scholarly journals Improved Sample Quality and Decreased Turnaround Time When Using Plasma Blood Collection Tubes with a Mechanical Separator in a Large University Hospital

2020 ◽  
Author(s):  
Pierre-Olivier Hétu ◽  
Sacha Hobeila ◽  
François Larivière ◽  
Marie-Claire Bélanger
Keyword(s):  
Clinical Chemistry ◽  
Turnaround Time ◽  
Error Rates ◽  
University Hospital ◽  
Blood Collection ◽  
Sample Quality ◽  
Paired Samples ◽  
Deming Regression ◽  
Before And After ◽  
The Impact

Abstract Background Serum is commonly used for clinical chemistry testing but many conditions can affect the clotting process, leading to poor sample quality and impaired workflow. With serum gel tubes, we found a high proportion of sample probe aspiration errors on our Beckman AU5800 analyzers. We decided to implement the BD Barricor™ plasma tubes, and we validated an off-specification centrifugation scheme and verified that results obtained for 65 chemistry and immunochemistry tests were comparable to those obtained in serum gel tubes. Finally, we evaluated the impact of this new tube on sample error rate and laboratory turnaround time. Methods To validate centrifugation settings, 50 paired samples were collected in Barricor tubes and centrifuged at 1912 × g for 10 min or 5 min (off-specification). To compare serum gel tubes with Barricor plasma tubes, 119 paired samples were collected from volunteers and results were analyzed using weighed Deming regression. Finally, the proportion of aspiration errors and laboratory TAT for potassium were measured before and after implementing Barricor tubes. Results Barricor tubes showed clinically acceptable equivalence to serum gel tubes for the studied analytes, and the off-specification centrifugation scheme did not affect the results. Implementing Barricor tubes improved the laboratory workflow by decreasing the aspiration error rates (2.01% to 0.77%, P < 0.001) and lowering hemolysis (P < 0.001). The laboratory TAT for potassium were also significantly lowered (P < 0.001). Conclusion Use of Barricor tubes instead of serum gel tubes leads to better sample quality, shorter more reproducible laboratory TAT, and decreases costs associated with error management.

scholarly journals The Impact of a Policy-Based Multicomponent Nutrition Pilot Intervention on Young Adult Employee’s Diet and Health Outcomes

2018 ◽  
Vol 33 (3) ◽  
pp. 342-357 ◽  
Author(s):  
Désirée Schliemann ◽  
Michelle McKinley ◽  
Jayne V. Woodside
Keyword(s):  
Young Adult ◽  
P Value ◽  
Insurance Company ◽  
Diet Intervention ◽  
Work Related ◽  
Paired Samples ◽  
Before And After ◽  
Strict Diet ◽  
Pilot Intervention ◽  
The Impact

Purpose: Evaluate the effect of a policy-based, multicomponent workplace diet intervention on young adult employees’ diet and health. Design: A 6-month, single-armed pilot study with before and after assessments. Setting: Insurance company in Belfast, Northern Ireland. Participants: Employees who worked at the company throughout the intervention period were included. Employees were excluded if pregnant, breast-feeding, or following a strict diet. Intervention: Multicomponent diet intervention: ban of unhealthy foods brought into the premises, free fruit, education, individual advice, and further support. Measures: Mixed-methods approach: Diet-, health-, and work-related measures were assessed quantitatively. The campaign was evaluated quantitatively (via questionnaire) and qualitatively (via semistructured interviews). Analysis: Changes in measures were analyzed using paired samples t tests. Interviews were analyzed using thematic analysis. Results: Sixty (75.9%) staff completed all assessments. Males reduced their sugar intake on working days (−8.7% of total energy standard deviation [SD]: 20.1; P value <.01). Systolic blood pressure reduced in males and females (−3.3 SD: 9.9; P value <.05 and −8.0 SD: 7.7; P value <.001, respectively); 85.2% of staff strongly agreed/agreed that they appreciated the healthy eating ethos. This was supported by the qualitative analysis which furthermore suggested that the education, team support, individual advice, and free fruit were beneficial. Conclusion: Influencing workplace policies and offering additional dietary support could lead to meaningful changes in employees’ diet and health and may change workplace culture.

scholarly journals The Benefits and Challenges of an Interfaced Electronic Health Record and Laboratory Information System: Effects on Laboratory Processes

2017 ◽  
Vol 141 (3) ◽  
pp. 410-417 ◽  
Author(s):  
Athena K. Petrides ◽  
Ida Bixho ◽  
Ellen M. Goonan ◽  
David W. Bates ◽  
Shimon Shaykevich ◽  
...  
Keyword(s):  
Information System ◽  
Electronic Health Record ◽  
Government Regulation ◽  
Turnaround Time ◽  
Health Record ◽  
Laboratory Information System ◽  
Before And After ◽  
Electronic Health ◽  
Ordered Data ◽  
The Impact

Context.— A recent government regulation incentivizes implementation of an electronic health record (EHR) with computerized order entry and structured results display. Many institutions have also chosen to interface their EHR with their laboratory information system (LIS). Objective.— To determine the impact of an interfaced EHR-LIS on laboratory processes. Design.— We analyzed several different processes before and after implementation of an interfaced EHR-LIS: the turnaround time, the number of stat specimens received, venipunctures per patient per day, preanalytic errors in phlebotomy, the number of add-on tests using a new electronic process, and the number of wrong test codes ordered. Data were gathered through the LIS and/or EHR. Results.— The turnaround time for potassium and hematocrit decreased significantly (P = .047 and P = .004, respectively). The number of stat orders also decreased significantly, from 40% to 7% for potassium and hematocrit, respectively (P &lt; .001 for both). Even though the average number of inpatient venipunctures per day increased from 1.38 to 1.62 (P &lt; .001), the average number of preanalytic errors per month decreased from 2.24 to 0.16 per 1000 specimens (P &lt; .001). Overall there was a 16% increase in add-on tests. The number of wrong test codes ordered was high and it was challenging for providers to correctly order some common tests. Conclusions.— An interfaced EHR-LIS significantly improved within-laboratory turnaround time and decreased stat requests and preanalytic phlebotomy errors. Despite increasing the number of add-on requests, an electronic add-on process increased efficiency and improved provider satisfaction. Laboratories implementing an interfaced EHR-LIS should be cautious of its effects on test ordering and patient venipunctures per day.

scholarly journals Developing checklists to prevent diagnostic error in Emergency Room settings

Diagnosis ◽  
2014 ◽  
Vol 1 (3) ◽  
pp. 223-231 ◽  
Author(s):  
Mark L. Graber ◽  
Asta V. Sorensen ◽  
Jon Biswas ◽  
Varsha Modi ◽  
Andrew Wackett ◽  
...  
Keyword(s):  
Emergency Room ◽  
Diagnostic Errors ◽  
Evaluation Process ◽  
Diagnostic Error ◽  
Error Rates ◽  
Diagnostic Uncertainty ◽  
Maximum Benefit ◽  
Before And After ◽  
The Impact ◽  
Test Ordering

AbstractChecklists have been shown to improve performance of complex, error-prone processes. To develop a checklist with potential to reduce the likelihood of diagnostic error for patients presenting to the Emergency Room (ER) with undiagnosed conditions.Participants included 15 staff ER physicians working in two large academic centers. A rapid cycle design and evaluation process was used to develop a general checklist for high-risk situations vulnerable to diagnostic error. Physicians used the general checklists and a set of symptom-specific checklists for a period of 2 months. We conducted a mixed methods evaluation that included interviews regarding user perceptions and quantitative assessment of resource utilization before and after checklist use.A general checklist was developed iteratively by obtaining feedback from users and subject matter experts, and was trialed along with a set of specific checklists in the ER. Both the general and the symptom-specific checklists were judged to be helpful, with a slight preference for using symptom-specific lists. Checklist use commonly prompted consideration of additional diagnostic possibilities, changed the working diagnosis in approximately 10% of cases, and anecdotally was thought to be helpful in avoiding diagnostic errors. Checklist use was prompted by a variety of different factors, not just diagnostic uncertainty. None of the physicians used the checklists in collaboration with the patient, despite being encouraged to do so. Checklist use did not prompt large changes in test ordering or consultation.In the ER setting, checklists for diagnosis are helpful in considering additional diagnostic possibilities, thus having potential to prevent diagnostic errors. Inconsistent usage and using the checklists privately, instead of with the patient, are factors that may detract from obtaining maximum benefit. Further research is needed to optimize checklists for use in the ER, determine how to increase usage, to evaluate the impact of checklist utilization on error rates and patient outcomes, to determine how checklist usage affects test ordering and consultation, and to compare checklists generally with other approaches to reduce diagnostic error.

scholarly journals Dampak Program GEMAR dalam Pendampingan Pemberdayaan Perempuan Rawan Sosial Ekonomi di Kelurahan Belawan Bahari Kecamatan Medan Belawan

2019 ◽  
Vol 8 (1) ◽  
pp. 79
Author(s):  
Dedek Syahrani ◽  
Agus Suriadi
Keyword(s):  
Positive Impact ◽  
Case Processing ◽  
Test Analysis ◽  
Statistics Analysis ◽  
Paired Sample ◽  
Average Value ◽  
Descriptive Research ◽  
Paired Samples ◽  
Before And After ◽  
The Impact

AbstractThe purpose of this study was to find out how much the impact was felt directly and related to the positive impact of the GEMAR program in assisting the empowerment of socio-economic prone women in Belawan Bahari Village, Medan Belawan District. This type of research is descriptive research that is analyzed quantitatively. Sampling techniques using the formula N = n, the sample in this study were 30 respondents, namely women who received the benefits of the GEMAR program. This research instrument uses a questionnaire distributed to 30 respondents. The data obtained tabulated into the table is then analyzed and processed quantitative data by analysis of Case Processing Summary and Test of Normality that before and after the GEMAR program valid data amounts to 30 and no data is missing with a percentage of 100% and significance values before the program GEMAR is 0.083 and after the GEMAR program is 0.719 and greater than 0.05, the two data are declared to be normally distributed. Paired Sample Statistics analysis, Paired Samples Correlation and Paired Samples Test analysis. Based on the results of Paired Sample Statistics analysis after the GEMAR program is higher than before the GEMAR program with an average value before = 35.97 and after average value = 47.20 from 30 data, the results of Paired Samples Correlation analysis that the correlation value before and after the GEMAR program, which produces a number 0.622 with a probability value (Sig.) 0,000 that the correlation between before and after the GEMAR program relates strongly and positively, because the probability value is <0.05. Paired Samples analysis results calculated values for the impact of the GEMAR program are 7.157 with probability (Sig.) 0,000. Because the probability (Sig.) 0,000 <0,05 is rejected. This means that there is a significant influence before and after the GEMAR program in assisting the empowerment of socio-economic prone women.Keywords: Impact, GEMAR Program, Empowerment Assistance for Women in Socio-Economic Prone, Poverty AbstrakTujuan penelitian ini adalah untuk mengetahui seberapa besar dampak yang dirasakan langsung dan berkaitan dengan dampak positif program GEMAR dalam pendampingan pemberdayaan perempuan rawan sosial ekonomi di Kelurahan Belawan Bahari Kecamatan Medan Belawan. Tipe penelitian ini adalah penelitian deskriptif yang dianalisis secara kuantitatif. Jumlah sampel dalam penelitian ini adalah 30 responden yaitu perempuan yang menerima manfaat program GEMAR. Teknik pengumpulan data adalah dengan wawancara. Analisis data dilakukan analisis Case Processing Summary dan Test of Normality bahwa sebelum dan sesudah program GEMAR data yang valid berjumlah 30 dan tidak ada data yang hilang (missing) dengan persentase 100% dan nilai signifikansi sebelum program GEMAR sebesar 0,083 dan sesudah program GEMAR sebesar 0,719 dan lebih besar dari 0,05 maka kedua data dinyatakan berdistribusi normal. Analisis Paired Sample Statistics, Paired Samples Correlation dan analisis Paired Samples Test. Berdasarkan hasil analisis Paired Sample Statistics sesudah adanya program GEMAR lebih tinggi di banding sebelum ada program GEMAR dengan nilai rata-rata sebelum = 35,97 dan nilai rata-rata sesudah = 47,20 dari 30 data, hasil analisis Paired Samples Correlation bahwa nilai korelasi sebelum dan sesudah program GEMAR, yang menghasilkan angka 0,622 dengan nilai probabilitas (Sig.) 0,000 bahwa korelasi antara sebelum dan sesudah adanya program GEMAR berhubungan secara kuat dan positif, karena nilai probabilitas <0,05. Hasil analisis Paired Samples nilai t-hitung untuk dampak program GEMAR adalah 7.157 dengan probabilitas (Sig.) 0,000. Karena probabilitas (Sig.) 0,000 < 0,05 maka H₀ ditolak. Artinya terdapat pengaruh yang signifikan sebelum dan sesudah adanya program GEMAR dalam pendampingan pemberdayaan perempuan rawan sosial ekonomi. Kata Kunci: Dampak, Program GEMAR, Pendampingan Pemberdayaan Perempuan Rawan Sosial Ekonomi, Kemiskinan

scholarly journals Efficacy for the Annual Relapse Rate after the Immunosuppressive Therapy in Patients Associated with Anti-AQP4 or Anti-MOG Antibody-Positive Optic Neuritis

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Sotaro Mori ◽  
Takuji Kurimoto ◽  
Yusuke Murai ◽  
Kaori Ueda ◽  
Mari Sakamoto ◽  
...  
Keyword(s):  
Optic Neuritis ◽  
Immunosuppressive Therapy ◽  
Relapse Rate ◽  
Case Series ◽  
Oral Prednisolone ◽  
University Hospital ◽  
Double Positive ◽  
Before And After ◽  
The Impact ◽  
Aqp4 Antibody

Purpose. Although oral prednisolone is the first-line treatment for preventing recurrent optic neuritis (ON) after the completion of acute-phase treatment, especially anti-aquaporin 4 (AQP4) antibody-positive ON, and anti-myelin oligodendrocyte glycoprotein (MOG) antibody-positive ON, some patients experience relapses. Immunosuppressants could be effective in reducing the recurrence rate for neuromyelitis optica spectrum disorder and MOG antibody-related diseases, but there have been few studies addressing this issue focusing on the changes in ophthalmic parameters. The objective of the study was to analyze the impact of off-label uses of immunosuppressants to reduce recurrent ON. Design. Retrospective observational study, clinical case series. Methods. We reviewed the medical charts of 11 cases (22 eyes) who underwent immunosuppressive therapy in Kobe University Hospital and compared the annualized relapse rate (ARR) before and after immunosuppressive therapy. We also evaluated the dosage of prednisolone, complications of immunosuppressants, and other visual functional ophthalmologic parameters. Results. Eleven cases in total had AQP4 antibody (9 cases) and/or MOG antibody (3 cases). One case was double positive for these antibodies. Nine patients received azathioprine and two received mycophenolate mofetil as an initial immunosuppressive therapy. The median duration of immunosuppressant treatment was 2.8 years. The median ON ARR before immunosuppressive therapy was 0.33, and this decreased significantly to 0 after the therapy ( p = 0.02 ). The dose of prednisolone was reduced from 17.8 ± 7.1 mg/day before to 5.8 ± 2.2 mg/day after immunosuppressive therapy ( p < 0.01 ). Although two patients presented with mild elevation of liver enzymes and nausea, all patients were able to continue taking the immunosuppressants. Conclusions. Immunosuppressants can potentially decrease relapses and steroid dosage in patients with anti-AQP4 or MOG antibody-positive ON without severe adverse events and the exacerbation of visual acuities.

scholarly journals The Impact of Technology on Prescribing Errors in Pediatric Intensive Care: A Before and After Study

2020 ◽  
Vol 11 (02) ◽  
pp. 323-335 ◽  
Author(s):  
Moninne M. Howlett ◽  
Eileen Butler ◽  
Karen M. Lavelle ◽  
Brian J. Cleary ◽  
Cormac V. Breatnach
Keyword(s):  
Intensive Care ◽  
New Technology ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Error Rates ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Before And After ◽  
The Impact ◽  
Before And After Study

Abstract Background Increased use of health information technology (HIT) has been advocated as a medication error reduction strategy. Evidence of its benefits in the pediatric setting remains limited. In 2012, electronic prescribing (ICCA, Philips, United Kingdom) and standard concentration infusions (SCIs)—facilitated by smart-pump technology—were introduced into the pediatric intensive care unit (PICU) of an Irish tertiary-care pediatric hospital. Objective The aim of this study is to assess the impact of the new technology on the rate and severity of PICU prescribing errors and identify technology-generated errors. Methods A retrospective, before and after study design, was employed. Medication orders were reviewed over 24 weeks distributed across four time periods: preimplementation (Epoch 1); postimplementation of SCIs (Epoch 2); immediate postimplementation of electronic prescribing (Epoch 3); and 1 year postimplementation (Epoch 4). Only orders reviewed by a clinical pharmacist were included. Prespecified definitions, multidisciplinary consensus and validated grading methods were utilized. Results A total of 3,356 medication orders for 288 patients were included. Overall error rates were similar in Epoch 1 and 4 (10.2 vs. 9.8%; p = 0.8), but error types differed (p < 0.001). Incomplete and wrong unit errors were eradicated; duplicate orders increased. Dosing errors remained most common. A total of 27% of postimplementation errors were technology-generated. Implementation of SCIs alone was associated with significant reductions in infusion-related prescribing errors (29.0% [Epoch 1] to 14.6% [Epoch 2]; p < 0.001). Further reductions (8.4% [Epoch 4]) were identified after implementation of electronically generated infusion orders. Non-infusion error severity was unchanged (p = 0.13); fewer infusion errors reached the patient (p < 0.01). No errors causing harm were identified. Conclusion The limitations of electronic prescribing in reducing overall prescribing errors in PICU have been demonstrated. The replacement of weight-based infusions with SCIs was associated with significant reductions in infusion prescribing errors. Technology-generated errors were common, highlighting the need for on-going research on HIT implementation in pediatric settings.

Automated Dispensing Cabinet Functionality Expansion to Reduce Controlled Substance Inventory Discrepancies

2021 ◽  
pp. 001857872110613
Author(s):  
James A. M. Rhodes ◽  
Bryan C. McCarthy ◽  
Anthony C. Scott
Keyword(s):  
Medication Use ◽  
Error Rates ◽  
Before And After ◽  
Quasi Experimental ◽  
Unit Dose ◽  
Controlled Substance ◽  
The University ◽  
The Impact ◽  
Dispensing Error ◽  
Dispensing Errors

Background: Automated dispensing cabinets have the potential to create technology-induced errors that can arise during controlled substance medication dispensing. Despite enhancements made to the medication use process, the impact of ADC functionality on technology-induced controlled substance discrepancies have yet to be described. Objective: To evaluate the impact of ADC functionality expansion on technology-induced errors such as controlled substance discrepancies created during “blind inventory counts” and cassette dispensing errors. Methods: This quasi-experimental study was conducted over 18 months that evaluated the expanded use of dispensing cassettes within 8 ADCs at the University of Chicago Medicine. Unit-dose controlled substances with high usage were directed for inventory reassignment to cassettes. Controlled substance dispenses, blind inventory counts discrepancies and cassette dispensing errors were evaluated before and after cassette expansion. ADC discrepancy and Cassette Dispensing Error rates were calculated using 1-week segments across the study period. Results: Of the 64 040 dispenses during the study period, the proportion of cassette dispenses increased from 16% to 72% after cassette expansion. Controlled substance discrepancies decreased from 11 to 7 discrepancies for every 1000 dispenses ( P < .0001). After cassette expansion, cassette dispensing errors increased to roughly 28 errors for every 1000 dispenses ( P < .0001). Conclusion: Expansion of ADC functionality created opportunities for reduced technology-induced controlled substance discrepancy rates at the expense of increased cassette dispensing errors.

Comparative analysis of the impact of blood collection systems on the results of the study of indicators hemostasis system

2020 ◽  
Vol 65 (10) ◽  
pp. 607-610
Author(s):  
O. V. Petrova ◽  
O. V. Dymova ◽  
D. K. Tverdokhlebova ◽  
E. V. Smeltsova ◽  
E. V. Panova ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Visual Assessment ◽  
Blood Collection ◽  
Exclusion Criteria ◽  
Coagulation Tests ◽  
Before And After ◽  
Parametric Statistics ◽  
Inflammatory Drugs ◽  
The Impact ◽  
Routine Coagulation

Comparative analysis of the impact of blood collection systems on the results of routine coagulation tests. The aim of this study was to conduct comparative analysis of the effects of blood collection systems on the results of routine coagulation tests. The study involved practically healthy women over 18 years of age female (n=30). Inclusion criteria: practically healthy individuals. Exclusion criteria: taking non-steroidal anti-inflammatory drugs, or oral contraceptives. Blood collection was carried out in the following systems: 1 system-Vacuette Premium,2 system- Improvacuter, 3 system- BD Vacutainer® Plus. Before and after centrifugation, visual assessment of tubes was performed.No signs for the presence of clots, hemolysis, or insufficient filling was observed. In each sample we measured prothrombin time (PV, sec), activated partial thromboplastin time (APTT, sec), and fibrinogen (F, g/l) by clotting method on the automatic coagulometer «Sta Compact» («Diagnostica Stago», France). The results of laboratory analyses were processed using parametric and non - parametric statistics using The Statistica 12.0 software. At the preanalytical laboratory stage, there were no differences when using systems for blood sampling: the clots and hemolysis were not detected in the samples, the level of filling of the sistems was sufficient. Comparative analysis revealed small, though statistically significant, differences for: PT when comparing Improvacuter wiht Vacuette Premium or BD Vacutainer®; APPT when comparing Improvacuter wiht Vacuette Premium. No differences were observed for Fg levels. Our results support the data available in the literature on the effects of blood-taking systems on hemostasis , which should be taken into account when purchasing blood collection systems.

scholarly journals Impact of a participatory program to reduce noise in a Neonatal Unit

2012 ◽  
Vol 20 (1) ◽  
pp. 109-116 ◽  
Author(s):  
Nelma Ellen Zamberlan-Amorim ◽  
Cristina Ide Fujinaga ◽  
Vanderlei José Hass ◽  
Luciana Mara Monti Fonseca ◽  
Cinira Magali Fortuna ◽  
...  
Keyword(s):  
Intervention Program ◽  
Sound Pressure ◽  
Statistical Tests ◽  
Neonatal Unit ◽  
University Hospital ◽  
Sound Pressure Levels ◽  
Before And After ◽  
Quasi Experimental ◽  
Level Of Significance ◽  
The Impact

This study evaluated the impact of a participatory program to reduce noise in a neonatal intermediate care unit of a university hospital. A time-series quasi-experimental design was used, in which sound pressure levels were measured before and after the intervention was implemented using the Quest-400 dosimeter. Non-parametric statistical tests were used to compare noise with the level of significance fixed at 5%. Results showed significant reduction of sound pressure levels in the neonatal unit after the intervention program was implemented (p<0.0001). The average Leq before the intervention was 62.5dBA and was reduced to 58.8dBA after the intervention. A reduction of 7.1dBA in the average Lmax(from 104.8 to 87.7dBA) and of 30.6dBA in the average Lpeak(from 138.1 to 107.5dBA) was observed. The program was proven to be effective in significantly reducing noise levels in the neonatal unit, although levels were still more intense than recommended.

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