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PubMed1994

Building a patient record system. New information technologies will support development of patient-focused care.

As part of its plan to build a regional integrated healthcare delivery network, Genesys Health System, Flint, MI, has been developing a computerized patient record (CPR). The CPR will give users throughout the system immediate access to diagnostic studies, treatment information, discharge summaries, operative reports, x-rays, and other patient information. Before considering technical aspects of the system, healthcare executives considering implementation of a CPR should examine business and clinical issues to determine what they want to accomplish with the CPR. The Genesys information system is being designed with the following goals in mind: Organizing based on patient needs; Allocating resources at the point of care; Working as a broadly skilled, empowered staff; Delegating authority and accountability; Using technology to enable patient-focused care within the context of the system vision. Genesys envisions a CPR system that brings together records from such sources as emergency rooms, outpatient clinics, community service organizations, physicians offices, care teams, managed care companies, and financial systems. Genesys's use of care plans for specified procedures and diagnoses will enable it to use exception-based documentation of care delivered, whereby only departures from the protocol or unexpected outcomes are recorded.

Attitude to Computers↗
PubMedDate not supplied

[Analysis of quality in a first level trauma center in Milan, Italy].

BACKGROUND: In Italy there isn't a State Trauma System. Many attempts have been done to increase the quality of trauma care in prehospital and hospital phases, but only by local resources. In Mila (Italy)o Emergency Medical System is organized by Regional rules and five Hospitals warrant high level of care for trauma patients. There isn't an official registry for trauma. Creating a Trauma Registry is the prerogative to analyse the quality of assistance and to propose new solutions. OBJECTIVES: To analyse major trauma patients admitted to Ospedale Maggiore Policlinico IRCCS; to evaluate diagnostic and therapeutic protocols in order to identify preventable deaths. PATIENTS: We have observed trauma patients admitted to Ospedale Maggiore from January to December 2004. We collected demographic data, informations about the traumatic event and prehospital rescue, emergency room examination, diagnostic exams, surgical operations and results of treatment. We selected patients admitted among 6917 trauma patients observed in this period. We have calculated RTS, ISS and TRISS. Patients were followed during their staying at the hospital to record length of staying, lenght of ICU and mortality rate. We collected the autopsy of the all death patients. RESULTS: We selected 299 patients, 207 males and 92 females. Mean age was 42.4 +/- 19.5 for males (range 15 - 99) and 57.7 +/- 22.5 for female (range 7 - 101). Motorvehicle and road incident were the main cause of trauma (55.5%). A penetrating injury was observed only in 5% of cases. Mean RTS was 7.5 +/- 1. ISS and TRISS were (mean +/- SD) 13 +/- 9 and 94.9% +/- 11.5, respectively. Patients with ISS = 16 were 109 (36.4%). Forty five patients (15%) required a surgical treatment during the first 48 hours. Total length of staying was 8.9 +/- 11.2 (mean +/- SD) days (median of 5.5 days) and the length of ICU was (mean +/- SD) 11.7 +/- 10.3 days (median 9 days). 12 patients died (mortality rate 4.08%), 11 at Policlinico (2 in the emergency room, 3 in the operative room, 5 in ICU. One patient died in surgical ward), 1 at Ospedale Niguarda. Autopsy was available for 8 patients. In 2 cases the cause of death was established by clinical examination and in 1 case police are still investigating for poisons or other letal drugs. The main cause of death was the cerebral injury. Only for 1 patient it was impossibile to determine the cause of death so he was considered a potentially preventable death. His clinical RTS in the emergency room was 12 (7,4808 in the statistical analysis) and no severe lesions were observed during primary and secondary survey. CONCLUSIONS: Our data are typical of an urban area of a western country. Penetrating injury are very rare, 5% of incidence. Diagnostic and therapeutic protocols are similar to countries where a Trauma Center is active. The 4% of overall mortality rate is similar to Trauma Centers in USA. This result is better than other hospitals in Milan. The high number of ATLS providers in the trauma team could be one of causes of good results. Quality audit can't consider only RTS, ISS and TRISS. Scores are very practical and useful but they aren't enough. We must analyse every single case of death and Trauma Registry is the first tool to evaluate trauma care in a modern EMS.

Abdominal Injuries↗
PubMed2004

An organized approach to trauma care: legacy of R Adams Cowley.

The organized approach to caring for trauma patients was introduced into the civilian setting by the innovative pioneer, R Adams Cowley. His system in Maryland has the following 11 components: (1) a State Police Aviation Division that transports patients throughout the State; (2) trained paramedics at the scene of the accident as well as on the helicopter, who will stabilize the patients en route to the Shock Trauma Center; (3) one central dispatch communication center in Baltimore that coordinates information between paramedics and the Trauma Center; (4) a Shock Trauma Center with a helicopter landing zone near the building; (5) trained trauma nurses and trauma technicians to transfer the patient from the helicopter by stretcher to the resuscitation area; if there is a special complication, such as an airway problem, the anesthesiologist and or trauma surgeon may meet the helicopter on the roof as well; (6) trauma surgeons, board-certified in surgery, with a certificate of added qualification in surgical critical care, to treat the critically ill trauma patients in the resuscitation area; (7) a CT scan and portable X-ray units in the admission area that aid in the diagnosis of the injury; (8) operating rooms adjacent to the admission area for repair of trauma injuries; (9) a surgical intensive unit to care for the trauma patient; (10) a team of specialty physicians trained in a wide variety of specialties who work as a multidisciplinary unit caring for the hospitalized patient; and (11) an ambulatory outpatient unit that allows the patient to be followed in the center after discharge. Dr. R Adams Cowley incorporated each of these 11 components for an organized trauma center into Maryland. In recognition of his landmark contributions to trauma, the eight-story Shock Trauma Center was named the R Adams Cowley Shock Trauma Center. There is growing evidence that this organized system in trauma care seen in Maryland must be replicated in every state in our nation. The results of the Health Resources and Services Administration Report in 2002 show serious limitations in our nation's organized approach to emergency and trauma care. This report indicates that many Americans do not have access to well-trained pre-hospital emergency personnel. Between 10 and 15% of the US population does not have access to basic emergency medical and communication services. Moreover, the presence of key trauma system components continues to vary throughout the country, most likely because of growing economic constraints. Emergency communication systems remain fragmented, and adequate training programs and protective equipment for health personnel remains notably absent. The threat of inadequate funding for the state manifests itself in the consistent uneasiness regarding the recruitment and continued retention of trauma care providers. Federal authorities must devise national emergency medical and organized trauma programs to save the lives of injured Americans.

Disaster Planning↗
PubMed2000

An Aqueous Polymer Two-Phase System as Carrier in the Spray-Drying of Biological Material.

This investigation describes a novel concept in the formulation of carrier systems for the spray-drying of biological materials. As carrier material a system composed of poly(vinyl pyrrolidone) (PVP) and dextran was used. This system yields an aqueous two-phase system in which each phase is enriched in one of the polymers. By varying the composition of the system, the effective structure of a "stirred" system can be varied, covering the entire range from dextran continuous to PVP continuous. This facilitates encapsulation of either of these polymers in a spray-drying operation. In an attempt to investigate the spray-drying from such a system, the surface composition of the spray-dried powder obtained from various compositions of the two-phase system was analyzed by electron spectroscopy for chemical analysis (ESCA), providing information on the distribution of the polymers in the powder and thus also in the spray droplets. The two-phase system was applied for the spray-drying of live bacteria. The survival rate of the bacteria depended on the composition of the two-phase system. The storage stability of the bacteria in these formulations was investigated after storage at room temperature under dry conditions for 4 weeks, and it was found that the survival rate was 10-45%. The results therefore show that this type of formulation holds promise for future applications for micro-organisms as well as other sensitive biological materials such as proteins. Copyright 2000 Academic Press.

Journal Article↗
PubMed1993

Relating outcomes to processes of care: the Maryland Hospital Association's Quality Indicator Project (QI Project).

BACKGROUND: The Maryland Hospital Association's Quality Indicator Project (QI Project) is a program of indicator development and application that has grown from 7 hospitals in 1987 to more than 700 hospitals today. METHODOLOGY: Expert panels help to create sets of indicators that describe events involved in a specific sequence of patient care. Each hospital collects data elements for the 21 indicators on a quarterly basis using specifically designed data-collection software. Indicator data are adjusted for case complexity, risk of adverse outcomes, and patient group characteristics. A report is developed that states the rate of occurrence of each indicator and how the hospital's indicator rate compares to other hospitals in the database. Hospitals then use this information to determine if specific processes in their delivery of care yield results that deviate from those of other hospitals. The QI Project promotes regional sharing of information about specific hospital initiatives that might benefit other participants. It also provides a model to use in interpreting what the indicator data reveal about hospital performance. OPERATIONAL ISSUES: QI Project is testing process indicators for patient-level and service-level data to supplement current aggregate-level trend and profile analysis. Indicator data are shared solely with participating systems, but changes in the confidentiality policy are being studied. Reliability assessment surveys are periodically conducted. EXAMPLES: Case studies portray improvement of processes prompted by indicator data for unscheduled admission following ambulatory surgery, for surgical wound infections, and for reducing emergency room waiting times. CONCLUSIONS: The chief contribution of the QI Project and similar projects may not be that they identify all issues of quality, but rather that they may help develop a generation of hospital professionals who will be better able to quantify, evaluate, and improve health care quality.

Confidentiality↗
PubMedDate not supplied

The laboratory information float, time-based competition, and point-of-care testing.

A new term, the laboratory information float, should be substituted for turnaround-time when evaluating the performance of the clinical laboratory because it includes the time necessary to make test results both available (ready to use) and accessible (easy to use) to clinicians ordering tests. The laboratory information float can be greatly reduced simply by telescoping the analytic phase of laboratory testing into the preanalytic phase. Significant costs are incurred by such a change, some of which can be reduced by developing a mobile clinical laboratory (sometimes referred to as a "lab-on-a-slab" or "rolling thunder") to transport the analytic devices directly to patient care units. The mobile clinical laboratory should be equipped with an integrated personal computer that can communicate continuously with the host laboratory information system and achieve some semblance of continuous flow processing despite test performance in point-of-care venues. Equipping clinicians with palmtop computers will allow the mobile clinician to access test results and order tests on the run. Such devices can be easily configured to operate in a passive mode, accessing relevant information automatically instead of forcing clinicians to query the laboratory information system periodically for the test results necessary to render care to their patients. The laboratory information float of the year 2,000 will surely be measured in minutes through the judicious deployment of relevant technology such as mobile clinical laboratories and palmtop computers.

Clinical Laboratory Information Systems↗
PubMed1991

Bedside terminals can improve nursing efficiency.

Today's emphasis on cost containment and quality of care is leading hospitals to widen their automation focus from assisting financial departments to improving operations. Because acute nursing care accounts for a substantial portion of a hospital's personnel and services, developing an information system that places computer terminals at patient bedsides may lead to greater efficiency, among other benefits. Bedside access to information systems can mean that data is more accurately recorded and that nurses' time is more effectively spent on clinical care rather than clerical duties.

Computer Terminals↗
PubMed1980

Police and prosecution systems: An evaluation of a police criminal case preparation program.

Program evaluation can provide objective information relevant to decisions on program maintenance. A program to address problems in the preparation of criminal investigation reports in a metropolitan police department was evaluated. The program permanently altered environmental conditions under which reports were prepared to facilitate performance. Police officers, who had previously prepared reports without assistance, visited the Case Preparation Room to prepare reports with assistance from office personnel. Compared to reports prepared without assistance, reports prepared in the Case Preparation Room documented more case elements required by the state legal code for criminal prosecution, were completed in fewer days following arrests, and received higher ratings from Assistant District Attorneys. Operation of a permanent program available to approximately 945 officers proved a practical solution to improving the preparation of criminal investigation reports.

Journal Article↗
PubMed2004

The societal unit cost of allogenic red blood cells and red blood cell transfusion in Canada.

BACKGROUND: There is a dearth of information about the cost of allogenic red blood cells (RBCs) and RBC transfusion in Canada in the aftermath of the Canadian blood system reorganization and the introduction of various safety measures. The unit cost of allogenic RBCs and RBC transfusion in Canada in 1994 was estimated at 152.17 US dollars. The objective of this study was to determine the unit cost of allogenic RBC transfusion in Canada from a societal perspective. STUDY DESIGN AND METHODS: A cost-structure analysis using the cost information from 2001 through 2002 was used. Costs of blood collection, production, distribution, delivery (hospital transfusion service processing and patient administration), transfusion reaction management, and opportunity cost of donor's time were included in the analysis. Canadian Blood Services and Héma-Québec supplied the data for collection, production, and distribution stages. Delivery and transfusion reaction costs were collected from eight hospitals across six Canadian provinces. In-patient costs were assessed for the intensive care unit, emergency, general medicine ward, and operating room. RESULTS: The aggregate mean societal unit cost of RBCs transfused on an inpatient basis in 2002 was 264.81 US dollars (95% confidence interval [CI], 256.29 dollars-275.65 dollars). The mean cost of blood collection, production, and distribution was 202.74 US dollars (95% CI, 199.63 dollars-204.31 dollars), the mean opportunity cost of donor time was 18.21 US dollars (95% CI, 17.11 dollars-21.63 dollars), the mean cost of hospital transfusion service processing was 16.65 US dollars (95% CI, 13.50 dollars-19.79 dollars), of RBC transfusion was 26.92 US dollars (95% CI, 25.33 dollars-28.52 dollars), and of transfusion reaction management was 0.29 US dollars(95% CI, 0.22 dollars-0.36 dollars). There were substantial variations in hospital transfusion service processing and RBC transfusion costs across hospitals. CONCLUSION: The societal unit cost of RBC transfusion has doubled since 1994 to 1995. Further increases in unit costs would be expected as additional safety measures are introduced. This will have important financial implications for treating patient populations that require a high level of RBC transfusions.

Blood Banks↗
PubMed1995

Medication-management component of a point-of-care information system.

Implementation of and experience with the medication-management component of a point-of-care information system are described. A point-of-care information system (CliniCare) implemented at a 326-bed primary and tertiary care center provides online medication profiles, medication administration scheduling, and other patient data. All medications are bar coded and are scanned at or near the patient's bedside by using hand-held scanners; this prompts a safety check, records medication administration, and generates the drug charge. Use of the system has resulted in a lower medication error rate, improved medication records, improved scheduling of medications, better communication between nursing and pharmacy staff, more efficient drug monitoring, and more accurate and timely billing. Problems include the need for a bar-coding operation for unit dose oral solids and injectable dosage forms, the steep learning curve for some nurses and physicians, and resistance to the change from a manual system. A point-of-care information system has improved medication management but has been difficult to implement.

Clinical Pharmacy Information Systems↗
PubMed1999

Telemedicine and surgical robotics: urologic applications.

Medical treatment can be improved through integration and application of advances in technology, computers, and engineering. Accuracy and reliability are essential characteristics of any mechanical system, and with the evolution of machines capable of precise movements, the integration of medicine and machine is achievable. Early mechanical devices were effective in performing simple, repetitive tasks but were not sophisticated enough for independent function. In the automobile industry, robots could work on the assembly line executing these cyclic tasks. These machines could execute simple, reiterative movements without integrating new information from the environment. In this day and age, robots have evolved into sophisticated mechanical devices that can "react" to data detected in the environment to determine the next course of events. They have evolved from the assembly line to the operating room, assisting surgeons during surgery to participating in remote telesurgical procedures.

Journal Article↗
PubMed2005

Physiologic monitoring systems.

Physiologic monitoring systems monitor vital physiologic parameters so that clinicians can be informed of changes in a patient's condition. For this study, we evaluated systems from six monitoring suppliers--Dräger Medical, GE Healthcare, Nihon Kohden, Philips Medical Systems, Spacelabs Medical, and Welch Allyn. The intent of this study is to help facilities choose not just the most appropriate system, but also the most appropriate version of that system--the combination of components that will best suit the facility's needs. Our testing focused primarily on adaptability, alarm implementation, and human factors design. We rated the systems based on their capabilities and performance for each of seven care settings: critical care unit, emergency department, intermediate care unit and general medical/surgical floor, operating room (with separate ratings for use during conscious sedation and general anesthesia), postanesthesia care unit, and transport. The systems performed well against the majority of our criteria. Nevertheless, we found notable differences in specific features and performance areas. These differences will have varying levels of significance for different hospitals.

Costs and Cost Analysis↗
PubMed1992

A comparison of case retrieval times: film versus picture archiving and communications systems.

One of the advantages that a picture archiving and communications system (PACS) is supposed to provide over a film-based operation is improved performance in retrieving images. Although it seems self-evident that this should be so, this experiment was intended to verify this and to provide some time comparisons for the two methods. The experiment consisted of randomly selecting ultrasound and computed tomography cases and determining how long it took to retrieve files at a PACS workstation or in person from the file room. To simulate actual retrieval volumes, a total of 40 cases from current to 6 months old, 20 cases from the past year, and 10 cases more than 1 year old was selected. Results indicate that PACS retrieval can indeed be faster than file room retrieval. However, the difference is less for recent cases than for older cases. For cases 6 or fewer months old, the workstation retrieval was approximately 2.5 minutes faster per case than the film file room. This time difference increased markedly when extended to the 1-year and older-than-1-year groups. This report details the results of this study and provides information about the reliability of the two archives.

Filing↗
PubMed2006

A Web-based short messaging service system to enhance family-centered surgical patient care.

The purpose of this study was to develop a web-based short messaging service (SMS) system in the operating room (OR). At the same time, we integrated and analyzed the limits of SMS in the OR. A cross-sectional study with quantitative methods and convenience sampling was used to gather data in this study. In the SMS project, we approached the content of SMS with operation diagnosis, patient sources and time series (pre-, intra-, and post-operation). We also default the contents of SMS by patient individual conditions. In this study, 177 participants received 346 text messages and 139 participants answered satisfaction questionnaires (78.53 %). The findings show the usability of SMS as applied to clinical care, especially for reducing family anxiety, for real time information, physician-patient communication, medical care processes and patient safety. Therefore, it is suggested to exploit the effectiveness of a personal medical care information database under global goal in the future and to develop comprehensive management of the surgical patient relationship.

Adolescent↗
PubMed1982

Modern patient care using biotelemetry: its potential and technical realization at present and in the future.

Incorporation of biotelemetry has a number of advantages, such as reduction of the impediment of the information source (patient, subject or animal) reduction of the psychological effects on the information source, reduction of measuring artifacts, reduction of the risk for electroshock, reduction of the complexity of monitoring of physiological variables, as well as a potential reduction of the total cost of patient care. Therefore, biotelemetry may be incorporated advantageously not only in areas where this technique is absolutely needed (sport, work, function control during realistic circumstances of activity), but also in other areas such as patient monitoring during intensive care and in the operating room. There have been a number of drawbacks in biotelemetry for application in patient monitoring in the past mainly due to the problem of frequency allocations and regulations, but with the newly developed infrared systems future applications of biotelemetry in clinical monitoring seems promising.

Ambulatory Care↗
PubMed1977

A remote-controlled television-monitored laboratory records room.

One of the by-products of computerizing a clinical laboratory is the resultant increase in paper production and its associated manual system overloads. In an attempt to resolve this problem, we have devised a computer-generated laboratory record system that provides continuous access, yet ensures record security. By the use of closed-circuit television, intercom, and a microfilm reader/printer, it is possible to configure a remote record facility that is convenient for physician use and yet operates with a low original capital investment and utilizes no additional personnel.

Computers↗
PubMed2004

Laryngeal mask airway versus endotracheal tube for outpatient surgery: analysis of anesthesia-controlled time.

STUDY OBJECTIVE: To show that efficiency of operating room times can be improved significantly using rapid changes between operative procedures. DESIGN: Randomized, prospective clinical study. SETTING: Tertiary care university hospital, elective peripheral trauma-related orthopedic surgery. PATIENTS: 72 adult, ASA physical status I, II, and III patients scheduled for elective peripheral trauma-related orthopedic surgery requiring general anesthesia. INTERVENTIONS: Patient airways were managed using either a Laryngeal Mask Airway (LMA) or an endotracheal tube (ETT) in the hands of anesthesiologists experienced in both. They were not informed as to the primary intention of the study. All perioperative data, including the preoperative and postoperative outpatient stay at the outpatient surgical ward, were recorded with an anesthesia information management system. MEASUREMENTS: The primary outcome measures were: time needed for anesthesia induction and emergence from anesthesia. All manual recording into the anesthesia information management system during anesthesia was accomplished by nurses who were uninformed as to the aim of the study. MAIN RESULTS: Anesthesia induction was significantly (p < 0.01) shorter using LMAs (means +/- SD, medians, [interquartile ranges]) (LMA: 5.8 +/- 1.5, 5, [5;7] vs. ETT: 7.4 +/- 1.8, 7, [7;8] min), whereas emergence from anesthesia was not different (LMA: 11.8 +/- 3.3, 11, [9;14] vs. ETT: 13.2 +/- 4.8; 12, [10;16] min). CONCLUSION: The clinical relevance of reduced anesthesia induction time using LMA is questionable. The lack of difference in emergence time could be a result of the use of total intravenous anesthesia.

Adult↗
PubMed2006

From a radial operating theatre to a self-contained operating table.

Equipment congestion and a disarray of wires, tubes and lines (the spaghetti syndrome) is a common scenario in operating theatres. The radial arrangement of input and output signals and their interconnecting lines has been identified as the main source of clutter and congestion in this environment. Our aim was to present a comprehensive design concept for reducing electrical and physical clutter in the operating theatre. Data were collected from different operating theatres, including identification and sorting of equipment, cables, tubes and lines according to the direction and the features of the transmitted information and materials. We suggest a concept of a self-contained, 'built-in' operating table as a design solution for avoiding the clutter and congestion caused by the radial configuration. The operating table will function as a central integrated unit for management of the entire process of patient flow and control of supply systems and environmental conditions.

Electric Wiring↗