Cost-Effective Emergency
Dept. Practices
Cost-Cutting Measures that Sustain
Quality Care
Robert W. Kottman, MD, FACEP
Migraine Headache Drugs
 Imitrex (sumatriptan)
Cost
– 6 mg subQ
$48.61
– 60 % return with headache in 24 hours
Demerol 100 mg IM
$ 1.92
Phenergan 25 mg IM
$ 2.27
Total Cost
$ 4.19
5 pts./day (Dem+Phen.) saves daily
$243.05
Annual Savings (Dem+Phen)
$ 88,713.25
Anti-Nausea Drugs
 Zofran (ondansetron) 4 mg IV
$25.64
Excellent in chemotherapy pts.
 Torecan 10 mg IV
$ 5.53
– Also good in chemotherapy pts.
 Phenergan 25 mg IV
$ 2.27
May work in some chemo pts.
Savings/pt (Phenergan vs. Zofran)
$23.37
5 pts/day (Phenergan rather than Zofran) $116.85
Annual Savings with Phenergan
$42,650.25
Anti-Convulsant Loading Dose
 Cerebyx (phosphenytoin)
– 1 gm IV
$112.22
– Can give over 15 mins. Less phlebitis.
 Dilantin (phenytoin)
– 1 gm IV
$ 6.66
– Give over 1 hour, vein irritation
Cost savings/pt. (Dilantin vs Cerebyx) $105.66
5 pts/day—Annual Savings (Dilantin) $38,565
Analgesics
 Toradol 30 mg IV
$ 8.30
– Good for “stone pain” (renal/biliary colic)
– Increases bleeding if surgery is imminent
 Morphine 6 mg IV
$ 0.93
 Phenergan 25 mg IV
$ 2.27
 Total Cost (Morphine + Phenergan) $3.20
 No effect on blood—savings/pt
$5.10
 10 pts./day, Annual Savings
$18,615.
Pyelonephritis-Inpatient Therapy
 Cipro (ciprofloxacin)
 400 mg IV q12h
Daily Cost
$60.04
 Septra (sulfamethoxasole/trimethoprim)
 400/80 mg IV q 8h Daily Cost$15.90
 Daily savings/pt with Septra
$44.14
 5 pts./day (1 day therapy) Save $220.70
 Ave. 3 day stay-Save/pt
$132.42
 5 pts./day (3 day stay) X 365 d. $241,666
Scalp Laceration Repairs
 Laceration Tray
$34.50
 2 oz. Betadine
$ 0.43
 Total Cost
$34.93
 10 staple skin stapler
$ 7.54
 2 oz Betadine
$ 0.43
 4x4 gauze sponge pack
$ 0.47
 Total Cost
$ 8.99
 $25.94 X 5/day X 365 days-Save $47,340
Stool Hemoccult Tests
 If done by Emergency Physician
– (at bedside, results in 30 seconds)
$0.52
 If done in Laboratory
$2.77
– (in laboratory, results in one hour)
– Cost Savings at bedside by EDP
$2.25
– 50 /day---saves (daily)
$112.50
– $112.50 X 365 days-annually saves $41,062
Iodoform Gauze (5 yds-half-inch)
 Average amount used in abscess cavity
packing is 1 yard
 5 yard Bottle
Cost $3.01
 If bottle is re-used at 1 yd/pt Cost/pt $0.60
 Ave. 3,650 abscesses packed/year
– Cost if one bottle used/pt.
– Cost if one bottle used/5 pts.
– Cost Savings/year with re-use
$10,986
$ 2,197
$ 8,789
Skin Antiseptics
 Hibiclens 4 oz.
 Betadine 2 0z.
 Cost Savings with Betadine
$5.04
$0.43
$4.67
 35 laceration repairs daily
Betadine use, savings $4.67 X 35=$161.35
Annual Savings (Betadine) $58,892.75
Latex Gloves
 Latex Gloves, Sterile, size 7.5
$0.90
 Latex Gloves, Non-Sterile, Large
$0.06
 Savings from Non-Sterile gloves
$0.84
 Non-Sterile appropriate for pelvics, rectals,
I&D of abscesses
 50 uses of N.S. vs S./day saves $42/day
 Annual Savings (N.S. gloves)
$15,330
Cautery of Bleeding Vessels
 Disposable Surgical Cautery
 10 applicators of AgNO3
 Cost Savings with AgNO3/pt
 700 uses /year X $75.25
$78.00
$ 2.75
$75.25
Save $52,675
by using AgNO3 chemical cautery rather
than electrical cautery
Urine Tests
 Urinalysis (dipstick + Microscopic) $3.89
 Urine dipstick
 Savings of dipstick only
$2.12
$1.77
 20,000 urine tests annually
 20,000 X $1.77 (Annual Savings) $35,400
BNP (Beta Natriuretic Peptide)
 Lab test for CHF (vs dyspnea due only to
COPD)
 Cost is $16.40
 Most CHF-rales, JVD, S3 gallop-no BNP is
necessary
 If 5 pts/day spared BNP test—daily savings
is $80/day
 $80/day X 365 days-annually save $29,200
Overdose Pts.-Drug Screens
 Urine (benzos, THC, cocaine, opiates,
amphetamines, barbs, PCP)
 Serum (same drugs—sent out)
 Gastric (same drugs-sent out)
 If serum and gastric not done-save
$19.00
$17.98
$98.05
$116.03
 2 Pts/day (only urine) saves daily
 2 pts./day X 365 days saves/year
$232.06
$84,701
Vasopressors
 Dobutamine (500 mg in 250 ml) $142.85
 Dopamine (400 mg in 250 ml)
$ 36.75
 Savings for one pt./day
$106.10
 Savings by use of dopamine
 Ave. of 3 days/pt on vasopressors $318.30
 If 1 new pt/day on dopamine (365 pts/year)
 $318.30 X 365 days-annual save $116,179
Suppression of V-tach
 Amiodarone 50 mg/ml
$840.34/day
 Lidocaine 1%
<$50.00/day
(Loading dose 1 mg/kg & 24 hr. drip)
If 1 Pt./day gets Amiodarone $288,350/yr
If 1 pt. receives lidocaine instead $18,250
Annual savings
$270,100
Lumbosacral Spine X-rays
 Indicated for:
 Significant trauma,age>50 years, neuro
deficits,Hx of cancer,unusual weight loss or
fever,chronic steroid use, drug/alcohol
abuse, Work Comp or litigation, suspected
ankylosing spondylitis, persistent symptoms
after symptomatic treatment for > 4 weeks.
 Not indicated for pts. <50 years old who get
back pain after exertion (lifting, bending)
Lumbosacral Spine films
 L-S spine X-rays (3 views)
$94.40
 Average 15 patients/day with exertional
back pain
 Daily save-no L-S films obtained $1,416.00
 Annual savings $1,416 X 365 = $516,840
Analgesics

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Stadol 2 ml
$73.33
Nubain 20 mg
$37.81
Toradol 30 mg
$ 8.30
Morphine 6 mg
$ 0.93
If one pt./day gets Stadol, Nubain, Toradol
$43,595/year
 If 3 patients got 6 mg Morphine IV $339/yr
 Annual cost savings from MS $43,256
Extraordinarily Expensive Drugs
 Digibind 38 mg (1 vial)
 Crotaline antivenin (1 vial)
$ 511.31
$2,500.00
If average mild envenomation
gets 4 vials, then cost is
$10,000
1/3 of viper bites are “dry”
If CroFab not given, savings are $10,000