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PubMed2006

Wireless technologies and patient safety in hospitals.

In the development of policies for wireless technologies, it is important for healthcare organizations to reduce risks to patients from use of wireless devices. Policy should be devised for instructing hospital staff, visitors, and patients, avoiding unwarranted restrictions but not ignoring evidence regarding potential interference problems, and allowing comparison with other clinical facilities of benefits of policy. To inform policy developers and a general audience of hospital personnel, a review was conducted on the safety of wireless devices for communication within hospitals. This review targeted electromagnetic interference effects of devices on medical devices and summarises key recommendations from published reports and international standards. There is consensus that the highest risk of interference occurs with two-way radios used by emergency crews, followed by mobile phones, while radio local area networks produce negligible interference. Wireless technologies are deemed suitable for use throughout hospital areas including intensive care units and operating rooms, given that recommended separation distances from medical equipment are observed.

Cell Phone↗
PubMed1989

[Automated medical data processing for assessing surgical wound infections].

The ability of an automated medical data processing system to identify causative factors of postoperative wound infections was examined. The system provides an ongoing quality control tool in the general surgical ward. Data on 1212 abdominal or inguinal surgical wounds in 1101 patients, collected during a 2-year period, were analyzed. The correlation between rate of infection and the type of operation, operative findings, degree of operating room sterility, adequacy of surgical technique, and level of the surgeon's expertise were determined. The rate of infection was similar to that reported in the literature. The computer required only 6% of the time estimated for obtaining the same data by examining the patients' files. It is recommended that the software be modified to include additional factors in the data base in order to draw more detailed conclusions. It is also recommended that a program be developed to perform a 1-step extraction and analysis of data in general, and in respect to each surgeon. This will make the data processing system a rapid, efficient and user-friendly tool.

Hospital Information Systems↗
PubMed1994

Postoperative information transfer: a study comparing two university hospitals.

Several studies have addressed the processing of anesthetic information by paper anesthetic data records or by the electronic storage and transfer of anesthetic data. Our purpose was to analyze the oral transfer of information in the postoperative period. We investigated 198 post-operative transfer situations with 120 patients in a U.S. hospital to compare the results with those of a former study in a German hospital. A great number of parameters were used in both hospitals, but there were remarkable differences. In the U.S. hospital numeric values of current vital functions, including oxygen saturation, were more common during information transfer, whereas in the German hospital the emphasis was on case history and chronic health status. The data from the U.S. hospital and those of the German hospital show that in spite of complete anesthetic records, a short (112.3 +/- 104 sec in the U.S. and 94.1 +/- 83.6 sec in Germany) oral information transfer is inevitable when the patient is transferred from the OR to the recovery room, and from the recovery room to the ward (122.7 +/- 61.4 sec in the U.S. and and 88.0 +/- 73.0 in Germany). Software developers of patient data management systems could learn from this study that in some situations it is necessary and possible to create a small set of data which will reflect the patients status quite well.

Anesthesiology↗
PubMed2001

Making patients safer! Reducing error in Canadian healthcare.

Media reports of adverse events experienced by patients raise questions about whether these are isolated exceptions or part of a larger problem. There is no reliable Canadian data on medical error; but there is little reason to expect that the situation differs markedly from Australia or the United States which have rigorously studied the problem. Research in Australia has concluded that as many as 16% of hospital patients are injured as a result of their treatment. The Australian study and more recent research in the United States have created widespread concern that an epidemic of error exists in healthcare. Fortunately, experts in healthcare and other industries, have pointed toward a number of solutions that will reduce these errors. Three key strategies need to be pursued First, better information about the numbers and types of errors that occur is needed to help pinpoint change efforts. Non-punitive reporting policies must be put in place, to assist in altering the traditional culture of blame that has discouraged error reporting. Second, a set of strategies have to focus on developing more effective systems, including physician-order entry and medication administration systems which have been shown to have a dramatic impact in reducing errors. These systems are expensive, but their importance in reducing injury - and greatly reducing the costs of additional care that come from such injuries - make them an essential part of the answer. Finally, healthcare organizations need to work to create more effective cultures oriented toward preventing errors and intercepting errors that inevitably occur. These cultures will require a new emphasis on teamwork, a continual focus on redesigning care systems, particularly in high risk areas such as operating rooms, intensive care units and emergency rooms. These are not easy tasks and will require investments in new equipment and new skills. These steps are essential if we are to maintain public confidence in healthcare.

Australia↗
PubMed1989

Computerized schedules--one solution to variable workstyles.

A computerized scheduling program was developed to provide hospital anaesthetic coverage and yet still satisfy the complex workstyles of 30 anaesthetists. Hospital commitments required ten anaesthetists available each weekday and four each weekend day for after-hours coverage of the intensive care units and operating rooms. The workstyles included part-time arrangements, limited calls by some individuals, and calls restricted to certain anaesthetists with specific areas of expertise. Rules were defined to limit the proximity of late calls to avoid fatigue and computer software was developed. For each scheduling period, the program assists in making daily call assignments based on each anaesthetist's availability and a priority ranking system. It is flexible enough to allow personal preferences. The number and distribution of all calls scheduled are counted. When the assignments are completed, differences are reconciled. For two years, this program has proved superior to previous manual systems for scheduling this group of anaesthetists with variable workstyles.

Anesthesia Department, Hospital↗
PubMed2003

Reducing unnecessary cross-matching: a patient-specific blood ordering system is more accurate in predicting who will receive a blood transfusion than the maximum blood ordering system.

UNLABELLED: Most blood transfusions are given in the operating room. Adoption of the Maximum Surgical Blood Ordering Schedule in the 1970s reduced the amount of blood unnecessarily cross-matched, but the national cross-match-to-transfusion ratio remains at approximately two-to-one. We tested the ability of a patient-specific blood ordering system (PSBOS) to more accurately predict potential operative transfusion. All adult patients who had blood cross-matched before surgery (February through June 1999) for elective operative procedures at the University of Michigan Hospital were identified. Complex surgeries were excluded. Surgeons estimated the expected blood loss for their surgeries, and the expected postoperative hematocrit was calculated using the patient's blood volume, the surgeon-defined expected blood loss, and preoperative hematocrit. Lowest tolerated hematocrit was set at 21% except in patients with coronary artery disease or who were ASA physical status III or more (28%). Sensitivity, specificity, positive predictive value, and negative predictive value of the PSBOS were calculated. Our analysis included 178 cases in which blood was cross-matched before surgery, representing 69 different surgeries and 42 surgeons. Only 16% of patients received an intraoperative transfusion. Of the 156 patients that PSBOS predicted would not require an operating room transfusion, 139 were not transfused. Of the 21 patients PSBOS predicted would be transfused, 11 were. The sensitivity of the algorithm as tested was 41%, the specificity 93%, the positive predictive value was 55%, and the negative predictive value was 89%. We conclude that PSBOS, which includes patient and surgeon variables in transfusion prediction, is more accurate than the Maximum Surgical Blood Ordering Schedule, which uses only surgical procedure. IMPLICATIONS: Currently, many units of blood set aside for surgery are never required, resulting in extra work and expense for blood banks. A formula that included patient weight and hematocrit and typical surgery blood loss was used to predict who would require transfusions. We reduced the predicted number of patients who had blood set aside from 178 to 21.

Adolescent↗
PubMed1993

[Computerized recording of physiologic parameters monitored during anesthesia].

STUDY OBJECTIVE: The aim of the study is to describe a multifunctional anesthesia record system PC-based, for use in operating room, and to verify the possibility of statistical analysis of some of the signals registered. DESIGN: Anesthesia records with data entered automatically were performed in 650 patients undergoing anesthesia for abdominal or thoracic surgery. A randomized trial in patients allocated into two groups was performed too. The first group was ventilated with non rebreathing system, the second group was ventilated with circle system. SETTING: Inpatient surgery clinic at a medical center. PATIENTS: 24 patients ASA I undergoing general anesthesia for laparoscopic cholecystectomy. INTERVENTIONS: The first group was ventilated with O2 = 4 1/min-1 and N2O = 6 1/min-1; the second group was ventilated with O2 = 350 ml/min-1 and N2O = 250 ml/min-1, reducing the N2O flow in order to keep FIO2 = 0.4. MEASUREMENTS: Esophageal temperature was registered every 90 sec and automatically copied on a Microsoft Excel spread sheet for statistical analysis. RESULTS: The automated anesthesia record was easy to use and different information about anesthesia and surgery were recorded. The automated analysis of the signals can be performed if no artifacts exist. With this method we found a statistical difference in the esophageal temperature between the two groups after 45 min of anesthesia. CONCLUSIONS: Computerized records capture many more data than handwritten records and give the possibility to give a rationale in their customs.

Anesthesia↗
PubMed1993

Exploring the issues.

In the previous article, I gave an overview of National Vocational Qualifications and the structures which give support on a national and local basis, an understanding of which is essential before informed judgements can be made and implementation successfully achieved. This second article will address some of the issues which have raised concern within operating departments throughout the country, but which must be resolved if the needs to ensure effective staffing levels in the future are to be met. It is inevitable that there will be no easy answers and equally true that each and every operating departments and ODP assessment centre will address the issues in a different way. Our joint and ultimate aim is that of providing a high standard of patient care and, for once, there is a flexibility within the training system to facilitate just that!

Accreditation↗
PubMed1995

Quantitative standardised analysis of advanced laparoscopic surgical procedures.

To support the improvement of advanced laparoscopic surgical procedures, we designed a quantitative analysis method to monitor surgical activities. The emphasis lies on the time spent on these activities and on the instruments controlled by the hands of the surgeon. Our method uses combined video images originating from the laparoscope, an overview CCD camera placed in the operating theatre and, when available, a video colonoscope. After the operation is finished, the images are evaluated by means of a standardised analysis routine based on a spreadsheet program and a set of standard terms (thesaurus), to minimise subjectivity of the analysis. After calculations, the data are presented in tables and graphs, resulting in objective information for research on the operation. Seven advanced laparoscopic procedures, in this case colon resections, have been analysed, and it was demonstrated that the analysis method is capable of describing different laparoscopic procedures using the limited thesaurus. Possible areas of application of the method are the evaluation of time-consuming parts of the operation, of surgical tasks and measurement of the surgeon's learning curve. Other applications are the prediction and measurement of the impact of new instruments and techniques.

Colectomy↗
PubMed1990

Critical-care medicine and the acute-care laboratory.

Critical-care medicine today is practiced by anesthesiologists, internists, pediatricians, and surgeons. Outcome from today's management of critically ill patients is very good, yet associated costs are very high. Over one-half of the hospital costs of critically ill patients emanates from the intensive-care unit (ICU), although the ICU stay accounts for less than 20% of their time in the hospital. Outside of the operating room, the ICU is the most expensive location for patient care in the hospital, and laboratory tests are the most expensive single item. Plans for cost containment should incorporate the following: more effective data management, education of practitioners about appropriateness and costs of tests, conversion from laboratory measurements to appropriate in vivo and ex vivo measurements, and real-time utilization assessment. To provide high-quality, cost-effective critical care in the future, laboratorians and clinicians must work together today to meet the challenges of technology, data management, and staff education.

Blood Chemical Analysis↗
PubMed1995

OREST II--ergonomic workplace and systems platform for endoscopic technologies.

Endoscopic interventions require a multitude of technical devices, like gas-insufflators, cameras, light sources, high-frequency scalpels and others. The devices available today represent stand-alone "function-insulas" from the view-point of systems technique. They have to be placed in the operating theatre and set-up right before each specific intervention. From each of these single devices supplies, cables and hoses lead to the body of the patient and have to be connected on both sides within the sterile and the non-sterile field. This not only requires a long setup time in the OR but also restricts the mobility of the operative personnel. Besides the ergonomic and the hygienic weakness of the contemporary solution, significant functional problems limit the efficiency of the OR environment. One of the major drawbacks lies in the lack of direct control of the devices by the surgeon and the confusing display of parameters and technical status. Against this background the systematic revision of the current endo-surgical workplace appears to be a major requirement for further technical and surgical progress. As a result of close cooperation between surgeons and engineers a systems workplace for minimally invasive surgery, OREST, has been developed and clinically tested. It integrates all devices into a mobile cabinet. The single devices are connected to a central computer and can be remote controlled directly by the surgeon from the table. A special display continuously informs about the system status. The lines and cables are guided into the sterile field by means of a swivel arm from one side of the patient. Multi-plugs are used to connect all lines at a central terminal within the sterile area. Clinical application of the first prototype OREST I started in 1993. OREST II is now available as a series product. Further development is focused on the integration of advanced sub-systems like tactile devices and advanced vision system.

Computer Systems↗
PubMed1999

Automating the supply chain in the OR.

At the University of Louisville (Ky) Hospital, staff members from the materials management and surgery departments have worked together to automate the supply chain. The goals were to remove supply activities from clinical staff members whenever possible, obtain and apply information for better product ordering and use, reduce personnel in the materials management department, and improve perioperative nurses' ability to obtain supplies--all at a decreased cost to the facility. This article describes how, after implementing point-of-service technology for all surgical supplies, the facility realized a cost-per-procedure savings of 16% and increased satisfaction among staff members in both departments.

Automation↗
PubMed1995

Struggles of neonatology staff and the network system in the Hanshin-Awaji earthquake disaster.

More than 5500 people were killed in the Hanshin-Awaji earthquake disaster. Most of the neonatal intensive care units (NICU) could not offer proper services as a result of the earthquake and the Hyogo Emergency System for Neonates could not function. No one imagined that such a great disaster would occur in their home town, Kobe; however, the devastation of the quake has raised the opportunity to examine the operation of neonatal medicine in an emergency. We sent out questionnaires to perinatologists in the damaged area 2-3 months after the quake. Some hospitals in the demolished area suffered such serious damage that they could not continue work as NICU, and some in the surrounding area had problems in a number of areas, including staff, room capacity and transport methods. Under these difficult circumstances the greatest problem encountered by staff was maintaining fundamental care in NICU, that is to say keeping temperature, formula (nutrition) and prevention of infection techniques operating. In this report we discuss the effects on neonatal medicine of the earthquake in Kobe. Medical staff struggled patiently and made great efforts to recover and maintain the functioning of NICU. We believe this information will be useful for neonatology staff in other areas which may experience an earthquake in the future.

Community Networks↗
PubMed2006

[Revision prosthetic of the knee joint. The influence of a navigation system on the alignment and reconstruction of the joint line].

Recognizing the rising number of primary total knee arthroplasties (TKA) over the last decade, one may assume an increasing number for revisions after a certain time delay. Studies showing a rate of only 78% satisfied patients provide a hint that there is still room for improvement. Therefore, it seemed worthwhile to evaluate the benefits of the computer assisted technique in revision TKA and compare the alignment results with the conventional technique. In a prospective study, 120 patients were operated for revision TKA using either the Vector-Vision navigation system (n=60) or the conventional technique (n=60). The axial limb alignment was evaluated on standardized pre- and postoperative full length weight-bearing radiographs and the variation of the joint line was determined by the method of Figgie from 1986.A precise reconstruction of the mechanical limb axis was achieved in 57/60 Patients (95%) in the computer assisted group and in 48/60 (80%) in the conventional group. A reconstruction of the joint line with a variation of less then 4 mm was achieved in 47/60 (78%) in the computer assisted and in 33/60 (55%) in the conventional group. Revision TKA remains a challenging procedure for the surgeon. Modern navigation systems offer additional information intraoperatively and might therefore simplify the procedure. In particular, the adjustment of the extension and flexion gap and the reconstruction of the joint line the results were superior. Furthermore, the use of a CT-free navigation system provides a significant improvement of prosthesis and leg alignment in revision TKA.

Aged↗
PubMed2005

[A new method for computer-assisted orbitotomies].

BACKGROUND: Surgical planning and tumor margins from preoperative image data sets can be transferred to the surgical site by use of computer-assisted navigation systems. Usually registration markers are placed prior to image data acquisition in order to correlate the patient's preoperative image data set with his/her position in the operating room. Pointers are commonly used for navigation, and the position of the pointer within the surgical site is compared to its position within the image data set. With a new navigation system, patient registration can be performed without registration markers. Tumor margins and osteotomy lines can be projected onto the surgical site. MATERIALS AND METHODS: With the new navigation system, which has been developed by the Sonderforschungsbereich 414 of the Deutsche Forschungsgemeinschaft, markerless patient registration is performed using the contours of the patient's face. A scanner is mounted above the operating table, which detects the surface of the surgical site intraoperatively. Osteotomy lines and tumor margins are projected onto this surface using an intense beamer. The procedure is illustrated for a patient with a meningeal tumor of the orbit. RESULTS: Patients can be registered with an accuracy of 1 mm. Pointers are not required to transfer the data on the surgical site. Furthermore, monitors are no longer required, since the information is projected directly on the patient's surface. CONCLUSIONS: Surgical planning and tumor margins can exactly be visualized within the surgical site. Ergonomics are especially improved for navigated orbitotomies via a coronal approach.

Adult↗
PubMed1999

Complete clinical outcomes audit. Resource requirements and validation of the instrument.

BACKGROUND: Clinically relevant surgical outcomes are usually monitored by surgeons only for new and/or high-volume procedures. Prospective outcomes audit studies are rarely done on 100% of procedures performed by a single surgeon, a surgical practice, or an institution. Therefore, we set out to determine the resource utilization and accuracy of a well-validated system at its introduction into a North American university surgical practice. METHODS: The Otago Surgical Audit, which has been validated in a wide spectrum of surgical practices in Australasia, was applied to a university practice in general and laparoscopic surgery. Data were recorded by the surgeon on the day of operation, at discharge, and during any subsequent readmission. Resource utilization was determined by timing the important steps in data acquisition and computer entry. Data accuracy was assessed by an independent chart review of 22% of all records. Case capture was audited by reviewing operating room case logs. RESULTS: Over 1 year, from October 1, 1996 to September 30, 1997, 338 procedures were performed. Data recording and coding by the surgeon required 2 min per form, or a total of 676 min (11.3 h) annually. Data entry required 2.11 min per form, or a total of 713 min (11.9 h) for the year. Eight percent of cases were returned to the surgeon for additional information. In the medical record audit, no additional mortality or readmissions were discovered, and one minor complication was recorded in the hospital record but not the outcomes audit. One complication and three operations recorded in the audit database were omitted from operating room records. Two minor procedures on the operating room log were omitted from the audit database. Operating time reported by the surgeon averaged 19 min less than recorded in the operative log. Data accuracy and coding accuracy improved significantly between the 1st month (month 4) and the 2nd month audited (month 12), (p <.01). CONCLUSIONS: It is possible to perform a 100% clinical outcome audit with the use of minimal resources. When the surgeon is involved with data acquisition and coding, the accuracy and completeness of the log may outstrip the medical record, but a learning curve of 4-6 months may be required to achieve this goal.

Humans↗
PubMed2001

A novel large-memory neural network as an aid in medical diagnosis applications.

This paper describes the application of a large memory storage and retrieval (LAMSTAR) neural network to medical diagnosis and medical information retrieval problems. The network is based on Minsky's knowledge-lines (k-lines) theory of memory storage and retrieval in the central nervous system. It employs arrays of self-organized map modules, such that the k-lines are implemented via link weights (address correlation) that are being updated by learning. The network also employs features of forgetting and of interpolation and extrapolation, thus being able to handle incomplete data sets. It can deal equally well with exact and fuzzy information, thus being specifically applicable to medical diagnosis where the diagnosis is based on exact data, fuzzy patient interview information, patient history, observed images, and test records. Furthermore, the network can be operated in closed loop with Internet search engines to intelligently use data from the Internet in a higher hierarchy of learning. All of the above features are shown to make the LAMSTAR network suitable for medical diagnosis problems that concern large data sets of many categories that are often incomplete and fuzzy. Applications of the network to three specific medical diagnosis problems are described: two from nephrology and one related to an emergency-room drug identification problem. It is shown that the LAMSTAR network is hundreds and thousands times faster in its training than back-propagation-based networks when used for the same problem and with exactly the same information.

Computational Biology↗
PubMed1988

Point-of-care: being a pilot site. Interview by Bill W. Childs.

Scripps Memorial Hospital in Chula Vista, CA, a 159-bed acute care facility, opened in 1964. The facility was acquired in 1986 by the Scripps Memorial Hospitals family which has acute care facilities in La Jolla, Encinitas and Chula Vista, CA. Prior to 1986, the hospital was in severe financial difficulty and was very near to closing its doors. With the help of an excellent group of employees and medical staff, Scripps Memorial Hospital--Chula Vista has made significant changes in all aspects of the operation. The CliniCom pilot program is only one of many changes the hospital has introduced in its effort to continue its role as a major healthcare provider in the South Bay area of San Diego. Scripps Memorial Hospital--Chula Vista is a very active facility with 85 percent occupancy, 32,000 emergency visits and 4,200 deliveries a year. The hospital is planning an expansion program to meet the current and future needs of the community.

California↗