Weekends at Olive View presented by

The Weekend Warriors

June 2013

CastO Gezman AbdullahiO Saba Al-HashimiO Ashvin KamathO Sewon OumO Steven ReineckeO Geoffrey TsoO Adviser: Dr. Soma Wali

Case

45 yo F with ESRD, DM, HTN, HLD presenting with anasarca and hyperkalemia. Admitted for initiation of dialysis… on a Friday afternoon…

ChallengesO Getting non-emergent IR procedures over

the weekend does not happen at OVMC.

O Patients often stay in hospital unnecessarily for 2-3 days awaiting procedures.

O As result, patients may undergo extra invasive procedures (ie temporary dialsysis access while awaiting permacath)

PurposeO Identify key services not available

over the weekend that result in unnecessary hospital stays.

O Identify challenges in implementing these services that are lacking over the weekend.

Study Design

O Cross-sectional study

O Survey of housestaff on inpatient medicine for 3 weeks in January 2013

O Data collection from existing databases from Utilization Review, “Dr Balingit service”, and related departments

Survey1. Over the past weekend, what is the total

number of patients that stayed in-house without medical need? What is the total number of days?

2. Over the past weekend, what is the total number of patients that stayed in-house without medical need due to home health issues? What is the total number of days?

3. Over the past weekend, what is the total number of patients that stayed in-house without medical need due to interventional radiology? What is the total number of days?

Survey4. Over the past weekend, what is the total number of

patients that stayed in-house without medical need due to PICC line placement? What is the total number of days?

5. Over the past weekend, what is the total number of patients that stayed in-house without medical need due to PT/OT? What is the total number of days?

6. Over the past weekend, what is the total number of patients that stayed in-house without medical need due to cardiac stress test? What is the total number of days?

7. Other reasons?

ResultsServices Number of patients Number of total days stayed

Home health 6 11

IR 15 35

PICC line placement 8 27

PT/OT 5 5

Placement Issues 4 32

Stress test 12 32

Cardiac MRI 1 2

LHC 2 4

Pacemaker placement 1 4

TTE 3 9

TEE 1 2

AFB sputum results 2 2

Costs to Olive ViewO Cost of hospital stay: $2200/day

O Accounting for fixed costs such as salaries and variable costs such as medications, costs of ancillaries to operate a bed at Olive View. 

O OV gets approximately $1,500/day in reimbursement for Medi-Cal recipients.

Costs to Olive ViewO Cost of running one IR room (salaries and other

costs as of 2009)

O Radiology tech salary: $4,116.55 to $5,399.09 per month.

O RN II salary: $5,614.00 to $8,178.53 per month

O Interventional radiologist salary: O Dr. Au: $268,568 base, $45,190 overtime,

$41,339 additional compensation, total $355,097. 

O Dr. Lee: $263,926 base, $15,817 overtime, $70,809 additional compensation, total $350,551.

Cost AnalysisO For an unnecessary stay of 3 days, the

cost to Olive View is as much as $6600 per patient.

O According to survey, 15 pts stayed awaiting IR procedures over span of 3 weekends

O Thus considering an avg of 5 pts/weekend, will cost $33,000 for hospitalization

Cost AnalysisO Cost of running IR lab for one weekend

(two days):O Radiology tech: $359.92O RN: $545.24O IR attending: $1945.74O The cost of running the IR lab turns out to

be ONLY $2850.90!!!

O Over the 3 weekends surveyed, 15 patients stayed a total of 35 unnecessary days, costing $77,000

O Operating IR suite for 3 weekends, would cost $8552.70

O The hospital would have saved $68447.30!!!!!!

O If the data can be extrapolated, annual saving for 52 weekends would potentially be 1.1 million dollars!!!!

GoalsO Presentation of findings to QI, IR department

O Challenges faced by IR department

O Establishment of IR services over the weekend

O Future goal: Establishment of other ancillary services over weekend such as: PICC line placement, Social work, Stress tests, MRI, etc.

Thank you!

OPreguntas???

Welcome to the Olive View Family Interns!!