Post on 11-Mar-2018
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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
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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