Economics of microsurgical cases and routine cases in a medical center.

This report describes the economic impact of microsurgical cases and routine plastic surgery cases in our medical center. The study is based on a financial analysis of the practices of two surgeons. Financial data of patient encounters (admission to the hospital or a surgical unit) identified with each surgeon were categorized into microsurgical and related cases and routine cases (including cosmetic procedures and general hand cases). Revenues, costs, and profits were tabulated. Data were analyzed for 2 fiscal years (1994-95 and 1995-96). Analysis of the first fiscal year showed that microsurgery encounters (n = 188) generated $4.4 million in revenue with a profit margin after direct costs of $2.5 million (57 percent) and a net profit, after indirect costs, of $1 million (23 percent). Routine encounters (n = 262) generated $1.7 million with a net loss of -$145,000 after direct and indirect costs. In the second fiscal year, microsurgery encounters (n = 230) had income of $4.7 million, a profit over direct costs of $2.5 million (53 percent), and a net profit after indirect costs of $0.9 million (19 percent). Routine cases (n = 202) in the same period earned $1.3 million with a net loss of -$107,000. This analysis formulates a comprehensive definition of microsurgical practice and shows that cases within this definition generated dramatically higher hospital incomes and profits compared with routine plastic surgical practice. In the circumstances of our medical center, development of this subspecialty is fiscally justifiable.

The merger of two great forces in health care.

Two university medical centers, Stanford and the University of California at San Francisco, join to preserve excellence in patient care, research and education while enhancing their already impressive market share.

Culture and consent.

Consent for surgical procedures is a surgeon's nontransferable legal duty. However, nurses often are involved in the communication of relevant, culturally sensitive information.

Comparison of a fluorescence polarization immunoassay of netilmicin in plasma, peritoneal dialysate, and urine with a high-performance liquid chromatographic method.

The quantitative analysis of netilmicin in plasma, peritoneal dialysate, and urine using the fluorescence polarization immunoassay (FPIA) of the Abbott TDx system is compared with the modified high-performance liquid chromatography (HPLC) method of Peng et al., which was chosen as a reference. Using the least square method, we found that the results of the FPIA (y) correlated well with those obtained with HPLC (x). The three regression equations for the plasma, peritoneal dialysate, and urine samples, respectively, were y = 0.71x + 0.44 with r = 0.88 and n = 45; y = 0.94x + 1.22 with r = 0.93 and n = 95; and y = 0.92x + 0.70 with r = 0.93 and n = 61. The corresponding mean errors (FPIA-HPLC) with their 95% confidence intervals were -0.19 (-0.38 to -0.02), 0.69 (-0.42 to 1.81), and -0.13 (-1.13 to 0.87) microgram/ml. According to results of the Wilcoxon matched-pairs signed-ranks test, these errors did not represent a significant bias. The FPIA is thus suitable for analyzing netilmicin in the three biological fluids studied except when dialysate is contaminated with Amuchina. In this case, HPLC should be used.

The operating room of the future.

As more and more care moves to the home setting, the ability to undergo a surgical procedure from the comfort of your own home may not be that far away. As for the operating room itself, patient care will be radically different than it has been in the past. Radiologists, assisted by computers and robots, may be performing procedures on patients "anesthetized" by acupuncture, therapeutic touch and aromatherapy in a totally bloodless environment.

Reengineering: avoiding the pitfalls and overcoming the barriers.

Many health care facilities are in the process of reengineering in order to reduce costs and remain competitive in the marketplace. If your facility is in the planning stages or early on in the process of reengineering, here are tips from some experts to help with this process.

The future of minimally invasive surgery.

When it was first introduced, minimally invasive surgery longer to perform than open surgeries, limited the number of instruments that could be used simultaneously; restricted the manipulation of instruments, reduced the surgeon's depth perception, decreased eye/hand coordination and eliminated the ability to palpate tissue directly. However, recent advances have corrected some of these deficits and minimally invasive surgery eventually will be used for all gynecological procedures and most general surgery, chest and coronary artery bypass procedures.

Telepresence: what is it?

The great technological advances of the past 25 years are having a profound impact on the practice of medicine. Combined with the ever-present demand to decrease costs and improve quality driven by the managed care market, telemedicine has emerged as a possible method to at least reach more people and to improve the quality of care.

What is the future of the OR director?

So, if there are still some nurses out there who want to get into administration, here's some good advice: "Pick your mentors, get a master's degree early in your career, get involved in your professional association and the sooner you commit, the better." There are still a lot of opportunities for OR managers, and the better ones will flourish in tomorrow's OR. The efficient and forward-looking OR managers will always do well and the well-managed ORs will survive!

Mini-coronary artery bypass grafting.

Perioperative nursing has been impacted by a multitude of changes as medical technology continues its rapid advance. What may prove to be a major innovation in coronary artery bypass surgery is currently being performed in the United States, Europe and South America. Mini-coronary artery bypass grafting (CABG) is a minimally invasive procedure in which the surgery is performed through small incisions made in the chest wall, eliminating the need to "crack" the chest. This method reduces the pain and trauma to the patient and shortens the time required for hospitalization and recovery.

Perioperative introductory column.

Our future in the operating room (OR) depends on our ability to remain productive and valuable to surgeons, patients and administration. Together, we can ensure that quality and efficiency in the OR are not casualties of the health care revolution. Let us all share our knowledge and experience to help ourselves through to the next century.

Managing operating room budget variances.

Credibility, power, and the ability to obtain greater departmental resources are three benefits of managing the operating room (OR) department's operating budget effectively. Still, few resources exist to help novice as well as seasoned OR directors grapple with the practicalities of maintaining their budget after the annual budget process is completed. The authors examine how astutely controlling personnel, materials, and services budget variances will result in hospital administrators "hearing" and approving an OR director's requests for resources more readily, staff and physicians who enjoy the benefits of better-staffed services and new technology, and an OR director with a reputation as an effective department head among peers in the hospital.

The operating room director: functions and responsibilities.

Do you supervise the operating room (OR) director in your hospital? Are you thinking of applying for an OR director's position? Or are you in the process of clarifying your role as the OR director with your boss? If so, read these authors' analysis of one OR director's role in a large, teaching hospital. Not only will you learn about the functions one OR director performs to lead a 37 million dollar revenue-producing corporate division, but also you will get an appreciation for the pace, complexity, rewards, and dilemmas of such a position.

Footwear practices and operating room contamination.

The extent of bacterial transfer into the clean confines of the operating room (OR) was studied by comparing the use of protective footwear (i.e., polypropylene shoe covers and OR restricted shoes) with unprotected street shoes over a 5-week period. The study was divided into two experimental times: (a) early morning (disinfected floor) and (b) midmorning (dirty floor). Data obtained from the early morning experiment showed that OR restricted shoes and shoe covers transferred fewer bacteria onto the disinfected study area than unprotected street shoes; similar findings were obtained from the midmorning experiment for shoe covers, but not for OR restricted shoes. A comparison of changes in bacterial counts obtained from OR restricted shoes and shoe covers worn from the changing room through a common corridor to the disinfected study area did not differ significantly from OR restricted shoes and shoe covers that were put on immediately before walking through the study area at both experimental times. Overall results indicated that protective footwear may act to reduce bacterial contamination on OR floors.

Cover gowns. Researching their effectiveness.

1. Bacterial colony counts on the right shoulder of the subject's scrub suits were lower after lunch when a. cover gowns were worn over scrub suits outside the OR during lunch, and b. when fresh scrub suits were put on after lunch. 2. Bacterial colony counts were higher after lunch when a. scrub suits were worn without cover gowns outside the OR during lunch, and b. when they were removed before lunch, stored in a locker, and put on again after lunch. 3. The thigh region can be assumed to be dirtier than the shoulder area on scrub suits. From this study, the researchers concluded that wearing cover gowns outside the OR exerts a protective effect against bacterial contamination as determined by samples taken from the right shoulder. Furthermore, this protective effect is comparable to that seen when subjects changed into fresh scrub suits after lunch.

Drug information services in Quebec: determination of community and hospital pharmacists' needs.

A survey of Quebec pharmacists was conducted to determine drug information resources currently available, obtain information on pharmacists' involvement as drug information providers, and determine their perceived drug information needs. Responses were obtained from 665 of 3283 registered pharmacists for a response rate of 20.3 percent. Hospital and community pharmacists represented more than 90 percent of the respondents. The two reference texts most frequently found in community pharmacists' libraries were Compendium of Pharmaceutical Specialties and Goodman and Gilman's The Pharmacological Basis of Therapeutics, the latter being available to only 49 percent of the pharmacists. More than 60 percent of the hospital pharmacists had at least 10 of the reference texts listed on our survey instrument. The majority of pharmacists were actively involved in a variety of clinical pharmacy services. Providing drug information to consumers or health professionals was one of the most common activities. Several pharmacists expressed their needs for drug information center (DIC) support in different drug information categories. Information on drug interactions and adverse drug reactions was rated as an important need by 68 and 59.9 percent of the community pharmacists, respectively. The institution of a regional DIC may provide the support system needed by the pharmacists of Quebec.