Journal of general internal medicine
-
To measure the follow-up costs of preoperative coagulation screening tests, the authors studied 829 consecutive patients undergoing inpatient orthopedic surgery. The results of the initial prothrombin and activated partial thromboplastin time tests were divided into three groups: normal; abnormal above the hospital laboratory's upper limit of normal but below an "action limit"; and abnormal above an action limit. Patients with abnormal preoperative coagulation screening test results were matched on the basis of operative procedure and age with patients who had normal results. ⋯ The difference in average preoperative lengths of stay was not statistically significant. The attributable cost of evaluating an abnormal result added 3% to the cost of the initial coagulation screening program. This represents an average preoperative cost of $0.36 per patient in addition to the cost of the screening tests themselves.
-
Protocols concerning orders not to resuscitate have come into existence recently in order to facilitate decisions regarding resuscitation and to ensure that patient's rights to participate in such decisions are preserved. Prior to the do-not-resuscitate (DNR) decision is the decision whether to discuss the issue of resuscitation with the patient at all. ⋯ They found that the issue was discussed with only 10.8% of patients or their families on admission of the patients to these units. Such discussions occurred more frequently with older patients, those who were more severely ill or were estimated to have worse prognoses, those with poor intellectual function, and those admitted to the MICU rather than the CCU.