Cost-Effective Emergency Dept. Practices

Cost-Cutting Measures that Sustain Quality Care

Robert W. Kottman, MD, FACEP

Migraine Headache Drugs

Imitrex (sumatriptan) Cost– 6 mg subQ $48.61– 60 % return with headache in 24 hoursDemerol 100 mg IM $ 1.92Phenergan 25 mg IM $ 2.27Total Cost $ 4.195 pts./day (Dem+Phen.) saves daily $243.05Annual Savings (Dem+Phen) $ 88,713.25

Anti-Nausea Drugs Zofran (ondansetron) 4 mg IV $25.64

Excellent in chemotherapy pts. Torecan 10 mg IV $ 5.53

– Also good in chemotherapy pts. Phenergan 25 mg IV $ 2.27

May work in some chemo pts.Savings/pt (Phenergan vs. Zofran) $23.37

5 pts/day (Phenergan rather than Zofran) $116.85Annual Savings with Phenergan $42,650.25

Anti-Convulsant Loading Dose

Cerebyx (phosphenytoin) – 1 gm IV $112.22– Can give over 15 mins. Less phlebitis.

Dilantin (phenytoin)– 1 gm IV $ 6.66– Give over 1 hour, vein irritation

Cost savings/pt. (Dilantin vs Cerebyx)$105.66

5 pts/day—Annual Savings (Dilantin) $38,565

Analgesics

Toradol 30 mg IV $ 8.30– Good for “stone pain” (renal/biliary colic)– Increases bleeding if surgery is imminent

Morphine 6 mg IV $ 0.93 Phenergan 25 mg IV $ 2.27 Total Cost (Morphine + Phenergan) $3.20 No effect on blood—savings/pt $5.10 10 pts./day, Annual Savings $18,615.

Pyelonephritis-Inpatient Therapy

Cipro (ciprofloxacin) 400 mg IV q12h Daily Cost $60.04 Septra (sulfamethoxasole/trimethoprim) 400/80 mg IV q 8h Daily Cost $15.90 Daily savings/pt with Septra $44.14 5 pts./day (1 day therapy) Save $220.70 Ave. 3 day stay-Save/pt $132.42 5 pts./day (3 day stay) X 365 d. $241,666

Scalp Laceration Repairs

Laceration Tray $34.50 2 oz. Betadine $ 0.43 Total Cost $34.93 10 staple skin stapler $ 7.54 2 oz Betadine $ 0.43 4x4 gauze sponge pack $ 0.47 Total Cost $ 8.99 $25.94 X 5/day X 365 days-Save $47,340

Stool Hemoccult Tests

If done by Emergency Physician $0.52– (at bedside, results in 30 seconds)

If done in Laboratory $2.77– (in laboratory, results in one hour)– Cost Savings at bedside by EDP

$2.25– 50 /day---saves (daily) $112.50– $112.50 X 365 days-annually saves $41,062

Iodoform Gauze (5 yds-half-inch) Average amount used in abscess cavity

packing is 1 yard 5 yard Bottle Cost $3.01 If bottle is re-used at 1 yd/pt Cost/pt $0.60 Ave. 3,650 abscesses packed/year

– Cost if one bottle used/pt. $10,986– Cost if one bottle used/5 pts. $ 2,197– Cost Savings/year with re-use $ 8,789

Skin Antiseptics

Hibiclens 4 oz. $5.04 Betadine 2 0z. $0.43 Cost Savings with Betadine $4.67

35 laceration repairs daily

Betadine use, savings $4.67 X 35=$161.35

Annual Savings (Betadine) $58,892.75

Latex Gloves

Latex Gloves, Sterile, size 7.5$0.90

Latex Gloves, Non-Sterile, Large $0.06 Savings from Non-Sterile gloves $0.84 Non-Sterile appropriate for pelvics, rectals,

I&D of abscesses 50 uses of N.S. vs S./day saves $42/day Annual Savings (N.S. gloves) $15,330

Cautery of Bleeding Vessels

Disposable Surgical Cautery $78.00 10 applicators of AgNO3 $ 2.75 Cost Savings with AgNO3/pt $75.25

700 uses /year X $75.25 Save $52,675 by using AgNO3 chemical cautery rather than electrical cautery

Urine Tests

Urinalysis (dipstick + Microscopic) $3.89 Urine dipstick $2.12 Savings of dipstick only $1.77

20,000 urine tests annually 20,000 X $1.77 (Annual Savings) $35,400

BNP (Beta Natriuretic Peptide)

Lab test for CHF (vs dyspnea due only to COPD)

Cost is $16.40 Most CHF-rales, JVD, S3 gallop-no BNP is

necessary If 5 pts/day spared BNP test—daily savings

is $80/day $80/day X 365 days-annually save $29,200

Overdose Pts.-Drug Screens

Urine (benzos, THC, cocaine, opiates, amphetamines, barbs, PCP) $19.00

Serum (same drugs—sent out) $17.98 Gastric (same drugs-sent out) $98.05 If serum and gastric not done-save

$116.03

2 Pts/day (only urine) saves daily $232.06 2 pts./day X 365 days saves/year $84,701

Vasopressors

Dobutamine (500 mg in 250 ml) $142.85 Dopamine (400 mg in 250 ml) $ 36.75 Savings for one pt./day $106.10 Savings by use of dopamine Ave. of 3 days/pt on vasopressors $318.30 If 1 new pt/day on dopamine (365 pts/year) $318.30 X 365 days-annual save $116,179

Suppression of V-tach

Amiodarone 50 mg/ml $840.34/day Lidocaine 1% <$50.00/day

(Loading dose 1 mg/kg & 24 hr. drip)

If 1 Pt./day gets Amiodarone $288,350/yr

If 1 pt. receives lidocaine instead $18,250

Annual savings $270,100

Lumbosacral Spine X-rays

Indicated for: Significant trauma,age>50 years, neuro

deficits,Hx of cancer,unusual weight loss or fever,chronic steroid use, drug/alcohol abuse, Work Comp or litigation, suspected ankylosing spondylitis, persistent symptoms after symptomatic treatment for > 4 weeks.

Not indicated for pts. <50 years old who get back pain after exertion (lifting, bending)

Lumbosacral Spine films

L-S spine X-rays (3 views) $94.40

Average 15 patients/day with exertional back pain

Daily save-no L-S films obtained $1,416.00

Annual savings $1,416 X 365 = $516,840

Analgesics Stadol 2 ml $73.33 Nubain 20 mg $37.81 Toradol 30 mg $ 8.30 Morphine 6 mg $ 0.93If one pt./day gets Stadol, Nubain, Toradol

$43,595/year

If 3 patients got 6 mg Morphine IV $339/yr Annual cost savings from MS $43,256

Extraordinarily Expensive Drugs

Digibind 38 mg (1 vial) $ 511.31

Crotaline antivenin (1 vial) $2,500.00 If average mild envenomation

gets 4 vials, then cost is $10,000

1/3 of viper bites are “dry” If CroFab not given, savings are $10,000