US case study: US cost control

We were notified that a 27 year old woman had been admitted with acute cholecystitis in Des Moines, Iowa.  Further investigation revealed that she was suffering from emphysematous cholecystitis (a rare and life-threatening condition).  An emergency cholecystectomy was performed and the patient was subsequently admitted to the intensive care unit.

We maintained contact with the patient’s treating doctors; it was our opinion (and that of the doctors in the United States) that the patient was likely to recover quickly with no residual disability.

She was moved to a normal ward the day after her surgery and her discharge was anticipated to take place a few days later.  However, 56 hours after surgery her condition deteriorated with a high fever, low blood pressure and severe abdominal pain.  She was taken back to the operating theatre where she was found to have a large collection of pus in the abdomen as well as a leaking bile duct.  The pus was cleared but it was not safe to repair the leaking bile duct at that time; a drain was placed to allow the leaking bile to flow out of the abdomen.

Post-operatively the patient went again to the intensive care unit where she remained for several days until her infection was under control.  Subsequently, she was transferred to a surgical high-dependency ward.

At this time the patient was too weak to get out of bed and had two surgical drains in her abdomen.  She was on intravenous fluids and also intravenous nutrition as she was not eating or drinking.  She was on high-dose antibiotics and painkillers.  The surgical plan was to continue the antibiotics and intravenous nutrition for another two weeks before further surgery to attempt to repair the damaged bile duct.  We were informed by the patient’s case manager that it would be many weeks before the patient would be well enough to fly.

A detailed discussion of the patient’s condition took place between the patient’s treating doctor and one of our own doctors.  During this conversation, we established that it would be possible to continue all of the patient’s therapies on board an air ambulance. As a result of this, the doctor in the United States was quite happy to agree to an air ambulance transfer from Des Moines, Iowa to Edinburgh, Scotland.  We organised this transfer which took place without any problems.

On arrival in Edinburgh the patient was transferred to her local hospital where she subsequently underwent the surgery she needed for her damaged bile duct.  She has since made a full recovery.

By arranging timely transfer to the United Kingdom, our expert intervention in this case saved the insurer an estimated £110,000.