title: Retrospective imaging audit and cost analysis of medical oncology inpatients admitted to Westmead Hospital.
abstract: BACKGROUND
  Cancer patients often require complex and expensive admissions necessitating multiple investigations. We conducted an audit of cost of imaging performed on medical oncology inpatients in a teaching hospital in New South Wales.
  
  
  OBJECTIVE
  Our overall aim was to assess cost and appropriateness of imaging studies in inpatients.
  
  
  METHODS
  Data were collected on 219 consecutive evaluable inpatients admitted to Westmead Hospital (August-October 2012). A panel of oncology doctors assessed cost and appropriateness of imaging.
  
  
  RESULTS
  The total expenditure for the cohort was $106,488.15 over 624 investigations (range: 0-26, median: two per admission). Of this sum, $8881.91 (8%) was deemed inappropriate. The most frequently ordered test was chest X-ray (251). Imaging cost per admission was $0-2478 (range), $324.95 (median), $486.99 (mean). Cost trended to increase with age of patient ($186.40 (18-40), $477.22 (41-65), $489.50 (66-75), $575.33 (>75) ). Mean cost was higher for patients treated with palliative ($493.98) vs curative ($307.59) intent. Mean cost was higher for patients consulted by palliative care and other subspecialties. There was variation of average cost by discharge destination - other hospital ($262.23), palliative care unit ($334.08), home ($480.84) and death ($769.93). Although imaging ordered was deemed overwhelmingly clinically appropriate, approximately $35,000/year is spent on inappropriate tests, mostly due to duplication or scans that could have been performed as an outpatient.
  
  
  CONCLUSIONS
  Our audit supports that the current spending patterns on imaging within our department is predominantly appropriate and necessary. Duplication and expenditure may be reduced by improving electronic access from the ward to outpatient scan results.
authors.affiliation: Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.forename: N
authors.initials: N
authors.lastname: Taylor
authors.forename: D
authors.initials: D
authors.lastname: Selvakumar
authors.forename: P R
authors.initials: PR
authors.lastname: Harnett
authors.forename: N
authors.initials: N
authors.lastname: Wilcken
authors.forename: C I
authors.initials: CI
authors.lastname: Lee
mesh_terms: D054869:Clinical Audit; D003365:Costs and Cost Analysis; D003952:Diagnostic Imaging / Q000191:economics*; D057286:Electronic Health Records; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics; D008297:Male; D009369:Neoplasms / Q000175:diagnosis* / Q000191:economics*; D009517:New South Wales / Q000453:epidemiology; D010166:Palliative Care / Q000191:economics*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000191:economics*
keywords: audit; cost-analysis; imaging; inpatient; oncology