Josh Adler, MD, UCSF chief medical officer, says one such project directs clinicians to move patients from intravenous administration of about 20 drugs to less expensive oral doses whenever possible. Oral dosages lower the risk of infection, decrease potential injury to the vein that can lead to phlebitis, and reduce the severity of any medical error that may occur because IVs deliver drugs to the bloodstream much faster than oral doses.
"Cost is also a factor, because it's much more expensive to give an IV drug than an oral one, much easier on the nurse in terms of workflow and efficiency," he says. "If a nurse no longer has to give total attention to programming an IV drug, that means he or she has more time to concentrate on other important aspects of that patient's care, or maybe just listen to the patient or help them to the bathroom, those other activities that are compromised when nurses are doing other activities."
Adler says UCSF has made thousands of drug switches, and is in the process of analyzing data to estimate cost savings, which he says "could be in the hundreds of thousands of dollars" per year.
Ending unnecessary care
Moriates' High Value Care Committee has prompted efforts that Adler says have placed UCSF "somewhat on the forefront of systematically rooting out unnecessary care in ways that are less dangerous and less expensive. We're committing ourselves to change the status quo with a campaign to create the educational and moral imperative that we need to do this."
Among other UCSF efforts are these:
Nebs No More After 24. A cost saving of $250,000 on one floor of the hospital—and perhaps $1 million a year hospitalwide—is realized by having patients with obstructive pulmonary disease stop using nebulizers, which requires presence of a respiratory therapist. Instead, after 24 hours on nebulizers, the patients are trained to properly use inhalers while still in the hospital.
The $20 iCal test. Educational efforts and a change in the computerized physician order entry system have reduced the use of this test from 3,660 per month to 1,300, an estimated annual savings of $150,000 after one year. False or vague results can prompt intravenous administration of calcium, which can cause several adverse reactions, such as arrhythmia.
Transfusions. Providers are reducing the number of transfusions. When transfusions are required, fewer units may be given because of research in the past decade showing that transfusing too many units to maintain higher hemoglobin levels is unnecessary, and could result in worse patient outcomes.