Ow Tsai-Wing, Ralton Lucy, Tse Edmund
Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Liver Intensive Therapy Unit, King's College Hospital, London, UK.
Intern Med J. 2017 Sep;47(9):1005-1011. doi: 10.1111/imj.13465.
In keeping with recent trends, patients with hepatocellular cancer have had their care managed by a dedicated Nurse Coordinator at our tertiary Australian hospital since 2010. To date, there are few data to justify the cost-effectiveness of this approach.
To quantify the potential cost saved through the employment of a Nurse Coordinator in the management of patients with hepatocellular carcinoma at a single tertiary-level Australian hospital.
A retrospective audit of patients managed by the Nurse Coordinator between 2010 and 2015 was conducted. Consensus reports from previous meetings were reviewed, and nurse-initiated radiological procedures and encounters were identified. Clinical activities were prospectively evaluated over a 1-month period in July-August 2015. The equivalent annual number of outpatient medical encounters spared was calculated. Using the national average cost of each gastroenterology outpatient encounter, a total annual cost was determined and was compared against the cost of funding the position.
The activity of the Nurse Coordinator resulted in an equivalent of at least 175 outpatient encounters being spared per year, with a minimum annual cost saving of $85 750. A total of 113 encounters resulted from the independent delivery and initiation of multidisciplinary team meeting plans; 10 were attributed to nurse-led patient education, and 52 were equated to weekly clinical activities. This represented a net annual saving of $17 050.
The incorporation of the Nurse Coordinator in the care pathway of patients with hepatocellular cancer is associated with a reduction in medical outpatient load and, consequently, a significant annual cost saving.
顺应近期趋势，自2010年以来，澳大利亚一家三级医院的肝细胞癌患者一直由一名专职护士协调员负责管理。迄今为止，几乎没有数据能够证明这种方法的成本效益。
量化在澳大利亚一家三级医院通过聘用护士协调员管理肝细胞癌患者所节省的潜在成本。
对2010年至2015年间由护士协调员管理的患者进行回顾性审计。查阅了以往会议的共识报告，并确定了护士发起的放射学检查和会诊。2015年7月至8月期间对临床活动进行了为期1个月的前瞻性评估。计算出每年可避免的门诊医疗会诊等效数量。利用每次胃肠病门诊会诊的全国平均成本，确定了年度总成本，并与该职位的资金成本进行了比较。
护士协调员的工作每年至少可避免175次门诊会诊，每年至少节省成本85750美元。多学科团队会议计划的独立实施和发起导致了113次会诊；10次归因于护士主导的患者教育，52次等同于每周的临床活动。这意味着每年净节省17050美元。
在肝细胞癌患者的护理路径中纳入护士协调员可减少门诊医疗负担，从而每年节省大量成本。
