Cost awareness of anaesthetic consumable items among the National Health Service (NHS) staff and the financial impact on the NHS

Background The financial burden of running the National Health Service (NHS) is high. Staff members should be aware of the cost of the equipment they use to enable efficient use of resources, reduce waste, and control spending. However, limited financial education at undergraduate and junior stages has contributed to relatively poor knowledge among healthcare workers at all levels. Anaesthetics is a speciality which uses a large amount of equipment; therefore, we aim to assess the cost awareness among staff for commonly used consumables. Furthermore, we aim to assess staff members' attitudes towards the financial and environmental impact of the equipment they use and whether this would change their practice. Methodology An electronic survey was sent to staff members from the anaesthetic department of the Medway NHS Foundation Trust during a one-month period. Respondents were asked to estimate the cost of 19 commonly used anaesthetic consumables, with an estimate categorised as correct if it was within 20% of the actual cost. At the end of the survey, there were five questions for respondents to answer regarding the financial and environmental impact of their current healthcare practice and possible alternatives. Results There were 69 respondents within the anaesthetic department from a variety of roles. Overall, only 9.37% of items were estimated correctly, with cheaper items commonly being overestimated and more expensive items being underestimated. Overall, 60% of respondents said the cost of an item would influence their use. The overwhelming majority claimed that the environmental impact was a concern, and most would favour recyclable/reusable alternatives. Conclusions Cost awareness among anaesthetic staff for commonly used equipment is poor. More education and training are necessary in this area as limited knowledge of service costs restricts the ability to make cost-efficient choices which are needed in the current NHS. [Abstract copyright: Copyright © 2024, Divekar et al.

A survey of the estimated cost of surgical consumable items within trauma and orthopaedic departments

Introduction The impact of the current economic and environmental climate, both nationally and globally, is further straining the NHS. This has led to scrutiny of high-expenditure areas, including consumables. Clinician's knowledge surrounding health economics is sparse, and we conducted this survey to assess cost-awareness within the Trauma and Orthopaedic (T&O) departmental staff. Methods A questionnaire was digitally distributed to T&O staff in the East Kent Hospitals Trust. This included demographic data and to make estimations of the cost of 10 specialty-specific items. The data were analysed to determine the average, median, and interquartile range (IQR) of the estimated prices and compared to the actual costs. Results Approximately 7.1% of all item estimates were deemed 'correct'. No correlation was seen between years of staff experience and the accuracy of estimates. 'Kenalog 1 mL ampoule' (Kenalog, Bristol-Myers Squibb, NJ) had the highest accuracy of estimation across all responses (13%), whilst both 'kirschner wires' and '3.2 drill bit' had the lowest accuracy (4% each). The median estimated cost was closest to the actual cost for 'cement pack' (median estimate/actual cost = 0.9). The median estimated cost was furthest from the actual cost for 'tourniquet cuffs' (median estimate/actual cost = 0.16). 'Velcro wrist splint' was the item that was the most overestimated (median estimate/actual cost = 1.57), with only two of the 10 items being overestimated ('velcro wrist splint' and 'dynamic hip screw and plate'). The most underestimated item was 'tourniquet cuffs' (median estimate/actual cost = 0.16). Conclusions There is a paucity of knowledge surrounding the cost of specialist T&O consumables. The limitations included the sample size (98 respondents) and geographical area (East Kent Hospitals Trust). This study shows that there is a need for further research into this topic, with long-term outcomes, which may be beneficial both economically and environmentally. [Abstract copyright: Copyright © 2024, Divekar et al.

Meniere's disease treated by grommet insertion

INTRODUCTION: Menière’s disease (MD) is an uncommon cause of sudden profound vertigo. A variety of medical and surgical treatments have been used to manage this condition. This study reviewed the outcomes of patients treated with grommet insertion and transtympanic steroid injection. METHODS: Patients diagnosed with MD between 2007 and 2017 were identified, and case notes and audiological data were retrieved for those managed by grommet (ventilation tube) insertion with and without transtympanic steroid injection. RESULTS: Thirty-three patients were identified as being diagnosed with MD. Grommet insertion resulted in cessation or improvement of attacks in 91% of cases. The mean follow-up duration was 33.8 months (median: 29 months). The mean hearing threshold across the low frequencies improved from 57.2dBHL to 49.4dBHL (p=0.031). Following the intervention, improved tinnitus was reported in 80% of cases. Twelve patients (36%) reported aural fullness prior to grommet insertion; all reported improved symptoms following the procedure. CONCLUSIONS: Early grommet insertion with transtympanic steroid injection, combined with customised vestibular physiotherapy, may provide an alternative first-line strategy for MD, preventing further true MD attacks. In some patients, it may significantly improve hearing thresholds

The effect of virtual reality on visual vertigo symptoms in patients with peripheral vestibular dysfunction: a pilot study

Individuals with vestibular dysfunction may experience visual vertigo (VV), in which symptoms are provoked or exacerbated by excessive or disorientating visual stimuli (e.g. supermarkets). VV can significantly improve when customized vestibular rehabilitation exercises are combined with exposure to optokinetic stimuli. Virtual reality (VR), which immerses patients in realistic, visually challenging environments, has also been suggested as an adjunct to VR to improve VV symptoms. This pilot study compared the responses of sixteen patients with unilateral peripheral vestibular disorder randomly allocated to a VR regime incorporating exposure to a static (Group S) or dynamic (Group D) VR environment. Participants practiced vestibular exercises, twice weekly for four weeks, inside a static (Group S) or dynamic (Group D) virtual crowded square environment, presented in an immersive projection theatre (IPT), and received a vestibular exercise program to practice on days not attending clinic. A third Group D1 completed both the static and dynamic VR training. Treatment response was assessed with the Dynamic Gait Index and questionnaires concerning symptom triggers and psychological state. At final assessment, significant betweengroup differences were noted between Groups D (p = 0.001) and D1 (p = 0.03) compared to Group S for VV symptoms with the former two showing a significant 59.2% and 25.8% improvement respectively compared to 1.6% for the latter. Depression scores improved only for Group S (p = 0.01) while a trend towards significance was noted for Group D regarding anxiety scores (p = 0.07). Conclusion: Exposure to dynamic VR environments should be considered as a useful adjunct to vestibular rehabilitation programs for patients with peripheral vestibular disorders and VV symptoms

Intra-abdominal pectus bar migration – a rare clinical entity: case report

We present the case of a 20-year-old male who underwent successful surgical correction of pectus excavatum with the Highly Modified Ravitch Repair (HMRR). At 29 months the attempted operative removal of the Ravitch bar was unsuccessful despite the impression of adequate bar location on chest x-ray. Subsequent imaging with computed tomography was unclear in determining whether the bar was supra or infra-diaphragmatic due to the tissue distortion subsequent to initial surgery. Video assisted thoracoscopic surgery (VATS) successfully retrieved the bar and revealed that it was not in the thorax, but had migrated to the intra-abdominal bare area of the liver, with no evidence of associated diaphragmatic defect or hernia. Intra-abdominal pectus bar migration is a rare clinical entity, and safe removal can be facilitated by the use of the VATS technique

Assessing the Unterberger test: introduction of a novel smartphone application

Background: Peripheral vestibular function is commonly assessed using the Unterberger test. Patients are asked to march on the spot and their extent of rotation is recorded. The sensitivity of this test depends on an assessor accurately estimating the degree of rotation. This study therefore aimed to compare observer estimates with a smartphone application (DplusR Balance) that accurately records rotation. Method: Twenty-five participants were asked to estimate the degree of rotation in 10 successive Unterberger tests performed by a volunteer. Results: The average difference between estimated and application recorded extent of rotation was 30°. Conclusion: Assessors poorly estimate the degree of rotation in this clinical test, to an extent sufficient to affect clinical interpretation and diagnosis. We recommend the use of this application or alternative methods to record the degree of rotation in patients