title: Fever evaluation cost and time to treatment in the general surgery patient can be reduced by using a fever practice guideline.
abstract: OBJECTIVE
  Evaluation of surgical patients with fever and leukocytosis (FAL) for an infection source often results in unnecessary laboratory and radiographic tests. The average cost of an FAL work-up ranges from $2200 to $5600. Lack of a systematic approach drives costs higher than necessary. We evaluated differences in time to treatment and costs using usual methods of FAL work-ups versus FAL work-ups using an established fever practice guideline (FPG).
  
  
  METHODS
  In phase I, a retrospective electronic chart review was conducted for 82 adult surgery patients who underwent FAL work-ups to determine time from initial temperature presentation to fever treatment and total cost per fever evaluation. In phase II, an established FPG was applied to 30 intensive care unit patients from the original group of 82 using phase I data points. Differences in cost and time to treatment were compared using a paired t-test.
  
  
  RESULTS
  Mean time to fever treatment decreased from 51.57 hours pre-FPG use to 11.23 hours afterward (p < 0.001), a 78% reduction in time to definitive treatment. Mean cost of FAL work-up decreased from $1,009.73 without FPG use to $399.00 with a 60% reduction in costs.
  
  
  CONCLUSIONS
  Using a standardized FPG, FAL work-up time to treatment and cost can be significantly reduced.
authors.affiliation: Department of General Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Building 3, 4th Floor, San Diego, CA 92134.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Russo
authors.affiliation: Department of General Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Building 3, 4th Floor, San Diego, CA 92134.
authors.forename: Matthew
authors.initials: M
authors.lastname: Landon
authors.affiliation: Department of General Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Building 3, 4th Floor, San Diego, CA 92134.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Burkard
authors.affiliation: Department of General Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Building 3, 4th Floor, San Diego, CA 92134.
authors.forename: Chad T
authors.initials: CT
authors.lastname: Andicochea
authors.affiliation: Department of General Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Building 3, 4th Floor, San Diego, CA 92134.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hannon
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017046:Cost Savings; D003422:Critical Care / Q000191:economics; D003428:Cross Infection / Q000191:economics; D005334:Fever / Q000191:economics*; D017048:Health Care Costs; D006772:Hospitals, Military / Q000191:economics*; D006801:Humans; D007755:Laboratories, Hospital / Q000191:economics; D007964:Leukocytosis / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000191:economics*; D013997:Time Factors