Running head: PROPOSAL FOR BONE DENSITY 1
Proposal for Hologic QDR 4500 Elite Bone Densitometer
Student Name
Adventist University of Health Sciences
PROPOSAL FOR BONE DENSITY
UNIT 2
2
TABLE OF CONTENTS
1.0 ABSTRACT……………………………………………………………………………3
2.0 PROBLEM SUMMARY………………………………………………………….......4
2.1 Statistics and Demographics…………………………………………………………….4
2.1 Analysis………………………………………………………………………………....5
3.0 PROJECT DESCRIPTION…………………………………………………………..7
3.1 Relevant Alternatives…………………………………………………………………...8
3.2 Work Plan……………………………………………………………………………….8
3.3 Significance……………………………………………………………………………..9
4.0 METHODS…………………………………………………………………………….10
5.0 BARRIERS…………………………………………………………………………....12
6.0 BUDGET……………………………………………………………………………....12
6.1 Projected Reimbursement……………………………………………………………….14
7.0 TIMELINE…………………………………………………………………………….14
8.0 EMPLOYEE QUALIFICATIONS…………………………………………………..15
9.0 References……………………………………………………………………………...16
PROPOSAL FOR BONE DENSITY
UNIT 3
3
1.0 Abstract
The radiology department at Claiborne Medical Center does not currently have a bone density
unit. Bone density scanning, also called dual-energy x-ray absorptiometry, or DEXA scan, can
generate higher volumes of patients that patronize the facility, thereby having a significant
impact on revenue for the hospital. A used bone density unit is available at a sister facility. This
facility is upgrading their equipment and their current bone density unit is on the market. This
unit can be purchased for a fraction of the cost of a new unit. Bone fragility in men and women
65 years and older along with younger postmenopausal women who have certain risk factors for
osteoporosis can be evaluated with DEXA scan using only a small amount of radiation. DEXA
scan is considered preventive medicine because it can diagnose and result in the treatment of
osteoporosis and as a result decrease the amount fractures that can occur due to brittle bones.
The following proposal will display the need for a bone density unit and how it can be beneficial
for the facility as well as patients.
PROPOSAL FOR BONE DENSITY
UNIT 4
4
2.0 Problem Summary
Claiborne Medical Center does not currently have the capabilities to perform DEXA scans.
There is no known clinic or facility in the area that performs DEXA scans, resulting in patients
driving approximately 45 minutes to another facility.
2.1 Statistics and Demographics
Statistics show that approximately 25 percent of women and 6 percent of men have
osteoporosis. These numbers increase when involving osteopenia, where bone loss is apparent
but has not reached osteoporosis. Almost half of seniors (48 percent)-more than 52 percent
being women and 44 percent being men-have osteopenia (Osteoporosis Facts and Statistics,
n.d.).
2.2 Analysis
A SWOT analysis (Figure 1) was perf ...
Energy Resources. ( B. Pharmacy, 1st Year, Sem-II) Natural Resources
Running head PROPOSAL FOR BONE DENSITY 1 .docx
1. Running head: PROPOSAL FOR BONE DENSITY 1
Proposal for Hologic QDR 4500 Elite Bone Densitometer
Student Name
Adventist University of Health Sciences
PROPOSAL FOR BONE DENSITY
UNIT 2
2. 2
TABLE OF CONTENTS
1.0
ABSTRACT…………………………………………………………
…………………3
2.0 PROBLEM
SUMMARY…………………………………………………………...
....4
2.1 Statistics and
Demographics………………………………………………………
…….4
2.1
Analysis………………………………………………………………
………………....5
3.0 PROJECT
DESCRIPTION………………………………………………………
…..7
3.1 Relevant
Alternatives…………………………………………………………
………...8
3.2 Work
Plan……………………………………………………………………
………….8
3.3
4. PROPOSAL FOR BONE DENSITY
UNIT 3
3
1.0 Abstract
The radiology department at Claiborne Medical Center does
not currently have a bone density
unit. Bone density scanning, also called dual-energy x-ray
absorptiometry, or DEXA scan, can
generate higher volumes of patients that patronize the facility,
thereby having a significant
impact on revenue for the hospital. A used bone density unit is
available at a sister facility. This
facility is upgrading their equipment and their current bone
density unit is on the market. This
unit can be purchased for a fraction of the cost of a new unit.
Bone fragility in men and women
65 years and older along with younger postmenopausal women
who have certain risk factors for
5. osteoporosis can be evaluated with DEXA scan using only a
small amount of radiation. DEXA
scan is considered preventive medicine because it can diagnose
and result in the treatment of
osteoporosis and as a result decrease the amount fractures that
can occur due to brittle bones.
The following proposal will display the need for a bone density
unit and how it can be beneficial
for the facility as well as patients.
PROPOSAL FOR BONE DENSITY
UNIT 4
4
2.0 Problem Summary
6. Claiborne Medical Center does not currently have the
capabilities to perform DEXA scans.
There is no known clinic or facility in the area that performs
DEXA scans, resulting in patients
driving approximately 45 minutes to another facility.
2.1 Statistics and Demographics
Statistics show that approximately 25 percent of women and
6 percent of men have
osteoporosis. These numbers increase when involving
osteopenia, where bone loss is apparent
but has not reached osteoporosis. Almost half of seniors (48
percent)-more than 52 percent
being women and 44 percent being men-have osteopenia
(Osteoporosis Facts and Statistics,
n.d.).
2.2 Analysis
A SWOT analysis (Figure 1) was performed to identify the
strengths, weaknesses,
opportunities and threats that comprise the Hologic QDR 4500
Elite bone density unit.
PROPOSAL FOR BONE DENSITY
8. densitometer with fan beam geometry;
may affect BMD assessment
Opportunities
facility
Threats
facilities
PROPOSAL FOR BONE DENSITY
UNIT 6
6
One of the strengths displayed in the SWOT analysis is that
9. there is no other bone density unit
in close proximity to Claiborne Medical Center. This is a
positive factor because patients will
not have to travel long distances to have this exam done.
3.0 Project Description
There are certain elements that impact the decision to
invest in new or different equipment.
Every aspect must be considered, from cost of the equipment to
where the equipment will be
housed once it is at the facility.
3.1 Relevant Alternatives
A different alternative to the Hologic QDR 4500 Elite bone
density unit was researched.
Information gathered from GE about the Lunar Prodigy bone
density unit was obtained. This
unit is available in two sizes, full size, which is 8 feet long, and
compact, which is 6 feet long.
The Lunar Prodigy unit has a closed format.
3.2 Work Plan
10. fractures owing to osteoporosis
PROPOSAL FOR BONE DENSITY
UNIT 7
7
Hologic was contacted to request a list of facilities in East
Tennessee that use the QDR 4500
Elite bone density unit. Their report showed that two facilities
in Knoxville, Tennessee and one
facility in Morristown, Tennessee used this specific bone
density unit.
3.3 Significance
A bone density unit is needed at Claiborne Medical Center
for a number of reasons. First, it
will increase patient load for the hospital since patients will not
have to go elsewhere to have this
type of exam performed.
4.0 Methods
11. The two bone density units that were compared were the GE
Lunar Prodigy and the Hologic
QDR 4500 Elite. The GE Lunar Prodigy was available brand
new for $32,000.00. This unit is
state-of-the-art but is not within the radiology department’s
budget.
5.0 Barriers
The Hologic QDR 4500 Elite bone density unit, although
used, is within the radiology
department’s budget. However, there are some concerns
regarding this unit. First, the unit is 12
years old and has no available warranty.
6.0 Budget
The Hologic QDR 4500 Elite bone density unit can be
purchased from Cumberland Medical
Center for $2,500.00. Figure 2 visualizes ….
Figure 2
ITEM COST
Hologic QDR 4500 Elite bone density unit
$2,500.00
12. PROPOSAL FOR BONE DENSITY
UNIT 8
8
from Cumberland Medical Center
Dismantle, transport and reassembly of unit,
test of operation and completion of FDA 2579 form
fulfilled by Remesta Medical Corporation
$5,500.00
Physicist inspection and survey
$400.00
HL7 interface and license, linkage to Aspyra PACS
$1,000.00
Upgrade to FRAX software
13. $500.00
Lead shielding for room where bone density room will
be housed
$400.00
Grand total:
$10,300.00
6.1 Projected Reimbursement
Projected reimbursement is based on the amount of patients
who receive mammograms;
research shows that the majority of the patients who come to the
Women’s Imaging Center are
postmenopausal women. Projected reimbursement is as follows:
that Claiborne Medical Center
performs 3,500 mammograms
a year; if only 25 percent (875) of these patients undergo bone
density testing and
14. reimbursement is $60.00 per exam, this equals $52,500.00.
.00
reimbursement for exams equals
$18,000.00
Hologic QDR 4500 Elite unit
is capable of, the CPT code #77080 can be used and the
reimbursement per exam is
$79.91. If only 25 percent (875) of patients who receive
mammograms undergo bone
PROPOSAL FOR BONE DENSITY
UNIT 9
9
density testing with a reimbursement of $79.91 per exam, this
equals $69,921.25. The
Hologic bone density unit will be more than paid for in a year.
7.0 Timeline
Site visits to three other facilities that use the Hologic bone
density unit were conducted
on September 14, 2015 and September 22, 2015. The Women’s
15. Imaging Center where the
bone density unit will be going is undergoing minor
construction; this project is estimated to
take two weeks. The projected date for the bone density unit to
be operational is January 2,
2016. Lead shielding for the room where the bone density unit
will be housed is scheduled
to take place on November 30, 2015. Arrival and reassembly of
the unit will be on
December 7, 2015. This is estimated to take one day. HL7
interface and license and linkage
to Aspyra PACS will take place on December 11, 2015.
Software upgrade will take place
during this time as well. The physicist will be contacted and
estimated arrival for this
inspection is December 14, 2015. Training sessions for
radiologic technologists will begin
on December 15th through December 18th and December 21st
through December 23rd. All
technologists will be trained on the unit. The unit is projected
to be operational on January
2, 2016.
8.0 Employee Qualifications
16. The radiologic technologists at Claiborne Medical Center are
all registered through the
American Registry of Radiologic Technologists (ARRT). The
technologists will be cross-
trained in bone density imaging by a fellow technologist who
has five years experience in
performing these exams and who has previously worked with
and is knowledgeable about
the Hologic QDR 4500 Elite bone density unit. All
technologists must acquire Tennessee
PROPOSAL FOR BONE DENSITY
UNIT 10
10
radiation operator license. Technologists may become certified
in bone density at their
discretion.
17. 9.0 References
Bone Densitometry (DEXA, DXA). (2014). Retrieved from
http://www.radiologyinfo.org/en/info.cfm?pg=dexa#limitations
Osteoporosis Facts and Statistics. (n.d.). Retrieved from
http://www.iofbonehealth.org/facts-
statistics
PROPOSAL FOR BONE DENSITY
UNIT 11
11
18. Running head: PROPOSAL FOR TRANSEASOPHAGEAL
DISINFECTION 1
Proposal for Transesophageal Disinfection System
Student Name
Adventist University of Health Sciences
PROPOSAL FOR TRANSESOPHAGEAL
DISINFECTION
2
Executive Summary
Non invasive cardiology is currently having issues with a
transesophageal echocardiology
(TEE) disinfector. There is only one disinfector and it is
currently out of order. This will have a
four week turnaround time. This poses a problem because there
19. is only one machine.
The current solution requires sending the machine to the
company for repair and using
the equipment that is the property of the operating suite. The
operating suite has two machines,
but they are having mechanical issues with one of their
machines.
PROPOSAL FOR TRANSESOPHAGEAL
DISINFECTION
3
Problem Identification
In 2009, the Heart, Lung and Mechanical Cardiac Assist
Program was established. By
2013, there were 70 ventricular assist devices (VADs)
implanted and 33 heart transplants. To
date 216 VADs have been implanted, 42 lung transplants, one
20. lung transplant and 59 heart
transplants.
The benefits of resolving this problem will be to increase
productivity, and turnover time.
More procedures can be done in a shorter period of time.
A PEST was done to evaluate the forces that should be
considered in the decision making
process. The chart (Fig. 1) illustrates the forces identified.
Political Forces
Economic Forces Social Forces Technological forces
National institutes
for health funding-
decline in
pharmaceutical sales
due to patent
expirations and
decline in new drug
therapies. This causes
21. reduction in public
funding worldwide.
Increase in revenue-
with an increase in
tests the machines
will pay for
themselves faster
Increased patient
satisfaction-
increased Press-
Gainey score- Patient
satisfaction.
Technologists will
be able to turn the
rooms over quicker-
providing reports
faster and availability
to do more tests.
22. Federal drug
administration-drug
lawsuits for drugs
that are used for some
of the disease
processes can slow
the approval of new
drugs.
Single device
inventions- pose a
single time fix
instead of years of
expensive drug
therapy
Same day procedure
and reduction of
frequent blood test
visits to check of
therapeutic levels.
23. More machines will
make more tests
possible- less
equipment fatigue
and failure.
Affordable care act-
imposing new fees on
the pharmaceutical
manufacturing sector
Advantage of
technology-
Economies of scale
Reduction of cost-
drug therapy
important to patients.
Reduction in
nosocomial
infection- of patient
24. PROPOSAL FOR TRANSESOPHAGEAL
DISINFECTION
4
of 2.8-4.1 billion each
year from 2012-2019.
causes per test cost to
decrease.
due to better
sanitation practice.
Affordable care act -
other hospitals in the
area are partnering
with larger facilities
to provide some of
these services that
have only been
offered here.
25. Competition will
increase for some of
these services.
Ability to increase
number of tests- the
ability of opening
another procedure
room.
Matching
performance with
patient
expectations-patient
expectations of
timely testing staying
on schedule.
Technologist’s
safety-technologists
are not exposed to
26. chemicals.
Figure1- PEST analysis
There has been a decline in the approval of the number of
chemicals that become drugs
directed towards cardiovascular disease by the federal drug
administration (FDA) since 1999.
Description of plan
The solution should be the purchase of three new TEE
disinfectors.
Significance
This solution will resolve the problem of ever having to go
without a unit to disinfect
probes for four weeks when there are at least 40-50 procedures
scheduled for that time period
and the unknown number of unscheduled inpatients.
Methods
There is one vendor. Due to the exclusivity of the product, it is
not recommended to have
one unit with the volume of studies done.
27. PROPOSAL FOR TRANSESOPHAGEAL
DISINFECTION
5
Problems
There are potential problems in the current budget as money has
been slated for some
construction that has gone over budget. The amount of $62,000
may have to come from a source
that will set back plans that are already earmarked and in the
works. Current volumes can replace
the money in two-three months and can replace money for a
project that is already on hold.
Budget
Proposed Budget 2016
Transesophageal
probe disinfector
$10,000 3 $30,000*
Transducer cabinet $0 $0
Plumbing $2,225 1 $2,225
28. Electrical $500 2 $1,000
Room outfit $0 $0
Discount for buying
multiples
$1,000 3 -$3,000
Components $30,225
Monthly supplies for
the year
Case of solution (32
bottles)
$250 24 $6,000
Case of cleaning
sponges(50 sponges)
$250 12 $3,000
Case of printer paper
(5 rolls)
$12 52 $624
29. Air Filter $395 1 $395
Neutralization kit $125 2 $250
Supplies $10,269
Maintenance
Repair $3,000-$4,000 2 $6,000-$8,000
PROPOSAL FOR TRANSESOPHAGEAL
DISINFECTION
6
Shipping parts and
service
$5,000 2 $10,000
Preventative
maintenance
$300 (3 machines) 12 $3,600
Maintenance budget $21,600
Entire budget $62,094
30. *The disinfector company will offer a discount of $1,000 off for
purchase of multiples.
The current charge per TEE is approximately $1,000-1,500 per
study (the higher rate
includes an anesthesiologist). At $1,200 per study and 10
studies average per five day week, the
equipment will pay for itself in two-three months. This includes
potential maintenance plan.
Timeline
The timeline, barring unforeseen problems should take four-
eight weeks.
PROPOSAL FOR TRANSESOPHAGEAL
DISINFECTION
7
References
31. Laslett, L. J., Alagona, J., Peter, Clark, 3., Bernard A, Drozda,
J., Joseph P, Saldivar, F.,
Wilson, S. R.. . Hart, M. (2012). The worldwide environment of
cardiovascular
disease: Prevalence, diagnosis, therapy, and policy issues: A
report from the american
college of cardiology. Journal of the American College of
Cardiology, 60(25 Suppl),
S1.
Rutala, W.A., Weber, D.J., (HIPAC) 3. (2008). Guidelines for
disinfection and sterilization in
healthcare facilities 2008.Centers for Disease Control.
Retrieved from
http://www.cdc.gov/hicpac/Disinfection_Sterilization/3_1deLap
aroArthro.html
