What's A Bruise Cost? A case study of an MTP resulting from a bruise.

Alison Boyd and Sue Quiring

NICE 2014

22/11/2014 1

Case History

• JW had a bruise on his right thigh on Thursday, 6th September 2014.

• At the time he was working in a factory moving 44 gallon drums.

• He has a past history of eczema and pimples over his body that he tends to pick.

• Over the course of the next week the bruise became red and shiny and started to grow.

• JW presented to his doctor Tuesday, 9th September 2014 and was given "tablets“ to take by the GP.

• JW took the tablets, but started to feel dizzy and had episodes of chills followed by fever and sweating.

• He returned to his GP on Thursday, 11th September 2004 and was provided with a “piece of paper” and sent to the emergency department at the Northern Hospital. 2

Admission Notes

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Admission Notes

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Friday 19/09/2014

• 22:00 – MTP called in theatre.

• Blood Group O Positive and 3 cell CSL Abtect III was negative by Autovue ANOVA.

• MTP progressed from theatre to ICU and went continuously until 09:00 Saturday 20/09/2014.

• Products used were red cells, FFP, Cryoprecipitate, Novo 7, IVIg (Octagam), Albumex, Prothrombinex and Platelets.

• 3 deliveries were placed and received from ARCBS between midnight and 08:00.

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Blood and Blood Products

Product Number ARCBS Costs $

Red Cells 66 22,892.76

FFP 30 9,415.80

Cryoprecipitate 70 11,170.60

Platelets (Pooled) 6 2,152.74

Prothrombinex 10 2,734.70

Octagam 5 18 X 200 mL 5,228.01

Octagam 10 4 x 200mL + 2 x 50mL 3,485.34

Albumex 4 2 132.96

Novo 7 9g 17,982.00

Total 75,194.91

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Haematology Investigations

Test Number Cost $ (MBS)

FBE 81 1,372.95

Blood Films 8 135.60

D-Dimer 1 13.70

Coagulation Studies 44 602.80

ESR 2 15.70

Mixing Studies 1 13.70

Retics 1 10.20

VWF 1 70.90

Total 2,235.55

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Biochemistry Investigations

Test Number Cost $ (MBS)

UEC 73 1,142.45

LFT 47 2,735.40

CRP 54 523.80

Ca/Mg/Phosphate 37 1,076.70

Glucose 1 9.70

LDH 4 38.80

CK 12 116.40

Troponin 1 20.05

Gases 82 2,763.40

Haptoglobin 2 40.20

Total 8,466.90 9

Microbiology Investigations

Test Number Cost $ (MBS)

Blood Cultures (Included Fungal and Fluid)

39 2,396.55

Blood Culture Sensitivity 2 0

Urine MCS 5 102.75

Urine Sensitivity 1 0

Respiratory 1 33.75

Respiratory Virus 1 15.65

Swabs + CVC Tip 8 385.20

Total 2,933.90

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Other Investigations

Test Number Cost $ (MBS)

Histology Tissue 9 963.45

Micro Tissue Cultures 10 481.50

FMC + C. Diff 1 19.10

VRE Screen 3 19.10

Total 1,483.15

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Other Investigations

• HIV (1)

• Hepatitis C (1)

• Hepatitis B (1)

• Lipase (3)

• ANA (2)

• ENA (1)

• Iron Studies (2)

• B12 and RCF (1)

• Blood Group and Hold (7)

• Lipid (1)

• Conjugated/Unconjugated

Bilirubin (1)

• CMV (2)

• ANC (1)

• dsDNA (1)

• PEP (1)

• DAT (1)

• ß2 Microglobulin (1)

• EBV (2)

• RF (2)

• C3C4 (2)

• Snake Bite

• Ferritin (2)

• Vancomycin (7)

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Other Investigations and costs

• MRI (4)

• X-Ray Chest (16)

• Doppler (2)

• X-Ray Pelvic/Abdo (2)

• Ultrasound (3)

• Pharmaceuticals costs

• Physio/Occupational thearpies

• Theatre consumables and expenses e.g. airways, lines, gauze, compress etc.

• Operating costs e.g. artery forceps and sterilisation

• Oxygen support

• Fluid warmers

• IV Fluids – crystalloids

• Social worker

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Patient Summary as of 19/11/2014

Summary Number of Investigations

Summary 1

Legal 2

Emergency 3

Outpatients 1

Investigations 584

Correspondence 2

Admissions 35

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Costings at Day 69

Item Duration Cost $

Bed stay

• ED/SSU – 2 days • Unit E (Surgical) – 4 days • ICU – 9 days • CCU – 4 days • Unit B (Rehab) – 50+ days

129,397.00

Total costs for this stay 219,711.41

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