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D S Wilkinson

Publications and source records attributed to D S Wilkinson.

137 records · Page 8Linked to original sources
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CQI in action in the central laboratory.

Total quality management and continuous quality improvement are important tools for survival in today's turbulent economy. The George Washington University Medical Center (GWUMC) has initiated institution-wide training in total quality improvement. The FOCUS-PDCA process is one specific instrument used at GWUMC to pursue the goal of total quality. The FOCUS-PDCA acronym stands for: Find a process to improve; Organize a team that knows the process; Clarify current knowledge of the process; Understand the causes of process variation; Select the process improvement; and then Plan, Do, Check, Act. The FOCUS-PDCA process was used to solve a real-world problem in the Central Laboratory of GWUMC. Dramatic improvement in the success rate of phlebotomists resulted, and the percent of "unable to draw" events decreased from more than 5% to less than 1%.

Academic Medical Centers↗
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Developing a budget for the laboratory.

Cost accounting is the basic "tool" for identifying the expenses associated with laboratory operations. A budget is a planning tool that allows the director and manager to visualize the evolution of expenses, assets, liabilities, and revenues over a period of time. It is a quantitative annual plan of activities and programs that helps an organization measure the progress toward its financial goals on a periodic basis. A knowledge of how to develop and understand a budget is essential for every director and manager.

Accounting↗
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The role of technology in the clinical laboratory of the future.

Advances in automation and informatics will drive the implementation of new technology as we enter the 21st century. Five technologies which will have the greatest impact on the practice of laboratory medicine during the next decade include molecular diagnostics, near patient testing, image analysis, robotics, and information management. The list of molecular pathology tests with potential clinical utility expands daily. Some, such as tests for human immune deficiency virus (HIV) and hepatitis C virus, already are available as commercial kits. Quality assessment and proficiency testing programs still are evolving. DNA tests in oncology, such as T- and B-cell gene rearrangements and t(9;22) translocation, have proven useful in detecting small numbers of tumor cells and have demonstrated clinical utility in some circumstances. Tests for monogenetic diseases, such as sickle cell disease, are useful in planning antenatal management of mothers at risk. Screening tests for the genetic predisposition for certain forms of colon and breast cancer and Alzheimer's Disease are now possible. This suggests the potential for large scale screening of populations at risk. Continued improvements in biosensor technology and miniaturization will increase the ability to test for many analytes at or near the patient. The generally increased cost per test must be reconciled with the potential to decrease the overall cost of care by improved turnaround time. Computerized image analysis will radically change, and in some cases eliminate, manual clinical microscopy in urinalysis, hematology, immunohistochemistry, and cytology. Robotics will greatly decrease personnel requirements for repetitive tasks, such as specimen transport, processing, and aliquoting. We will process many specimens from start to finish without human intervention. Image management systems will allow archiving of diagnostic gross and microscopic images along with the traditional text descriptions and diagnosis. Telepathology will link smaller centers with expert consultants in tertiary centers. Voice recognition systems will obviate the need for transcriptionists. Modern database architectures will allow the clinical laboratory to measure performance effectiveness and clinical outcomes and will place laboratorians at the forefront of outcomes research. Hand-held devices will allow physicians to conveniently order laboratory tests and retrieve results, further decreasing the functional turnaround time for laboratory testing. All of these technologies will be expensive to implement, but well-planned deployment will both decrease cost and improve the quality of medical care.

Autoanalysis↗
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Role of medical, technical, and administrative leadership in the human resource management life cycle: a team approach to laboratory management.

We believe the team approach to laboratory management achieves the best outcomes. Laboratory management requires the integration of medical, technical, and administrative expertise to achieve optimal service, quality, and cost performance. Usually, a management team of two or more individuals must be assembled to achieve all of these critical leadership functions. The individual members of the management team must possess the requisite expertise in clinical medicine, laboratory science, technology management, and administration. They also must work together in a unified and collaborative manner, regardless of where individual team members appear on the organizational chart. The management team members share in executing the entire human resource management life cycle, creating the proper environment to maximize human performance. Above all, the management team provides visionary and credible leadership.

Administrative Personnel↗
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Impact of perceived stress, major life events and pregnancy attitudes on low birth weight.

CONTEXT: While low birth weight is the leading cause of infant mortality and morbidity, the factors influencing low birth weight are not well understood. In particular, the relationship between stressful life events and birth outcomes is unclear. It is important for health care providers to better understand the impact of stress on health outcomes. METHODS: Data from a statewide case-control study of 2,378 Missouri mothers are used to examine the relationship of perceived stress, pregnancy attitudes and major life events as psychosocial risk factors on very low birth weight (i.e., birth weight lower than 1,500 g). Such births are contrasted with moderately low birth weight births (those weighing between 1,500 and 2,499 g) and normal-birth-weight infants (those weighing 2,500 g or more). A stepwise logistic regression model is used to control for all study and control variables. RESULTS: The risk of very low birth weight is one and one-half times greater if the mother perceived that she "almost always" felt stress during her pregnancy. The regression model confirms that besides perceived stress, several other factors are independently associated with an increased risk of very low or moderately low birth weight. For example, getting back with a husband or partner or experiencing a major injury accident or illness were associated with an elevated risk of low birth weight (odds ratio, 1. 7), as was pregnancy denial (1.4-1.6) and unhappiness about the pregnancy (1.3). On the other hand, a few factors (taking out a mortgage or loan, having a close relative die and having a mistimed pregnancy) appear to have reduced the odds of low birth weight (odds ratio, 0.5-0.8). CONCLUSIONS: Interventions with pregnant women, especially those assessing perceived stress and attitudes toward the pregnancy, have the potential to improve pregnancy outcomes. Additional prospective research with pregnant women on the origins and effects of stress, including the biological effects of stress, is needed.

Adult↗
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Technology assessment: measuring the outcomes of laboratory practice.

The collision of explosive growth in biomedical technology and pressure to contain cost requires that managers of health-care services base decisions to introduce new technology on hard evidence that the benefits outweigh the costs of the new technology. Outcomes research measures the impact of new technology and changes in clinical practice on patient well-being or financial performance. Outcomes research in the clinical laboratory requires a systematic collection of data that is best accomplished in conjunction with a broader health services research effort that includes a multi-disciplinary team of laboratorians, clinicians, administrators, and statisticians. The major requirement for successful outcomes research is an integrated information system that includes clinical, demographic, administrative, claims, financial, and survey information.

Cost-Benefit Analysis↗