Promising Practices: Advanced Referral System - Illinois Division of Rehabilitation Services, BPA&O Project Human Services Center

Changes in disability policy at the state and federal level have presented many new opportunities for meaningful systems change and services delivery for people with disabilities. Since 2000, the Social Security Administration, the U.S. Department of Labor, the Centers for Medicare & Medicaid Services and the Rehabilitation Services Administration have issued many grants to state agencies, community-based service providers and advocates to address barriers to employment for people with disabilities. Many of these grants have competitive employment as the goal, yet very few of these grants have built in support for benefits planning and assistance – a function that many believe is critical to achieving competitive employment. In this Promising Practices, the Illinois Division of Rehabilitation Services BPA&O Project (DRS BPA&O Project) and the Human Services Center (HSC), a community-based mental health center and the recipient of a DOL Customized Employment Grant, created a model partnership to ensure that the 600 consumers with severe mental illness served by HSC under their grant would gain access to benefits planning services. They call their model partnership an “Advanced Referral System.

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care