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S J Steindel

Publications and source records attributed to S J Steindel.

14 recordsLinked to original sources
PubMed1995

Timeliness of clinical laboratory tests. A discussion based on five College of American Pathologists Q-Probe studies.

Along with accuracy and reliability, timeliness is considered an essential quality for laboratory tests. Only for highly specific instances involving situations in operating theaters has timeliness been shown to affect outcome. Some studies have shown timeliness can shorten length of stay in certain emergency department situations, but rarely for hospital inpatients. Clinicians' expectations for emergency department laboratory test timeliness call for results in less time than the laboratory expects to or does provide. Data from five College of American Pathologists Q-Probes studies on test turnaround time support these observations, but also show central laboratories can provide results in a timely fashion if they optimize the total testing process.

Diagnostic Tests, Routine↗
PubMed1995

Conducting outcomes research: past experience and future directions.

The Centers for Disease Control and Prevention (CDC) was delegated authority to conduct the studies mandated in the Clinical Laboratory Improvement Amendments of 1988 (CLIA). Since that time, the CDC has been planning and implementing a research program, Evaluation of Quality of Laboratory Practices and Standards (EQLPS), aimed at demonstrating a clear linkage between patient outcome and laboratory practices and standards such as proficiency testing, quality assurance, and personnel standards. The goal of EQLPS is to improve the quality of laboratory medicine by providing a scientific and technical basis for laboratory practices and standards. In October 1995, the CDC will sponsor an Institute entitled "Frontiers in Laboratory Practice Research," during which strategies for conducting laboratory practice research will be discussed. The Institute should help identify research strategies that will eventually provide the information necessary to develop appropriate practice guidelines for laboratory medicine.

Centers for Disease Control and Prevention, U.S.↗
PubMed1993

Digoxin therapeutic drug monitoring practices. A College of American Pathologists Q-Probes study of 666 institutions and 18,679 toxic levels.

We investigated digoxin therapeutic drug monitoring practices in 666 institutions participating in Q-Probes, a quality improvement program of the College of American Pathologists. Participants used 13 different lower and 16 different upper limits for their therapeutic range. More than 280,000 digoxin levels were studied, and 6.7% (n = 8679) of results were in the toxic range (> 2.6 nmol/L). For the 77% of patients with toxic levels, the last digoxin dose was given orally; for 23% of patients, it was given intravenously; and for less than 1%, it was given intramuscularly. Between 22% and 31% of specimens in the toxic range were obtained before steady state had occurred, depending on the criteria used. Small institutions (less than 150 beds), outpatients, stat specimens, and laboratory policies not requiring the time of the last dose before measurement were associated with higher percentages of specimens drawn before the recommended time had elapsed. We describe digoxin monitoring practice patterns and provide suggestions for improvement.

Digoxin↗
PubMed1993

Physician goals and laboratory test turnaround times. A College of American Pathologists Q-Probes study of 2763 clinicians and 722 institutions.

Laboratory test turnaround times (TATs) for emergency department patients were studied in 722 institutions using Q-Probes, a quality improvement program of the College of American Pathologists. The medians of the TATs required by 2763 clinicians were 10 minutes for PO2, 20 minutes for hemoglobin, and 30 minutes for potassium and glucose measurements. Surgeons had the shortest TAT requirements for hemoglobin, potassium, and glucose measurements, whereas emergency department physicians had the shortest requirements for PO2. The measured TATs of most hemoglobin and potassium determinations did not meet clinician goals. In contrast to laboratorians, the majority of clinicians defined a TAT start time as test ordering, and a TAT ending time as result reporting. We recommend laboratorians and clinicians mutually agree on the definition of TAT, jointly develop timeliness goals, and together improve TAT performance to fulfill these goals.

Diagnostic Tests, Routine↗
PubMed1992

A nationwide quality assurance program can describe standards for the practice of pathology and laboratory medicine.

An important component of quality assessment is the analysis of peer group comparisons, although little data are available for evaluation. We developed and tested six interinstitutional quality indicators related to Pathology and Laboratory Medicine among 36 institutions. Results showed that the mean frequency of intraoperative frozen section consultations (6.0%), sensitivity of fine needle aspiration cytology diagnosis (87%), nosocomial infections (5.0%) and average cross-match to transfusion ratio (2.1%) was comparable with previous studies, but the range of values was large. The median stat laboratory turnaround time of approximately 1 hr for CSF cell count, glucose, protein and gram smear was considerably longer than expected from previous investigations, and was longer for larger institutions. Analysis of serious laboratory reporting errors showed the lowest number detected by individuals working in transfusion medicine, and highest numbers among hematology workers. We conclude that interinstitutional comparison of data from quality assurance programs can be used to describe performance standards related to the quality and effectiveness of care.

Biopsy, Needle↗
PubMed1992

Emergency department stat test turnaround times. A College of American Pathologists' Q-Probes study for potassium and hemoglobin.

We report aggregate turnaround times (TATs) from phlebotomy to result reporting of emergency department patients' hemoglobin and potassium results for 722 subscribers to the College of American Pathologists Q-Probes program. Approximately 40,000 specimens were obtained for each analyte. Median interinstitutional TAT time of 25 minutes for hemoglobin and 36 minutes for potassium varied little by shift, weekdays, or weekends. The type of personnel collecting the specimen and the method of specimen transport were the most important factors affecting TATs. Specimen transit times accounted for approximately one third of the total TATs, but when couriers transported hemoglobin specimens, the median transit time was equivalent to the median intralaboratory test TAT. The influence of various measures used to improve test transit and TATs is presented.

Bloodletting↗
PubMed1991

Intralaboratory performance and laboratorians' expectations for stat turnaround times. A College of American Pathologists Q-Probes study of four cerebrospinal fluid determinations.

More than 400 laboratories participated in the module of the College of American Pathologists' quality assurance program, Q-Probes, which measured intralaboratory turnaround time (TAT) of stat cerebrospinal fluid tests. Four determinations encompassing more than 14,000 specimens were monitored and intralaboratory TATs were compared with participants' TAT goals. The median TATs were as follows: cell count, 32 minutes; glucose, 34 minutes; protein, 37 minutes; and Gram's stain, 45 minutes. Between 14% and 21% of participants (test dependent) met their goals 100% of the time, with 72% of the determinations completed within the time laboratorians required. Standard statistical stepwise regression analysis was used to model influence of up to eight factors on TAT. Correlations were test and bed-size dependent, but ranged from a high of .23 to a low of .02. Only computerized reporting and instrumentation measuring protein and glucose had a consistent effect, delaying TAT, whereas use of a stat laboratory, one workstation, automation, computerized order entry, and centralized processing gave variable results. We conclude that laboratorian goals for cerebrospinal fluid test TAT are met most of the time, and that a stepwise regression analysis poorly explains factors that statistically influence TAT.

Cerebrospinal Fluid↗
PubMed1980

Liquid-chromatographic separation of urinary 5-hydroxy-3-indoleacetic acid, with measurement at 254 nm.

A "high-performance" liquid-chromatographic procedure for 5-hydroxy-3-indoleacetic acid is described and compared with a colorimetric method in which 1-nitroso-2-naphthol is used. The analyte and an internal standard, p-nitrobenzoic acid, were extracted into diethyl ether from urine at pH 4.0 (acidified with HCl) to which sodium chloride had been added, and the ether was back-extracted with acetate buffer, pH 9.2. Aliquots of this extract were injected into a reversed-phase liquid-chromatographic column and eluted with pH 3.5 acetate buffer/methanol (95/5 by vol); the effluent was monitored at 254 nm. The precision (CV) of the method was 11.8% at 1.8 mg/L, 5.5% at 92 mg/L. Analytical recovery averaged 84%. The colorimetric method gave higher values for the analyte than did the chromatographic method for all patients' urines.

Chromatography, High Pressure Liquid↗