Can you imagine a robot running your central sterile department? Researchers suggest that they might offer major improvements to the process of reprocessing.

GE and the U.S. Department of Veterans Affairs are partnering to develop an automated system that can track, retrieve, sort, sterilize and transport surgical instruments. The 2-year, $2.5 million project will eventually be trialed and evaluated in a VA hospital.

Industrial robots and computer "vision" have become staples of mass manufacturing and assembly, though they aren't common in clinical environments. Along with radiofrequency ID and other automated identification technologies, though, they could streamline scheduling and carry out reprocessing instructions tirelessly and precisely.

"We believe that in combination with a new level of intelligence, [robotic systems] can help make operating rooms run more efficiently, lead to better patient outcomes, and save millions of dollars in healthcare costs," says Lynn DeRose of GE Global Research.

David Bernard

Discharge instructions for colorectal surgery patients should include a list of specific symptoms that warrant follow-up with surgeons, according to a report in the February issue of the Journal of the American College of Surgeons.

An 11-member panel comprised of surgical oncologists, colorectal surgeons and general surgeons deliberated on the warning signs patients should watch for after being discharged home. They decided the following symptoms warrant calls to the operating physician:

• wound drainage, opening or redness (all 3 can indicate an infection)
• no bowel movement or lack of gas/stool from any ostomy for more than 24 hours
• increasing abdominal pain
• vomiting
• abdominal swelling
• high ostomy output and/or dark urine or no urine
• fever greater than 101.5 F
• unable to take anything by mouth for more than 24 hours

The panel also says patients should head to the nearest emergency department if they experience shortness of breath or chest pain.

Including these warning signs in discharge instruction packets will let patients have clear and open communication with surgeons when they suspect something is wrong, notes the panel.

The ACS says more than 600,000 patients undergo colorectal procedures each year, but many aren't aware of what symptoms could lead to serious complications. In fact, 11.4% of patients end up hospitalized within 30 days post-op, with each stay lasting 8 days on average and costing the healthcare system $300 million dollars annually, according to the ACS.

"Whether patients are discharged for a medical or surgical reason, all the discharge instructions are similar — 'call if you're vomiting, having abdominal pain, or a fever,'" says Linda T. Li, MD, research fellow at the Houston VA Health Services Research Center of Excellence, where the expert panel convened. "We felt that surgical and medical patients are different, and there might be some specific concerns that may not be addressed by generic instructions."

Daniel Cook

Prices on hip replacements are scarce and, when you can get a price quote, those costs vary greatly, say researchers who tried to obtain such information from hospitals nationwide. The researchers published their findings on JAMA Internal Medicine's website.

Jaime A. Rosenthal of the University of Iowa's Carver College of Medicine in Iowa City and colleagues randomly selected 2 hospitals from each state and Washington, D.C., that perform total hip arthroplasty, as well as 20 top-ranked orthopedic hospitals. They requested the bundled price — hospital fees and physician fees — for the procedure for an uninsured patient with the financial means to pay out of pocket.

"We found that only 16 percent of a randomly selected group of U.S. hospitals were able to provide a complete bundled price, though an additional 47 percent of hospitals could provide a complete price when hospitals and health care providers were contacted separately," the authors note. "Finally, we found that price estimates varied nearly 10-fold across hospitals, which is surprising considering that all hospitals were provided with standardized information about the procedure being requested."

Nine top-ranked hospitals (45% of the surveyed facilities) and 10 non-top-ranked hospitals (10%) were able to provide a complete bundled price. Researchers also obtained complete price estimates from an additional three top-ranked hospitals (15%) and 54 non-top-ranked hospitals (53%) by contacting the hospitals and physicians separately, the study indicates. Complete total hip arthroplasty prices ranged from $12,500 to $105,000 at top-ranked hospitals, and from $11,100 to $125,798 at the state-selected facilities.

Stephanie Wasek

When your patients have to be readmitted soon after discharge, your facility looks bad. Besides reflecting poorly on your quality of care, a high readmission rate also can result in reduced Medicare reimbursements, per the healthcare reform law. On Oct. 1, 2012, Medicare began fining hospitals that have too many patients readmitted within 30 days. Tell us in this week's InstaPoll what your 90-day readmission rate is.

Three-fourths (75%) of the 395 respondents to last week's poll strongly agree (41%) or agree somewhat (34%) that laws requiring transparency in health care — public reporting of infection rates, never events and other outcome data — are generally good for health care. The results:

• Strongly agree: 41%
• Agree somewhat: 34%
• Neither agree nor disagree: 5%
• Disagree somewhat: 17%
• Strongly disagree: 3%

Dan O'Connor

• Docs must report financial ties CMS has issued a final rule on its "National Physician Payment Transparency Program: Open Payments", which requires manufacturers of drugs, devices, biologicals, and medical supplies covered by Medicare, Medicaid, or the Children's Health Insurance Program (CHIP) to report payments or other transfers of value they make to physicians and teaching hospitals to CMS, beginning Aug. 1. Manufacturers and GPOs will have to disclose to CMS any physician ownership or investment interests. CMS will post the information to a public website beginning in September 2014. CMS says the increased transparency will help reduce the potential for conflicts of interest that physicians or teaching hospitals could face as a result of their relationships with manufacturers. The agency is developing an electronic system to facilitate the reporting process.
• Adolescent ACLs ACL injuries among adolescents are on the rise, and these pediatric patients demand special care, according to a study in the Journal of the American Academy of Orthopaedic Surgeons. In order to prevent future complications such as early onset osteoarthritis, researchers say orthopods specializing in pediatrics should handle kids' ACL injuries; non-surgical treatment options should be considered for partial tears; surgical reconstruction of complete ligament ruptures should spare the growth plate in younger children; and conventional repair should be used for children approaching skeletal maturity.
• Better design for better nursing Patient care depends on a healthcare worker's ability to juggle many tasks while filtering out distractions. A facility's design can influence the success or failure of their attempts. A professor at Cornell University studied hospital floor plans to develop a process by which facilities might redesign their layouts to match their workflow, which could conserve staffing efforts, energy, time and money.