Angry Doctor

Friday, February 17, 2006

NICE

Oz Bloke's comments on a previous post led me to dig up this article evaluating the NICE head injury guidelines.

I reproduce the Result and Conclusion:


Result: 1130 patients with head injury were studied in four 1 month periods (two in each centre). At the teaching hospital, the CT head scan rate more than doubled (3% to 7%), the SXR declined (37% to 4%), while the admission rate more than halved (9% to 4%). This represented a saving of £3381 per 100 head injury patients: greater than predicted with no adverse events. At the District General Hospital, the CT head scan rate more than quadrupled (1.4% to 9%), the SXR dropped (19 to 0.57%), while the admission rate declined (7% to 5%). This represented a saving of £290 per 100 head injury patients: less than predicted.

Conclusion: The implementation of the NICE guidelines led to a two to fivefold increase in the CT head scan rate depending on the cases and baseline departmental practice. However, the reduction in SXR and admission appears to more than offset these costs without compromising patient outcomes.


I once asked a senior why we did not practise the same protocol in our hospital. He told me that the savings in the study was due to the high inpatient costs in the countries studied; locally, in view of the lower ward charges compared to the cost of a CT scan, it was still more cost-effective to admit and observe the patients.

I'm not sure how true that was or is now, but I thought this was a good illustration of how economics affect clinical practices.

5 Comments:

  • Hi doc. Could I ask ya what's wrong with me if I'm continuously wanting to do something but I end up forgetting it a while later. Short term memory loss?

    By Anonymous n33dh3lp, At February 20, 2006 11:09 pm  

  • n33dh3lp,

    Sorry, I can't offer medical advice on the blog.

    Besides, I'm sure I gave you the answer yesterday... :)

    By Blogger angry doc, At February 21, 2006 5:21 pm  

  • Hey angry doc, the reply to those letters you mentioned is out in today's ST!

    http://www.straitstimes.asia1.com.sg/
    forum/story/0,5562,372731,00.html?

    By Blogger Dr Oz bloke, At February 21, 2006 5:21 pm  

  • It's interesting they say

    "He raised the issue of access to specialists care at hospital specialist clinics for patients with chronic medical conditions. It is more important and effective that such patients get appropriate care in the appropriate setting.

    Such patients are best treated and monitored at the primary care setting where possible, as this saves them time and the cost of specialist care that may not be required. "

    But it sure looks like the public don't give a hoot about GPs. Sigh.

    By Blogger Dr Oz bloke, At February 21, 2006 5:24 pm  

  • What do you think of this letter?

    http://www.straitstimes.asia1.com.sg/
    forum/story/0,5562,372710,00.html?

    All I can say is, don't give good medicine be damned. Give good medicine also be damned.

    And at the end of the day these foolish people don't realise that with the common cold or flu, you don't need antibiotics most of the time! I bet the writer is one of those patients who always insist on getting "stronger medicine" ,"more better medicine" types.

    By Blogger Dr Oz bloke, At February 21, 2006 5:28 pm  

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