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* Context.--Laboratories face the challenge of providing quality patient care while managing costs and turnaround times (TATs). To this end, we brought the heparin-induced thrombocytopenia (HIT) antibody test in-house with the goal of reducing costs and the time to diagnosis. Objectives.--To determine the cost-effectiveness and return on investment of our in-house HIT antibody test by comparing it to send-out assays with TATs of 2, 3, or 4 days. Design.--We performed a retrospective chart review of all patients with a HIT antibody assay and analysis of laboratory financial records. Analysis included the percentage of patients receiving alternative treatment, cost of treatment, startup costs of bringing the test in-house, and average TAT of the in-house test. Results.--We found significant reductions in the cost of treatment for patients and the overall cost to the health care system. The in-house assay became cost-effective at between 8 and 20 tests, with a return on investment of up to 298%. Conclusions.--Bringing the HIT antibody assay in-house becomes cost-effective at a very low test volume with excellent return on investment. This novel analysis can provide a framework for other laboratory medicine professionals to analyze the benefits of bringing this and other assays in-house. doi: 10.5858/arpa.2023-0141-OA), Modern clinical laboratories aim to provide excellent quality by producing accurate and cutting-edge results with the least turnaround time (TAT) possible while simultaneously balancing health care costs. To achieve this, [...]

Objectives Analysis of laboratory value often lacks assessment of the laboratory's impact on quality of care. In this study, we aimed to determine the impact of bringing a heparin-induced thrombocytopenia (HIT) antibody assay in-house on a quality metric—patient hospital length of stay (LOS)—and assess any associated cost savings. Methods A retrospective review of patient visits with a HIT antibody assay over a 7-year period determined the mean LOS in send-out vs in-house HIT antibody assay cohorts as well as cohorts of positive and negative results. Our systemwide mean LOS and metrics of acuity were analyzed. We performed a financial analysis of estimated cost savings. Results We found a mean LOS reduction of 3.97 days in the in-house cohort, with no evidence of a systemwide LOS decrease or a decline in patient acuity. This reduction was largely driven by a reduction in LOS among patients with a negative assay result. We found an estimated total cost savings of $3.9 million and an estimated mean savings per patient of $7,305, despite escalating health care costs over time. Conclusions We demonstrated a reduction in LOS following the introduction of an in-house HIT antibody assay that cannot be attributed to either systemwide initiatives or reduced patient acuity and was driven largely by patients with negative assays. This reduction was associated with significant estimated cost savings. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has provided the biggest recent test of the valuation profession and valuation standards, notably 'RICS Global Standards — Valuation "Red Book"' ('Red Book Global'). Many positive lessons have been learnt from the crisis, the principal one being for valuers to be prepared for changing valuation practice in the light of severe market challenges, while still adhering to valuation standards requiring the provision of accurate, objective and evidenced advice. The demand for explicit valuation techniques and a comprehensive rationale, increased automation and digitisation, with more demanding governance is unlikely to be reversed following the initial impact of COVID-19. This paper analyses how valuers will continue to rise to these challenges. [ABSTRACT FROM AUTHOR]

Purpose. The relationship between initial fentanyl infusion dosage and time to goal sedation in nonobese and obese critically ill children was examined. Methods. A retrospective cohort study of 75 fentanyl infusions initiated in mechanically ventilated children age 2-17 years with an inpatient admission between January 1, 2012, and May 31, 2014, who subsequently received a fentanyl infusion was conducted. The primary outcomes of the study included the time to goal sedation and fentanyl dosage characteristics (i.e., underdosage, optimal dosage, or overdosage). Sedation scores were assessed by the State Behavioral Scale, a validated instrument to assess sedation in children. Key independent (predictor) variables were collected, including baseline demographics and admission diagnoses. Multivariable regression models were used to examine the association between initial fentanyl infusion dosage and time to goal sedation or dosing characteristics while controlling for obesity status and other modifying or confounding factors. Results. A total of 75 infusions met the study's inclusion criteria, representing 74 patients. The majority of patients (52%) were boys, and the median age was 8.1 years. Eighteen children (24%) were obese. The median time to goal sedation was 10.9 hours. Among nonobese children, every 10-mg/hr increase in initial fentanyl dosage was associated with a 19% lower probability of achieving goal sedation at any point in time. Initial fentanyl dosage was not associated with time to goal sedation in obese children. Conclusion. Fentanyl infusion rates in obese and nonobese children varied widely in the time needed to achieve goal sedation. At any given time, initial fentanyl infusion rates were less likely to result in goal sedation in nonobese than in obese children. [ABSTRACT FROM AUTHOR]