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P J Howanitz

Publications and source records attributed to P J Howanitz.

At least 37 records · Page 2Linked to original sources
PubMed1996

Indications and immediate patient outcomes of pathology intraoperative consultations. College of American Pathologists/Centers for Disease Control and Prevention Outcomes Working Group Study.

OBJECTIVE: To evaluate the reasons (indications) for and immediate intraoperative surgical results (outcomes) associated with pathology intraoperative consultation. DESIGN: In 1992 and 1993, surgeons collaborated with pathologists in 472 voluntarily participating institutions from the United States (462), Canada (7), Australia (2), and New Zealand (1) in a study jointly sponsored by the College of American Pathologists and the Centers for Disease Control and Prevention. Pathologists selected 20 consecutive intraoperative consultations and assembled a cover letter, a checklist questionnaire, and a copy of the corresponding surgical pathology report, all of which were sent to the surgeon(s) for retrospective evaluation. PARTICIPANTS: The study was distributed to participants in the College of American Pathologists voluntary Q-Probes quality improvement and Surgical Pathology Performance Improvement programs and to Canadian and Australian hospitals with more than 200 beds. RESULTS: Evaluation of 9164 cases established the five most common indications for intraoperative consultation: (1) establish or confirm diagnosis to determine type or extent of operation (51%), (2) confirm adequacy of margins (16%), (3) confirm nature of tissue to direct sampling for immediate culture or other laboratory study (10%), (4) expedite obtaining diagnosis to inform family or patient (8%), and (5) confirm sufficient tissue submitted to secure diagnosis in permanent section (8%). The information provided by the intraoperative consultation resulted in changed surgical procedures that were either modified, terminated, or newly initiated in 47%, 30%, 6%, 9%, and 28% of cases, corresponding respectively to each of the above five common indications. Rarely cited reasons for intraoperative consultation were to expedite obtaining diagnosis for surgeon's knowledge (3%), to facilitate patient management, other professional communication or discharge planning prior to permanent section availability (3%), academic protocol (< 1%), and consultation not needed or no reason for request (< 1%). CONCLUSIONS: This multi-institutional, interdisciplinary database confirms that pathology intraoperative consultations, regardless of the initial indications, influence immediate patient care decisions, resulting in changed surgical procedures in an average of 39% of all operative cases.

Australia↗
PubMed1996

Bedside glucose monitoring. Comparison of performance as studied by the College of American Pathologists Q-Probes program.

OBJECTIVE: To measure changes in practice characteristics and accuracy of bedside glucose monitoring between studies performed in 1991 and 1994. DESIGN: Participants in a 1991 and a 1994 bedside glucose monitoring study of the College of American Pathologists Q-Probes program were compared using data collected by a questionnaire for 15 quality variables and data from paired specimens for accuracy. Accuracy goals of bedside testing were those defined by the American Diabetes Association as within 10% of the laboratory value. Accuracy was estimated using a daily paired comparison of patient specimens for 30 days, one bedside glucose instrument, and individuals who commonly performed these measurements. SETTING: Institutions subscribing to the College of American Pathologists' voluntary quality improvement program, Q-Probes. PARTICIPANTS: In 1991 and 1994, 605 and 544 institutions collected data about performance characteristics, whereas 171 and 242 institutions participated in the accuracy components, respectively. MAIN OUTCOME MEASURE: Changes in accuracy between 1991 and 1994. RESULTS: When compared, improvement occurred for 12 of 15 quality variables. However, no significant changes were found for the percentage of values within stated accuracy goals. CONCLUSIONS: Although the process of bedside glucose testing improved between the 1991 and 1994 studies, the testing accuracy remained unchanged.

Blood Chemical Analysis↗
PubMed1996

Bedside glucose monitoring quality control practices. A College of American Pathologists Q-Probes study of program quality control documentation, program characteristics, and accuracy performance in 544 institutions.

OBJECTIVE: To investigate the adequacy of bedside glucose monitoring (BGM) quality control documentation and monitoring, characterize program structure and organization, and identify characteristics associated with the ability to produce accurate results. DESIGN AND SETTING: College of American Pathologists Q-Probes laboratory quality improvement study in 544 institutions. MAIN OUTCOME MEASURES: Percent compliance with quality control (QC) documentation, appropriate corrective action, and frequency of inappropriate patient testing, and the percentage of BGM results within +/-10% and +/-15% of a corresponding clinical laboratory glucose result. RESULTS: Five hundred forty-four institutions reviewed a total of 19543 individual QC paper documents from 2543 separate BGM instruments. Ninety percent of QC determinations that should have been performed and noted on these documents were recorded; of those performed, 2.8% of QC results were outside of the acceptable range. Thirty-two percent of the out-of-range QC results had no record of corrective action. There were 527 reported instances of one or more patients being tested when there was no record of corrective action for out-of-range QC results. There were 20665 undocumented potential QC events, with 2053 instances of one or more patients being tested when there was no documentation. Two hundred forty-two institutions submitted 6653 paired BGM and clinical laboratory results for comparison. Approximately 56% of BGM results were within +/-10%, and 74% were within +/-15% of the corresponding clinical laboratory result. Factors associated with better accuracy performance are discussed. CONCLUSIONS: There is a need for improving compliance with QC documentation, improving appropriate corrective action follow-through, decreasing the frequency of inappropriate patient testing, and improving BGM accuracy performance. We provide recommendations for improvement.

Blood Chemical Analysis↗
PubMed1996

Quality assurance of autopsy permit form information, timeliness of performance, and issuance of preliminary report. A College of American Pathologists Q-Probes study of 5434 autopsies from 452 institutions.

OBJECTIVE: To develop a multi-institutional reference database of autopsy practices and performance for quality improvement purposes. DESIGN: In 1992, participants in the Q-Probes quality improvement program of the College of American Pathologists each prospectively evaluated consecutive autopsies performed over a 6-month period, up to a maximum of 20 autopsies per institution. SETTING: Hospital-based autopsies, excluding forensic cases and stillborn infants. PARTICIPANTS: Four hundred forty-nine North American institutions and three Australian laboratories. MAIN OUTCOME MEASURES: Completeness of information contained on autopsy permit forms, timeliness of autopsy performance between patients' deaths and autopsy prosections, and turnaround time of preliminary autopsy reports. RESULTS: In the aggregate database of 5434 autopsy cases, 7 of 11 selected data items were consistently present on autopsy permit forms in 80% of the participating institutions. The median percentage of autopsies in which permission was given for an unrestricted (complete) autopsy was 71%. The following median time intervals were obtained: time of the patient's death to time the autopsy permission was received, 5 hours, 23 minutes; time the autopsy permission was received to time the prosection was started, 3 hours, 30 minutes; and time of the patient's death to time the prosection was started, 14 hours, 52 minutes. Differences were observed in some time intervals when the participating institutions were grouped by reported demographic characteristics. Preliminary reports were completed in 2 days or less in 80.9% of the autopsies. CONCLUSIONS: Through this multi-institutional study, we have documented a consistent core of autopsy permit form information requested and a wide range of time intervals elapsed between the patients' deaths and autopsy performance. We have also established that the majority of participating institutions meet the College of American Pathologists' laboratory accreditation standard of providing a documented preliminary report of the gross pathologic diagnoses submitted to the attending physicians and institutional record within 2 working days following autopsy completion.

Autopsy↗
PubMed1996

Intralaboratory timeliness of surgical pathology reports. Results of two College of American Pathologists Q-Probes studies of biopsies and complex specimens.

OBJECTIVE: To develop multi-institutional reference databases for intralaboratory timeliness of surgical pathology routine biopsies and complex specimens from the time of specimen accessioning to report completion, and to examine the influence of laboratory characteristics and practices on turnaround time (TAT). DESIGN: Participants in the Q-Probes quality improvement program of the College of American Pathologists took part in two separate studies, the first conducted in 1992 and 1993 and the second in 1993 and 1994. Each participant tracked the number of days from specimen accessioning to report completion for 30 routine biopsies and 30 complex specimens in each study. Based on this intralaboratory time interval, performance was compared with the College of American Pathologists' laboratory accreditation standard of 2 working days. PARTICIPANTS: Five hundred twenty-five surgical pathology laboratories responded to the study of routine biopsies, and 489 laboratories responded to the study of complex specimens. Participants were mainly located in the United States, but there were respondents from Canada, Australia, New Zealand, and Hong Kong as well. RESULTS: In the first study, evaluation of 15 725 biopsy cases showed that the cumulative aggregate percentage of routine biopsy cases processed from the time of specimen accessioning to report completion was 79% by 1 working day, 95% by 2 working days, and 98% by 3 working days. Individual participant's data revealed that all reports were completed by the second working day in 90% of the laboratories and by the third working day in 95% of laboratories. Factors that significantly contributed to increased report TAT included larger institutional size, a greater number of surgical pathologists, greater annual surgical pathology volume processed, technical processing resulting in delayed slide availability, pathology practices that integrated residency training, and reduced staffing levels of histotechnologists/technicians and transcriptionists. Shorter TATs were achieved in those institutions that had previously established a TAT goal for routine biopsy specimens. In the second study of 14 298 aggregate complex specimen cases, 68% required routine processing and 32% required special handling. Overall, 56% of all complex specimen reports were processed and completed in 1 working day, 81% in 2 working days, 91% in 3 working days, and 95% in 4 working days. On average, the percentage of cases processed and reports signed out in 2 working days or less was 80% for all complex specimen cases, 90% for routine cases, and 60% for special-handling cases. The mean of all participants' median TATs was 1.5 days (range 0-5 days) for complex specimens, 1.3 days (range 0-5 days) for cases requiring routine handling, and 2.6 days (range 0-13.5 days) for cases requiring special handling. Several factors were associated with increased report TAT: institutional occupied bedsize greater than 450, routine responsibility for gross dissection assigned to residents only, earliest availability of slides after 12 pm, resident involvement in sign-out, interposing a day between availability of slides and final slide sign-out for resident education purposes, and a greater number of surgical pathologists. CONCLUSIONS: We have documented that for the majority of routine cases, the College of American Pathologists Laboratory Accreditation Program's TAT standard of report completion time within 2 working days for the intralaboratory component of TAT is a reasonable goal. This standard was successfully met by participants in 95% of routine biopsy cases and 91% of routine complex specimens. Special-handling procedures for complex specimens contributed, on average, an additional delay of 1.3 days. To our knowledge these are the first systematic studies to describe timeliness from the time of specimen accessioning to report completion for surgical pathology specimens, and they may serve as reference databases for benchm

Biopsy↗
PubMed1995

Financial justification of alternate site testing.

Fixed costs are higher and variable costs lower for clinical laboratory testing than for alternate-site testing (AST). For AST to become cost-effective, variable costs must be reduced. Four models for accounting for the costs of clinical laboratory testing and AST are compared. A common error is to omit some of the indirect costs of a cost-per-test analysis for AST, thereby providing false claims. For a cost-per-test analysis, we recommend that identical categories be used for both the central laboratory and for AST. However, cost-per-test data alone do not completely represent institutional costs or savings associated with laboratory testing at any site.

Centralized Hospital Services↗
PubMed1995

College of American Pathologists Conference XXVIII on alternate site testing. What must we now do?

Implementation of the conference consensus that alternative site testing should be under the direction of the laboratory director supported by an institutional structure of users, laboratorians, and possibly administrators will optimize success. Information is needed if, when, and where alternative site testing improves the care of patients, and if faster results are associated with better and less expensive patient care. Costs and the timeliness of both central clinical laboratory and alternative site testing must be estimated in an identical fashion, then both must be compared with the costs and timeliness attributed to all steps of the total testing process included. As has been done with glucose, accuracy and precision goals must be developed for analytes measured at alternative test sites, then agreement reached on what these goals are and whether speed of measurement can influence these goals. Consideration of successful models is essential by those implementing or reevaluating alternative site testing programs. Required scientific information cannot be obtained in a timely manner unless improved funding occurs.

Accreditation↗
PubMed1995

Transfusion medicine monitoring practices. A study of the College of American Pathologists/Centers for Disease Control and Prevention Outcomes Working Group.

OBJECTIVE: To survey transfusion medicine practices in 1990, to determine the distribution of defects in the transfusion process, to examine the relationship between defects and complications, and to recommend improvements in the transfusion process. DESIGN: A mail survey that divided the transfusion process into 24 risk-prone steps and gathered defect rates on each step, along with incidence data for eight known complications of transfusions and other demographic information. SETTINGS: Hospitals, independent laboratories, and blood centers that provide transfusion medicine services. OTHER PARTICIPANTS: Respondents were 1365 participants in the College of American Pathologists 1991 Blood Bank Quality Assurance Survey. RESULTS: While processing 6.2 million units of blood and blood products, respondents reported detecting over 88,000 defects: 41% in the preanalytic phase of testing, 55% in the postanalytic phase, and only 4% in the analytic phase, the phase to which most monitoring efforts were devoted. A median of eight steps were actively monitored by survey participants overall, whereas 96 facilities sought defects in all 24 steps. CONCLUSIONS: Analysis of the data showed several monitoring steps provide similar information. Although monitoring of the transfusion process could not be linked with prevention of the complications studied, active surveillance does focus attention on defect-prone steps and allows testing of strategies to improve the transfusion process. We describe how defect detection systems may be improved.

Blood Banks↗
PubMed1995

Ordering accuracy. A College of American Pathologists Q-Probes study of 577 institutions.

Five hundred seventy-seven institutions examined how accurately physicians' test orders on inpatients were transmitted to the laboratory. Written orders could be found on laboratory requisitions or the medical record for 97.5% of 224,431 completed tests (median institution = 99.3%). Participants indicated that entry of extra tests into a hospital computer was the most common reason for completing unordered tests. In a multivariate analysis, factors associated with completing unordered tests were the lack of a policy requiring nursing staff to recheck computer orders against the medical record, average census of 301-450 patients, College of American Pathologists accreditation, and the use of preprinted "checkoff" order forms. Overall, 97.1% of 225,457 test orders were completed by the laboratories (median institution = 98.1%). Factors associated with not completing ordered tests were the lack of a policy requiring staff to check computer orders, teaching hospital status, and urban hospital location. Several interventions commonly thought to improve communication of orders were not found to affect performance. These results indicate that many institutions have a problem accurately transmitting test orders to their clinical laboratories.

Data Collection↗
PubMed1995

Complete blood count specimen acceptability. A College of American Pathologists Q-Probes study of 703 laboratories.

OBJECTIVE: to determine the frequency and reasons for rejection of specimens submitted to the laboratory for complete blood count studies. DESIGN AND SETTING: College of American Pathologists' Q-Probes laboratory quality improvement study prospective recording of rejected complete blood count specimens and associated factors in 703 laboratories. MAIN OUTCOME MEASURE: Percentage of submitted specimens rejected for testing. RESULTS: Of 7,894,882 complete blood count specimens submitted for testing to the participating laboratories during the data collection period, 35,347 (0.45%) were rejected. The most frequent reason for rejection was a clotted specimen, which occurred about six times more frequently than the second most cited reason, insufficient specimen quantity. Compared with their respective frequency of use for specimen collection, significantly more rejected specimens were collected in microtubes than in other containers. Compared with the respective frequency with which they collect specimens, laboratory personnel had significantly fewer rejected specimens than the other personnel groups. The poorest performance was exhibited by other in-hospital nonlaboratory personnel. Hospital bedsize was also a significant performance factor; smaller hospitals demonstrated lower rejection percentages. CONCLUSIONS: Specimen rejection should be monitored on a regular basis, identifying institution-specific factors that are associated with rejection. Monitoring of sufficient significant variables will help narrow the focus of corrective action. Action thresholds should be set sufficiently low to assure ongoing efforts toward improvement.

Blood Cell Count↗
PubMed1994

Quality improvement practices in clinical and anatomic pathology services. A College of American Pathologists Q-probes study of the program characteristics and performance in 580 institutions.

Participants of the College of American Pathologists Q-Probes program described their quality improvement practices for clinical and anatomic pathology. In 580 institutions, the median time required for a median of 12 indicators of quality was 40 hours/month, with the number of indicators and the time spent directly dependent on bed size (P = .0001). The overwhelming majority of participants reported benefit from their quality improvement programs in terms of patient outcomes, as a management tool, and for risk management. Six indicators in clinical pathology and four indicators in anatomic pathology were used in more than 75% of laboratories, whereas an additional seven indicators in clinical pathology and five in anatomic pathology were used in more than 50% of laboratories. The authors conclude that quality improvement practices are similar among laboratories, and irrespective of increasing regulatory requirements, pathologists and senior laboratory personnel spend large amounts of time for activities that they believe improve the quality of services rendered.

Humans↗
PubMed1994

Phlebotomists' safety practices. A College of American Pathologists Q-Probes study of 683 institutions.

We report on phlebotomists' safety practices in 683 institutions participating in the College of American Pathologists Q-Probes program. Participants inspected 38,357 phlebotomy tourniquets and 31,952 blood collection tube holders in use and found 2098 tourniquets and 2966 holders visibly contaminated with blood. In 67.8% of the institutions, at least one tourniquet or collection tube holder was contaminated. Needlestick injuries reported by phlebotomists during 1990 through 1992 were analyzed from approximately 11 million inpatient venipuncture procedures. These injuries ranged between 9.2 and 9.8 needlesticks per 100,000 venipunctures per year. Over 99% of the participants had a policy preventing recapping of needles, 45% discarded tourniquets when contaminated with blood, and 3.3% routinely assigned tourniquets to specific patients. Between 1990 and 1992, increasing frequencies of phlebotomists using gloves, replacing gloves between each inpatient phlebotomy, and handwashing after degloving were found. We cite the lack of compliance of handwashing between glove changes as suggesting need for regulatory rereview.

Bloodletting↗
PubMed1994

Inpatient phlebotomy practices. A College of American Pathologists Q-Probes quality improvement study of 2,351,643 phlebotomy requests.

We report outcomes of requests for inpatient phlebotomy procedures from 683 institutions participating in the College of American Pathologists Q-Probes programs. Of the 2,351,643 phlebotomy requests analyzed, 93.2% of venipunctures were successful, 1.6% were unsuccessful, 0.4% were partially successful, and 4.9% were not attempted by the assigned phlebotomist. Administrative inefficiencies prevented the assigned phlebotomist from attempting these venipunctures of which the most frequent reasons were patient unavailability (1.4%), patient transferred or discharged (0.9%), followed by the specimen already collected by someone else (0.7%). These results suggest that performance improvement of phlebotomy services, in general, would achieve the greatest gains by focusing attention to specific processes associated with administrative inefficiencies identified, rather than phlebotomists' technical skills.

Appointments and Schedules↗
PubMed1994

Nosocomial infections. A college of American pathologists Q-probes study in 512 North American institutions.

We report nosocomial infection surveillance methods and hospital infection rates in 512 institutions obtained from a Q-Probes study of the College of American Pathologists, Northfield, Ill. The results showed that nosocomial infection surveillance procedures were well standardized. Use of microbiology reports was the most common case-finding method (97.3%), followed by review of the patient's medical record (86.1%). The median number of full-time equivalents per 100 occupied beds utilized for infection control services was 0.64, and these full-time equivalents spent 40% of their time on surveillance activities. A computer was used in 81% of institutions to assist in conducting surveillance, although this usage was not associated with decreased surveillance time or personnel required. This study provided data on total and site-specific infection rates for a wide range of small to large hospitals. When stratified into subgroups (based on teaching status and hospital size), infections rates in this study were comparable with those of the National Nosocomial Infection Surveillance program, and showed a trend of increasing rates of nosocomial bloodstream and surgical wound infections.

Computers↗
PubMed1993

Bedside glucose monitoring. A College of American Pathologists Q-Probes study of the program characteristics and performance in 605 institutions.

In 1991, the College of American Pathologists' Q-Probes quality improvement program studied precision, accuracy, and program characteristics of bedside glucose monitoring (BGM) in 605 institutions. Precision measurements made in 569 institutions were based on 15,950 quality control results. Precision, expressed as a percentage coefficient of variation, was less than 10 in almost 90% of the institutions. For accuracy, 4517 BGM results from 181 institutions were compared with clinical laboratory glucose results. Approximately 58% of BGM results were within +/- 10% and 75% of BGM results were within +/- 15% of the corresponding clinical laboratory results. Program characteristics associated with better performance were (1) laboratorian program responsibility, laboratorian BGM test performance, and laboratorian involvement in training; (2) a policy requiring repeated scheduled operator training and/or performance review; (3) use of an internal comparison program; and (4) participation in an external proficiency testing program. We conclude that BGM frequently does not meet quality goals and provide recommendations on how BGM programs can be improved.

Australia↗