHODS: Chart review was conducted to identify patients who received and did not receive a one-time dose of IV antibiotics in the ED between April 30, 2020, and April 30, 2022. A microcosting approach was used to determine ED-associated costs per patient. Comparisons in primary and secondary outcomes were performed using statistical inferential tests. RESULTS: A total of 102 patients were analyzed in each group. Patients who received a one-time dose of IV antibiotics in the ED before being discharged on oral antibiotics had an average length of stay of 4.55 hours, as opposed to patients who did not receive a one-time dose of IV antibiotics before being discharged on oral antibiotics who had an average length of stay of 2.82 hours (absolute difference 1.73 hours, P < 0.001). One-time dosing of IV antibiotics in the ED incurred an additional cost of approximately $556 per patient, totaling to more than $56,000 in our study cohort. CONCLUSION: The use of one-time IV antibiotics in the ED did not confer any additional benefits to patients. The use of one-time doses resulted in statistically significant reduced throughput in the ED and statistically significant increased health care costs.

Effect of bark beetle infestation on secondary organic aerosol precursor emissions.

Bark beetles are a potentially destructive force in forest ecosystems; however, it is not known how insect attacks affect the atmosphere. The emissions of volatile organic compounds (VOCs) were sampled i.) from bark beetle infested and healthy lodgepole pine (Pinus contorta var. latifolia) trees and ii.) from sites with and without active mountain pine beetle infestation. The emissions from the trunk and the canopy were collected via sorbent traps. After collection, the sorbent traps were extracted with hexane, and the extracts were separated and detected using gas chromatography/mass spectroscopy. Canister samples were also collected and analyzed by a multicolumn gas chromatographic system. The samples from bark beetle infested lodgepole pine trees suggest a 5- to 20-fold enhancement in total VOCs emissions. Furthermore, increases in the ß-phellandrene emissions correlated with bark beetle infestation. A shift in the type and the quantity of VOC emissions can be used to identify bark beetle infestation but, more importantly, can lead to increases in secondary organic aerosol from these forests as potent SOA precursors are produced.

A device for fully automated on-site process monitoring and control of trihalomethane concentrations in drinking water.

An instrument designed for fully automated on-line monitoring of trihalomethane concentrations in chlorinated drinking water is presented. The patented capillary membrane sampling device automatically samples directly from a water tap followed by injection of the sample into a gas chromatograph equipped with a nickel-63 electron capture detector. Detailed studies using individual trihalomethane species exhibited method detection limits ranging from 0.01-0.04 µg L(-1). Mean percent recoveries ranged from 77.1 to 86.5% with percent relative standard deviation values ranging from 1.2 to 4.6%. Out of more than 5200 samples analyzed, 95% of the concentration ranges were detectable, 86.5% were quantifiable. The failure rate was less than 2%. Using the data from the instrument, two different treatment processes were optimized so that total trihalomethane concentrations were maintained at acceptable levels while reducing treatment costs significantly. This ongoing trihalomethane monitoring program has been operating for more than ten months and has produced the longest continuous and most finely time-resolved data on trihalomethane concentrations reported in the literature.