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Waste in the NHS
Cost-effectiveness of antiseptic impregnated catheters
Cost burden of latex allergy in healthcare systems
Economic analysis of Ottawa knee rule

The Bandolier/Impact management site here on the Internet now has over 170 stories of interest to people who want to make their healthcare system better. The policy is to add more material on a continuous basis. This month there are a number of new articles. Four examples follow:

Waste in the NHS


This is the title of a Praefectus' seminar for postgraduate students of Balliol College in Holywell Manor in 1999. The updated lecture is being posted on the management site. It is a series of examples of how the NHS wastes its resources, and how it could do better with the resources it has. This is not a criticism of the good people who work in the NHS and who make it work, but a call for more support for them.

Cost-effectiveness of antiseptic impregnated catheters


A US study in JAMA shows that antiseptic impregnated central venous catheters save an average of $196 per catheter in healthcare costs in patients at high risk of catheter related bloodstream infections, like those in intensive care. It is based on high quality information from a meta-analysis of randomised trials. Although it has a US context, it is likely that savings would occur in any healthcare model.

Cost burden of latex allergy in healthcare systems


These results relate to Georgia, USA, which has very conservative worker compensation benefits. Countries with more generous benefits packages would make the use of latex-safe gloves more cost-effective. This article demonstrates how any institution could approach the issue of latex allergy for itself. That might be a very sensible thing to do. The evidence about latex and its health consequences is substantial. Workers injured through latex contact when there are safe alternatives with a cost argument that is balanced might have a good case for significant damages for negligence against management. That would send the costs of not having a latex-safe policy even higher.

Economic analysis of Ottawa knee rule


Bandolier 49 carried an article about the way in which the Ottawa knee rule was determined and tested. The clinical decision rule helps determine whether an X-ray is necessary in acute knee injuries. It examined five simple clinical findings and had a sensitivity of 100% for detecting important fractures. Use of the rule reduced use of X-rays by 26% and average waiting time by 33 minutes per patient. An economic evaluation demonstrates substantial cost reductions of about $33 (£20) per patient in a north American setting.

 

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