Louis De Canniere

Does offering pricing information to resident physicians in the emergency department potentially reduce laboratory and radiology costs

Objectives The aim of this study was to establish whether price list information could reduce laboratory and radiological examination costs in emergency departments (EDs). Materials and methods A prospective survey of adult (>16 years old) admissions was conducted at the ED of a university hospital in Belgium. Nine resident emergency physicians were followed for a span of 6 months, which was divided into 2-month periods: control (October and November 2011), intervention (December 2011 to January 2012), and washout (February and March 2012). Laboratory and radiological costs for each of the daily admissions were calculated during the respective periods and compared. Results A total of 3758 patients were registered: 1093 in period 1 (control), 1329 in period 2 (intervention), and 1336 in period 3 (washout). We observed significant reductions in examination costs: 10.73% (P=0.015) for laboratory and 33.66% (P<0.001) for radiological costs in period 2 versus period 1; 5.02% (P=0.014) for laboratory and 40.00% (P<0.001) for radiological costs in period 3 versus period 1. In addition, we found that laboratory examination costs increased slightly between periods 2 and 3 (+6.4%), whereas costs related to radiologic examinations continued to decrease (−10.16%); however, these differences were not statistically significant. Conclusion We conclude that the distribution of price lists at EDs promotes cost awareness, which can result in significant decreases in examination costs.

Gastrodiaphragmatic fistula after transabdominal Nissen fundoplication. An unusual complication.

A 60-year-old woman developed a gastrodiaphragmatic fistula as a late complication of transabdominal Nissen fundoplication. For 6 years, she had complained of chest pain and was considered to have pericarditis. At reoperation the fistulous track was found and easily resected. No other causative factor could be identified.

Spiral computed tomography with three-dimensional reconstructions for severe blunt abdominal traumas: a useful complementary tool?

Spiral computed tomography (CT) has proved to be a valuable tool by providing three-dimensional (3D) images of the studied structures. We hypothesized that a more realistic depiction of lesions by 3D CT could be of interest for surgeons who are treating blunt abdominal traumas and lead to less inappropriate triage. A good working relationship between surgeons and radiologists allowed us to perform a 3D CT examination in six patients. In the first patient, the 3D CT accurately demonstrated spleen fragmentation without devascularized fragment. The second patient had complete devascularization of the spleen upper pole. Conservative treatment was pursued for both patients. For the third patient, 3D CT helped us to differentiate peritoneal-perisplenic fluid from subcapsular fluid. The fourth patient had minor spleen injury associated with severe lacerations of the left kidney. 3D CT showed a complete separation of the kidney lower pole. A delayed partial lower nephrectomy was performed. The fifth patient presented a fragmented spleen and transient massive haematuria related to a well-contained laceration of the kidney upper pole that were amenable to nonoperative management. The sixth patient was emergency operated for active bleeding from a fragmented spleen. 3D CT performed 2 months after spleen repair allowed the assessment of the amount of devascularized tissue, as well as the status of the upper abdomen arteries. For haemodynamically stable patients, 3D CT could be a helpful addition to conventional axial CT for quantifying blunt abdominal traumas, for making the choice between nonoperative and operative treatment, but also between emergency and delayed surgical strategy.