Biomedical subjects

K E Tate

Publications and source records attributed to K E Tate.

5 recordsLinked to original sources

PubMed1995

Nurses, pagers, and patient-specific criteria: three keys to improved critical value reporting.

At LDS Hospital, we have developed and evaluated a computerized critical value reporting system based on digital pagers. Criteria used to identify critical values are patient-specific. An evaluation of the system was conducted from October 23, 1993 to January 21, 1994. Results showed that 100% of all critical values (497 values in the form of 335 alerts) were reported to clinicians within an average of 38.6 minutes, and that 51% of all alerts were received within 12 minutes. Data also showed that 92% of the alerts were considered valid, that 76% were communicated directly to the primary care nurse, and that 67% of the time nurses were previously unaware of the critical value(s).

Artificial Intelligence↗

PubMed1994

Decision support in medicine: examples from the HELP system.

Computerized health information systems can contribute to the care received by patients in a number of ways. Not the least of these is through interactions with health care providers to modify diagnostic and therapeutic decisions. Since its beginning, developers have used the HELP hospital information system to explore computerized interventions into the medical decision making process. By their nature these interventions imply a computer-directed interaction with the physicians, nurses, and therapists involved in delivering care. In this paper we describe four different approaches to this intervention. These include: (1) processes that respond to the appearance of certain types of clinical data by issuing an alert informing caregivers of these data's presence and import, (2) programs that critique new orders and propose changes in those orders when appropriate, (3) programs that suggest new orders and procedures in response to patient data suggesting their need, and (4) applications that function by summarizing patient care data and that attempt to retrospectively assess the average or typical quality of medical decisions and therapeutic interventions made by health care providers. These approaches are illustrated with experience from the HELP system.

Adult↗

PubMed1993

Computerized continuous quality improvement methods used to optimize blood transfusions.

Blood transfusion, although common, is not without risk and expense. Recently there has been a national focus on both overtransfusion and undertransfusion. To provide the best quality of patient care, there must be a balance between both over and undertransfusion. We used a computer system to minimize overtransfusion by prompting physicians when orders that did not meet accepted criteria were made. Continuous quality improvement methods were used to optimize blood transfusions. We also evaluated undertransfusions by assessing patients who did not receive a red cell transfusion when the Hemoglobin or Hematocrit showed it was clearly indicated. Using our computerized alerting system we are able to promptly notify physicians when such conditions exist. Results of the blood ordering show that overtransfusions of red cells have been minimized. Reductions in both mean Hematocrit and the standard deviation have occurred as predicted by continuous quality improvement theory. Assessment of undertransfusions showed that it was a minimal problem, but one that can be easily addressed with our laboratory alerting system.

Blood Transfusion↗

PubMed1993

Computers, quality, and the clinical laboratory: a look at critical value reporting.

The reporting of critical values is an important function of the clinical laboratory. The success of critical value reporting depends on laboratory personnel recognizing critical values and effectively communicating them to clinicians, and on clinicians correctly interpreting and using the critical values to provide appropriate patient care. At LDS Hospital, we have conducted a study of the critical value reporting process. Results of the study indicate that few critical values are actually reported by the clinical laboratory (only 28 of 294 critical values during November 24-30, 1992). Data on the quality of critical value documentation showed that 19 of 124 (15%) patient charts audited during January-February, 1993 contained no documentation that clinicians were ever aware of the critical value, or that corrective actions were taken. Other data on the quality of critical value reporting were also collected and analyzed. Study results have been used to design and implement a computerized critical value reporting system to improve the quality of critical value reporting at our hospital.

Clinical Laboratory Information Systems↗

PubMedDate not supplied

A computerized laboratory alerting system.

A computerized laboratory alerting system (CLAS) has been developed as part of an ongoing effort to improve the quality of care at LDS Hospital. The system identifies potentially life-threatening conditions on the basis of laboratory findings and then generates appropriate warnings and transmits them to clinicians. Use of the system has led to a significant increase in the proportion of patients in life-threatening situations who have received appropriate care (50.8% before implementation vs. 62.5% afterward, P less than 0.05). Among patients with hypokalemia, falling potassium levels, hyperkalemia, hypokalemia during treatment with digoxin, hyponatremia, falling sodium levels, hypernatremia, hypoglycemia, or hyperglycemia, the average length of time spent in the life-threatening situation has decreased from 30.4 to 15.7 hours (P less than 0.05) and the average length of stay has decreased from 14.6 to 8.8 days (P less than 0.05). There has been little change in the proportion of patients with findings indicating metabolic acidosis who have received appropriate care (32.3 vs. 34.6%). We conclude that CLAS has an important role in patient care at our hospital.

Artificial Intelligence↗