Cockpit crew pairing Pareto optimisation in a budget airline

Crew pairing is the primary cost checkpoint in airline crew scheduling. Because the crew cost comes second after the fuel cost, a substantial cost saving can be gained from effective crew pairing. In this paper, the cockpit crew pairing problem (CCPP) of a budget airline was studied. Unlike the conventional CCPP that focuses solely on the cost component, many more objectives deemed to be no less important than cost minimisation were also taken into consideration. The adaptive non-dominated sorting differential algorithm III (ANSDE III) was proposed to optimise the CCPP against many objectives simultaneously. The performance of ANSDE III was compared against the NSGA III, MOEA/D, and MODE algorithms under several Pareto optimal measurements, where ANSDE III outperformed the others in every metric.

First Application of Non-Coiled Tubing Cement Packer Solution in the Region: A Game Changer in Revolutionizing an Enabling Solution During Low Price Environment

Cement Packer is a cost-effective alternative to workover for monetizing hydrocarbon reservoirs above the well top packer. While conventional cement packer utilizes coil tubing for cement placement, an innovative and more cost-effective approach was successfully implemented with only slickline and pumping unit, without utilizing coil tubing. This reduced the overall cost of the well intervention by 60%, significantly reduced operational safety risks and is exceptionally suitable in the current challenging environment. Similar to conventional cement packer, the operation begins with setting a plug inside the tubing below the targeted perforation depth and punching the tubing to create tubing-casing communication. The tubing was then flushed with surfactant and weak acid to remove any potential contaminants. The cement was then bullheaded from the surface through the tubing and into the casing while being chased by two foam wiper balls. The foam wiper balls were subsequently pushed with inhibited sea water mixed with cement retarder to prevent any leftover cement from hardening in the tubing. The hardened cement column in the production casing then acts as a barrier to satisfy operating guideline for two pressure barriers in a well. Two cement packer jobs were performed during this campaign; one via conventional method with coil tubing unit (CTU) and a fit-for-purpose version without the CTU. Pressure test from the tubing and casing after the cement hardened indicated that the cement has effectively isolated both tubulars. Subsequent Cement Bond Log and Ultrasonic Imaging Tool demonstrated thick column of good cement thus confirming the cement integrity of the non-CTU method. It was able to achieve similar pressure isolation as the conventional CTU method at 60% lower cost which allowed for significant cost saving. It also reduced the operation time by 50% since the cement was pumped at a higher rate through the well tubing. The turbulent flow regime via high rate pumping also resulted in thicker column of good cement (200m vs 120m) compared to conventional method. The only drawback encountered was the unexpected obstruction caused by leftover cement behind the foam ball. However, this can be removed through milling or fine-tuning the retarded sea water recipe. Post perforation, there was a sharp increase in the tubing pressure while the casing pressure remained low, further confirming the success of this method. This innovative method will be the standard method for any future cement packer operations while the conventional method with coil tubing will only be applied in complex situations. This new Cement Packer technique has introduced substantial cost saving compared to the conventional cement packer method. It will enable monetization of more minor reservoirs. The method is exceptionally relevant to a mature field especially in the current challenging business environment.

Consultant-led triage of paediatric hospital referrals: a service evaluation

ObjectiveWe established a paediatric demand management (PDM) service in our paediatric department in 2017. The aim of this consultant-delivered service is to manage referrals more efficiently by providing active triage of all referrals, daily rapid access clinics and easily accessible advice for primary healthcare professionals. This study presents an evaluation of this service.DesignMixed-methods service evaluation with analysis of data for every contact with the PDM service over a 2-year period. For each patient, the method of contact, reason for contact, presenting complaint and triage outcome were recorded. Feedback from general practitioners (GPs) and patients was gathered.ResultsData were analysed for 7162 patients. More than a quarter (2034; 28%) of all referrals were managed with advice only. Of the 4703 outpatient clinic referrals, 1285 (27%) were managed without a clinic appointment. More than half (54%) of the requests for paediatric assessment unit (PAU) admission were managed alternatively, typically with advice only or a rapid access clinic appointment. This has reversed the increasing trend of PAU admissions from primary care of preceding years. Financial analysis suggested the avoidance of these clinic appointments, and PAU admissions provided a substantial cost saving.ConclusionsOur results indicate that the PDM service has succeeded in reducing unnecessary hospital attendances by managing patients more effectively and strengthening partnerships with primary care. The service has received overwhelmingly positive feedback from GPs. This service could be replicated in other Trusts and developed in the future to facilitate further management of paediatric cases in a primary care setting.

Cost saving analysis of specialized, eHealth-based management of patients receiving oral anticoagulation therapy: Results from the thrombEVAL study

To evaluate the cost-saving of a specialized, eHealth-based management service (CS) in comparison to regular medical care (RMC) for the management of patients receiving oral anticoagulation (OAC) therapy. Costs of hospitalization were derived via diagnosis-related groups which comprise diagnoses (ICD-10) and operation and procedure classification system (OPS), which resulted in OAC-related (i.e. bleeding/ thromboembolic events) and non-OAC-related costs for both cohorts. Cost for anticoagulation management comprised INR-testing, personnel, and technical support. In total, 705 patients were managed by CS and 1490 patients received RMC. The number of hospital stays was significantly lower in the CS cohort compared to RMC (CS: 23.4/100 py; RMC: 68.7/100 py); with the most pronounced difference in OAC-related admissions (CS: 2.8/100 py; RMC: 13.3/100 py). Total costs for anticoagulation management amounted to 101 EUR/py in RMC and 311 EUR/py in CS, whereas hospitalization costs were 3261 [IQR 2857–3689] EUR/py in RMC and 683 [504–874] EUR/py in CS. This resulted in an overall cost saving 2368 EUR/py favoring the CS. The lower frequency of adverse events in anticoagulated patients managed by the telemedicine-based CS compared to RMC translated into a substantial cost-saving, despite higher costs for the specialized management of patients.Trial registration: ClinicalTrials.gov, unique identifier NCT01809015, March 8, 2013.

Implementation of Lean Daily Management: A Vascular Access Team Quality Improvement Project to Enhance Nurses’ Workflow and Patient Outcomes

Highlights Abstract Background: The process for patients to receive a peripherally inserted central catheter (PICC) has been unclear, allowing for delays in care and discharge and increased costs. To address these problems, a vascular access team implemented the Lean process. The purpose was to evaluate the effect of an ultrasound initiative to insert peripheral intravenous lines (IVs) and midlines and modification of PICC insertion hours on the nurses’ workflow and patient outcomes. Methods: This quality improvement project used retrospective data analysis. Patients’ data from fiscal year (FY) 2010 to FY 2019 was analyzed using descriptive statistics, independent t tests for continuous data, and a Poisson regression for count data. Results: After the ultrasound initiative, the volume of PICC insertions decreased by 20%, which represents a significant reduction. The mean cost also decreased from $171,681 to $147,620. Although there was no substantial cost saving, the total cost was reduced by 14%. After implementation of ultrasound guidance for peripheral IV and midline access, the central line–associated bloodstream infection (CLABSI) rate dropped by 70%. The estimated treatment cost for CLABSI significantly decreased from $481,600 to $156,800. After implementation, the total estimated cost savings was $1,624,000. Modified PICC insertion hours resulted in significantly reduced mean hours from order time to insertion. Conclusions: Standard work and process improvements using the Lean process were effective. The ultrasound initiative decreased unnecessary PICC insertions, reduced cost, and decreased the CLABSI rate. Modified PICC insertion hours enhanced the nurses’ work by reducing the average time from PICC order to placement.

Economics of using telehospice to supplement hospice care in rural areas.

11535 Background: Hospice care in rural areas is often characterized by provider shortages and vast geographical service areas to cover, making access to quality end-of-life care challenging. Telehospice, the utilization of interactive video (ITV) technology to provide health services over a distance for hospice patients, has been proposed as a solution to address access issues. In 2017, the University of Kansas Medical Center (Kansas City, Kansas) partnered with Hospice Services, Inc. (HSI) (Phillipsburg, Kansas) to augment traditional, in-person hospice care with hospice care delivered via mobile tablets.This work examines the costs of Telehospice when compared with the costs of in-person hospice services. Methods: Detailed administrative data from July 1, 2018 to December 31, 2018 was analyzed to estimate the costs of service after Telehospice use was inculcated into routine practice. Results: Hospice Services, Inc., which averages a daily census of 34 patients, conducted 257 calls, averaging 28 hours a month. The average time for a Telehospice call was 21 and 18 minutes for nursing and medical director calls, respectively. Through various hospice functions, including administrative, patient, and non-patient related connections, HSI saved over $115,000 in staff travel time and mileage reimbursement. Administratively, by hosting their weekly 14-member interdisciplinary meeting via ITV, HSI saved $29,869 of staff travel time and mileage reimbursement. Conclusions: Our estimates indicate substantial cost saving potential with the use of Telehospice services. Further research is needed to assess the effects of Telehospice utilization on the experiences and subsequent cost of hospice care. Additional cost data specifics will be presented in poster form. [Table: see text]

Using collagenase to treat Dupuytren’s disease: a hypothetical cost benefit analysis

Background: Collagenase, an enzyme produced by clostridium histolyticum (CCH), is a relatively new injection able to cleave collagen strands in vitro. While not yet available on the PBS, the side effect profile and risk of recurrence of collegenase injections are comparable to fasciectomy in appropriately selected patients. In this study, we aimed to demonstrate the safety and cost-effectiveness of collagenase for the treatment of Dupuytren’s disease. Method: Twenty-five patients at our hospital received collagenase injections for treatment of their Dupuytren’s disease. Data from this cohort was compared to a hypothetical group extrapolated from the literature. Results: Surgical treatment, excluding outpatient visits, costs on average AU$5852 per patient and collagenase costs AU$1176 per patient (gross cost difference AU$4676). Moderating this cost difference by the effect of complications using the incremental cost effectiveness ratio, the cost saving is AU$1137.71 per unit decrease in complications with collagenase treatment. Surgical fasciectomy has a lower risk of recurrence than collagenase but costs up to AU$543 more for patients for whom the condition does not recur within five years of treatment. In our cohort, 25 patients had 31 cords injected with collagenase. All but two patients achieved full range of motion of their affected joint and 20 per cent sustained minor skin tears requiring dressings. Conclusion: This analysis suggests that the investment of public health funds in the treatment of suitable patients with collagenase should produce a substantial cost saving without increasing the risk of complications.

Evaluating the effects of a peer-led suturing and wound management workshop for doctors working in a psychiatric hospital

BackgroundPsychiatric in-patients are often transferred to an emergency department for care of minor wounds, incurring significant distress to the patient and cost to the service.AimsTo improve superficial wound management in psychiatric in-patients and reduce transfers to the emergency department.MethodThirty-four trainees attended two peer-led suturing and wound management teaching sessions, and a suturing kit box was compiled and stored at the Royal Edinburgh Hospital. Teaching was evaluated using Kirkpatrick's model, and patient transfer numbers were acquired by reviewing in-patient Datix reports and emergency department case notes for 6 months before and after teaching.ResultsThe proportion of patients transferred to the emergency department decreased significantly from 90% 6 months before the workshop to 30% 6 months after (P < 0.05). Trainees engaged positively and there was a significant increase in self-confidence rating following the workshop (P < 0.05). The estimated cost saving per transfer was £183.76.ConclusionThe combination of a peer-led workshop and on-site suturing kit box was effective in reducing transfers to the emergency department and provided a substantial cost saving.Declaration of interestNone.

Economic evaluation of vitamin D and calcium food fortification for fracture prevention in Germany

ObjectiveThe study evaluates the economic benefit of population-wide vitamin D and Ca food fortification in Germany.DesignBased on a spreadsheet model, we compared the cost of a population-wide vitamin D and Ca food-fortification programme with the potential cost savings from prevented fractures in the German female population aged 65 years and older.SettingThe annual burden of disease and the intervention cost were assessed for two scenarios: (i) no food fortification; and (ii) voluntary food fortification with 20 µg (800 IU) of cholecalciferol (vitamin D3) and 200 mg of Ca. The analysis considered six types of fractures: hip, clinical vertebral, humerus, wrist, other femur and pelvis.SubjectsSubgroups of the German population defined by age and sex.ResultsThe implementation of a vitamin D and Ca food-fortification programme in Germany would lead to annual net cost savings of €315 million and prevention of 36 705 fractures in the target population.ConclusionsVitamin D and Ca food fortification is an economically beneficial preventive health strategy that has the potential to reduce the future health burden of osteoporotic fractures in Germany. The implementation of a vitamin D and Ca food-fortification programme should be a high priority for German health policy makers because it offers substantial cost-saving potential for the German health and social care systems.