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This study demonstrated the use of purchase data to determine the incidence of sharps injuries in a major tertiary referral hospital in Australia. The incidence rates of injuries per 100,000 items purchased were 2.65 and 12.60 for syringe needles and scalpel blades, respectively. These figures were lower than those reported previously using this method. The incidence rate for injuries with suture needles, which had not been reported previously, was 31.89/100,000 items purchased. Incidence data calculated in this manner may be used in conjunction with purchase cost estimates to inform policy and practices on institutional staff safety measures., (Copyright © 2020 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Objective: To evaluate perioperative red blood cell (RBC) ordering and interhospital variability patterns in pediatric patients undergoing surgical interventions at US children's hospitals., Study Design: This is a multicenter cross-sectional study of children aged <19 years admitted to 38 pediatric tertiary care hospitals participating in the Pediatric Health Information System in 2009-2014. Only cases performed at all represented hospitals were included in the study, to limit case mix variability. Orders for blood type and crossmatch were included when done on the day before or the day of the surgical procedure. The RBC transfusions included were those given on the day of or the day after surgery. The type and crossmatch-to-transfusion ratio (TCTR) was calculated for each surgical procedure. An adjusted model for interhospital variability was created to account for variation in patient population by age, sex, race/ethnicity, payer type, and presence/number of complex chronic conditions (CCCs) per patient., Results: A total of 357 007 surgical interventions were identified across all participating hospitals. Blood type and crossmatch was performed 55 632 times, and 13 736 transfusions were provided, for a TCTR of 4:1. There was an association between increasing age and TCTR (R(2) = 0.43). Patients with multiple CCCs had lower TCTRs, with a stronger relationship (R(2) = 0.77). There was broad variability in adjusted TCTRs among hospitals (range, 2.5-25)., Conclusions: The average TCTR in US children's hospitals was double that of adult surgical data, and was associated with wide interhospital variability. Age and the presence of CCCs markedly influenced this ratio. Studies to evaluate optimal preoperative RBC ordering and standardization of practices could potentially decrease unnecessary costs and wasted blood., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: There are scarce descriptions of hospital drug procurement in the primary literature. The aim of this study was to analyse the drug tender led by a clinical pharmacologist in a 1200-bed university hospital in Serbia, a developing country in socio-economic transition, and to give recommendations for future steps in hospital drug policy., Procedure and Outcomes: Drug tendering was conducted according to the public procurement law from January to April 2003. Analysis included the method of defined daily doses and anatomical therapeutic chemical classification, as well as minimal tender prices, free market prices, essential drugs and domestic and foreign manufacturers. The drug tender list consisted of 548 products, 1,315,501 pharmaceutical units and 312 drug entities, among which 164 were essential. For purchasing purposes, 479 drug formulations were selected, costing approximately 1.4 million Euros (approximately 10% of hospital budget). Three-quarters of the expenditure consisted of antimicrobials (29.1%), cytotoxics (28.8%) and intravenous infusions (17.7%). The top 20 drugs consumed 62.2% of the total drug expenditure. Competition for the most expensive and/or most used drugs was the key for financial success of applicants, even when they offered a limited number of drugs. The tender achieved 4.6% and 17.2% cost savings in comparison with minimal tender price and free-market price, respectively. The tender did not provide a fair balance between domestic and foreign manufacturers., Conclusion: The drug tender is resource-consuming, laborious, and risky job. Aggregation of individual tenders, on a national level and/or regional ones, is probably the best choice for hospitals in transition countries at this time.

In the rapidly changing group purchasing market, GPOs are focusing on customization to draw new customers and satisfy the ones they have. One particularly daunting challenge for GPOs involves coronary stents. These tiny devices can amount to big dollar volume, but price isn't the only issue.

This paper empirically examines the relationship between HMO market share and the diffusion of magnetic resonance imaging (MRI) equipment. Across markets, increases in HMO market share are associated with slower diffusion of MRI into hospitals between 1983 and 1993, and with substantially lower overall MRI availability in the mid- and later 1990s. High managed care areas also had markedly lower rates of MRI procedure use. These results suggest that technology adoption in health care can respond to changes in financial and other incentives associated with managed care, which may have implications for health care costs and patient welfare.

Healthcare decision makers and researchers have long been interested in the factors behind medical technology acquisition. The rate of environmental change in recent years has dramatically affected technology acquisition decision making in acute care hospitals. This study examines the relative role of decision-maker influence and environmental factors on the timing of MRI acquisition in hospitals operating in three western states with different levels of environmental uncertainty. The results suggest that the relative influence of decision makers and environmental factors on innovation acquisition timing varies depending on environmental turbulence, and that hospitals acquire new technology as one way of controlling the turbulence in their environments.

Objective: We studied hospital costs associated with healthcare worker (HCW) respiratory protection and respirator fit-testing programs recommended by the Centers for Disease Control and Prevention (CDC) and mandated by the Occupational Safety and Health Administration to decrease nosocomial or occupational Mycobacterium tuberculosis (TB)., Design: The number and cost of high-efficiency particulate air (HEPA)-filter and dust-mist (DM) respirators for 1989 to 1994 were obtained from study hospital purchasing departments, and the costs of HCW fit-testing and education programs for 1994 were estimated from information provided by infection control practitioners. Costs of N-class respirator programs were estimated for study hospitals using retrospective cost analysis and an observational study., Setting: Four urban hospitals with, and one rural community hospital without, documented nosocomial or occupational transmission of multidrug-resistant TB., Results: During the study period, four of five hospitals introduced HEPA and DM respirators and respirator education and fit-testing programs. Median costs in 1994 were $83,900 (range, $2,000-$223,000) for respirators and $17,187 (range, $8,736-$26,175) for respiratory fit-testing programs. The projected median annual cost of N95 respirators was $62,023 (range, $270-$422,526)., Conclusions: Compliance with CDC TB guidelines may require a substantial investment. However, outlays for respirators and education and fit-testing programs are more reasonable than would be suggested by analyses that estimated the costs of preventing one case of nosocomial TB.

In 1995, Healthcare Financial Management and Physician Services of America conducted a national survey on practice acquisition to determine the types of practices hospitals were buying, the amount they were paying, and whether the hospitals' financial expectations of the practice were being met. A follow-up to this survey was recently completed to evaluate practice acquisition from the physician's perspective. Approximately 500 physicians who had sold their practices to hospitals were surveyed to determine their degree of satisfaction with the sale of their practices. Sixty-seven percent of the responding physicians indicated that they were somewhat satisfied or extremely satisfied with all aspects of the acquisition experience, 60 percent said they would recommend acquisition to a colleague, and 77 percent stated that they were satisfied with how the details of the acquisition process were handled. Of the respondents, 77 percent were primary care physicians. Most of the responding physicians had the characteristics of physicians whose practices are sought by hospitals--that is, they were nearing retirement or wanted to continue practicing for a number of years but were seeking relief from administrative duties and wanted to obtain the equity from their practices.

Valuation of physician practices provides physicians with a benchmark of their business success and helps purchasers negotiate a purchase price. The Center for Healthcare Industry Performance Studies (CHIPS) recently conducted a survey of physician practice acquisitions. The survey collected data on salaries and benefits paid to physicians after practice acquisition, historical profitability of the acquired practice, and specific values assigned to both tangible and intangible assets in the practice. Some of the survey's critical conclusions include: hospitals tend to acquire unprofitable practices, value is based on historical revenues rather than historical profits, the importance of valuation methodology and payer mix is underestimated, tangible assets represent a large part of the purchase price, and hospitals tend to pay higher physician compensation than do other purchasers.

As integrated delivery networks mature, many are questioning whether purchasing groups are as relevant as they used to be. Sure, the groups promise purchasing muscle, but many systems already have enough buying heft to extract concessions from suppliers. And many systems can afford to hire their own purchasing experts or get what they need from consultants. As a results, the purchasing group isn't the automatic decision it once was.

Health technology refers to the instruments, equipment, drugs and procedures used in health care delivery, as well as the organizations supporting it. Health technology assessment, which is the process of conducting investigations to establish the criteria for efficacious, effective and efficient patient care, is becoming increasingly important in an era of diminishing resources. This survey of 39 community hospitals in southwestern Ontario found that improved purchasing strategies can result in substantial cost savings which can in turn be used to improve patient care. The study shows that optimizing the price of basic hospital commodities could save an average community hospital as much as $625,000 per year.

Like impulsive shoppers, hospitals can't seem to buy enough doctors. However, hospital-based systems aren't prepared for the management challenges of running medical groups. Many have been plagued by productivity slumps and high operating costs.

Hospital alliances and group purchasing organizations don't plan to stand still while mergers and acquisitions transform their traditional hospital members into integrated healthcare systems. Included are some survival strategies of the 10 largest groups responding to Modern Healthcare's 1995 group purchasing survey.

In an effort to assess trends in the number and type of physician practices being acquired by healthcare organizations throughout the country and to gather information on related costs, HEALTHCARE FINANCIAL MANAGEMENT and Physician Services of America, Louisville, Kentucky, cosponsored the first national survey on trends in practice acquisition and integration. More than 5,300 senior financial executives in healthcare organizations and systems were surveyed. Thirty-six percent of respondents said that their healthcare organization had acquired practices in the past five years. Most practice acquisitions were in primary care; family practice physicians and groups were in high demand, with the Midwest the most active region in the country regarding family practice acquisitions. In addition, the survey gathered information about the considerations involved in acquisitions. Respondents cited strategic planning, communicating with medial staff, negotiating compensation packages, and managing productivity as reasons to pursue acquisition opportunities.

We surveyed attitudes of decision makers involved in making decisions about technology acquisition in hospitals, receiving replies from 989 (72%) anglophone respondents and 201 (68%) from francophone respondents. Respondents split on whether to try unverified procedures, strongly agreed that medical technology should be evaluated, and expressed a desire for technology assessment data. The quality of health care, need, and compatibility with the institution's role and mission were seen as the most important factors affecting acquisitions. Our study suggests that half the battle has been won; decision makers appear convinced that technologies must be evaluated. Organizational mechanisms, however, may still be required to ensure implementation.

Departments of medical imaging and therapy must balance the need to improve delivery and efficiency with the need to lower costs by finding better ways to deliver their services. As each department struggles to find its way, new trends will develop. In October, 1994, the AHRA surveyed its membership to determine those trends in hospital and nonhospital facilities. This article presents data and analysis for equipment acquisition and maintenance; operations; staffing and professional coverage; education programs; competition; marketing and new programs. Demographic information and comparisons with AHRA Trends Surveys conducted in 1985, 1987, 1989 and 1991 are included. Editor's Note: Part II of this article will review trends in exam volume, charges and volume from referral sources. Also, data from hospital departments will be analyzed by bed size groupings. Part II will be published in the summer, 1995, issue of Radiology Management, 17(3).