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Biomedical subjects

G S Cembrowski

Publications and source records attributed to G S Cembrowski.

At least 19 recordsLinked to original sources
PubMed2000

Postanalytical quality improvement: a College of American Pathologists Q-Probes study of elevated calcium results in 525 institutions.

OBJECTIVE: To evaluate elevated patient calcium results as a postanalytic quality indicator of physician practices. DESIGN: Participants prospectively identified hypercalcemic patient results for 4 months or until they found 320 hypercalcemic results, and then, after at least 3 days, reviewed the medical records of these patients. Hypercalcemia was defined as a calcium value that exceeded the upper limit of each laboratory's reference range by 0.12 mmol/L or more. Participants, as well a subset of their physicians who did not acknowledge or respond to elevated results in the medical record, answered a questionnaire about their practices. PARTICIPANTS: Five hundred twenty-five laboratories enrolled in the College of American Pathologists Q-Probes program. MAIN OUTCOME MEASURES: The presence of hyercalcemic results in patients' medical records and physicians' acknowledgement and response to those elevated results. RESULTS: More than 5500 hypercalcemic results were identified, of which 53.2% represented a new finding. About 3.5% of results were not charted in the patients' records, and 23.1% of patient records did not contain clinician documentation of the abnormal result. Follow-up laboratory tests were not ordered for 13.8% of the elevated values. For 570 of the 808 results for which there was neither clinician documentation nor designated follow-up laboratory tests ordered, patients' physicians received written notification of the elevated calcium results along with a questionnaire. Responses were received from 386 physicians (68%). One hundred physicians indicated they did not order the specific calcium measurement, and of these 100, 85 responded it was part of a panel. The 286 physicians who ordered the test stated the results ultimately led to further testing (69%), a change of management (56%), or a new diagnosis (25%). CONCLUSIONS: We found that a high percentage of abnormal results (3.5%) were not documented in the patients' medical records, the diagnosis of hypercalcemia frequently was new (53.2%), and a high percentage of physicians did not respond to elevated calcium results by writing a note (23.1%) or ordering another test (13.8%). Opportunities for quality improvement at these postanalytical steps are far greater than at the analytical step. Laboratorians must help physicians identify and respond to clinically important laboratory results.

Calcium↗
PubMed1999

Laboratory restructuring in metropolitan Edmonton: a model for laboratory reorganization in Canada.

In 1994 the Alberta government acted to reduce to a decade-long deficit in the provincial budget with draconian reductions in the health, education and welfare expenditures. As a result, funding to Alberta clinical laboratories was to be reduced by approximately 40%. In response, the private and public laboratories in metropolitan Edmonton formed a unique alliance to provide laboratory testing in a more coordinated and efficient manner. Of the five metropolitan hospitals, only University of Alberta Hospital preserved its full service laboratory and its specialty reference testing. The other hospital laboratories were converted to rapid response laboratories with a merged private reference laboratory providing routine testing and support to the four hospitals, and far fewer outpatient collection facilities. This paper describes the steps in the laboratory restructuring from inception to execution.

Alberta↗
PubMed1997

Thoughts on quality-control systems: a laboratorian's perspective.

State-of-the-art prospective quality-control systems entail the use of medically relevant, analyte-specific quality control limits. With analyte-specific limits broader than those generally used in the clinical laboratory, there will be fewer false rejections, fewer unnecessary reanalyses, and shorter delays in run reporting. If the analyte-specific limits are narrower than those used in the laboratory, more errors will be detected, but the user is at risk of identifying errors over which s/he and the manufacturer have little control. The use of various patient data quality-control algorithms is described. Conservatism is stressed in adopting manufacturers' guidelines for surrogate, nondestructive quality-control testing. A simple, optimized approach is suggested for the systematic retrospective review of proficiency data. Finally, an approach is presented for converting from older, previously accepted quality control procedures to more efficient analyte-specific quality control.

Chemistry, Clinical↗
PubMed1996

Pump up your PT IQ.

Explore the source record for details and available documents.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1994

Patient and physician analytic goals for self-monitoring blood glucose instruments.

The study's objective was to determine the maximum analytical error that is allowable in portable whole blood glucose meters. Interviews were conducted to derive personal reference values and significant deviations from these values for the limit of hypoglycemia, the limit of hyperglycemia, and the upper and lower limits of acceptable blood glucose for physicians and patients with diabetes at the Park Nicollet Medical Center, Minneapolis, Minnesota. Fifty patients with diabetes (30 type I and 20 type II), and 43 physicians (14 endocrinologists, 14 family practitioners, and 15 general internists) were enrolled in the study. The results showed no significant differences between type I and type II diabetic patient responses. Nor were there significant differences among family practitioner, internist, and endocrinologist responses for any of the parameters (the limit of hypoglycemia, the limit of hyperglycemia, the upper and lower limits of acceptable blood glucose for the patient, and the corresponding allowable coefficients of variation at each of these glucose levels). There were significant differences when patients were compared to physicians. Physicians require the highest degree of precision at the limit of hyperglycemia (8.4 +/- 0.28 mmol/L [150.8 +/- 5.1 mg/dL]) with a maximum allowable coefficient of variation (CV) of 7%, a CV significantly lower than that of the patients (CV = 10%). Patients require the highest precision for glucose concentration around the lower acceptable limit (4.7 +/- .013 mmol/L [84.1 +/- 2.5 mg/dL]), with an allowable CV of 8%, a CV significantly lower than that of the physicians (CV = 14%). The authors conclude that the accuracy required by patients and physicians at normal and higher glucose concentrations is achievable by currently available meters. Manufacturers should ascertain that glucose measurements are optimally accurate at glucose levels of 4.7 mmol/L (84.1 mg/dL) and have CVs no higher than 7%.

Adult↗
PubMed1993

A systems approach to assure optimal proficiency testing in the hematology laboratory.

Although CLIA 88 has probably caused the laboratorian to place inordinate emphasis on proficiency testing, we believe that it will ultimately improve clinical laboratory practice. Due to the increased numbers of challenges within a mailing, the laboratorian has a greater ability to gauge magnitudes and types of any existing error. These magnitudes can be compared with previously established limits to determine the need for corrective action. Laboratories are encouraged to devise a system to guarantee accurate preanalytic, analytic, and postanalytic PT processing and reporting. Due to the relatively low imprecisions of today's hematology analyzers compared with the HCFA limits, most hematology laboratories should focus their attention on measures of and factors affecting long-term control and calibration. More attention should be paid to moving averages of indices and the analytic performance in regional or manufacturer control pools.

Calibration↗
PubMed1993

Performance characteristics of the HemoCue B-Glucose analyzer using whole-blood samples.

We evaluated the HemoCue B-Glucose (HemoCue Inc, Mission Viejo, Calif) analyzer for accuracy, precision, linearity, and recovery. One hundred eighteen capillary whole-blood samples were analyzed in duplicate on the HemoCue B-Glucose and the YSI 2300 STAT Glucose/L-Lactate (Yellow Springs [Ohio] Instruments) analyzers; corresponding plasma glucose levels were measured in duplicate on the Roche Cobas MIRA (Roche Diagnostic Systems, Nutley, NJ) analyzer. Plasma glucose levels were converted to whole-blood equivalent glucose levels by using a factor of 1.11. The following regression equations were obtained: HemoCue = 1.02 (YSI) + 0.19, Sy/x = 0.52, r2 = .984; and HemoCue = 0.98 (whole-blood equivalent glucose levels) + 0.26, Sy/x = 0.55, r2 = .982. Within-run coefficients of variation were 4.0%, 3.5%, 2.2%, and 1.0% at glucose concentrations of 3.9, 5.4, 8.7, and 17.1 mmol/L (71, 97, 156, and 308 mg/dL), respectively. Between-run imprecision and total imprecision using lyopholized materials with three lot numbers of cuvettes were 4.2% and 5.6% at 2.1 mmol/L (37 mg/dL) and 2.4% and 2.7% at 5.2 mmol/L (95 mg/dL), respectively. The HemoCue B-Glucose analyzer displayed linearity between 0 and 22.2 mmol/L (0 and 400 mg/dL), and the percent recovery averaged 98.7% +/- 4.5% (mean +/- SD). The HemoCue B-Glucose analyzer is a rapid, simple, and reliable method for determinations of whole-blood glucose levels.

Adult↗