scholarly journals Path of least resistance: how computerised provider order entry can lead to (and reduce) wasteful practices

2018 ◽  
Vol 7 (2) ◽  
pp. e000345 ◽  
Author(s):  
Joseph Choi ◽  
Cori Rebecca Atlin
Keyword(s):  
Blood Count ◽  
Complete Blood Count ◽  
Clinical Care ◽  
Work Flow ◽  
Quality Improvement Initiative ◽  
Order Entry ◽  
Clinical Value ◽  
Careful Planning ◽  
Order Sets ◽  
Before And After

BackgroundComputerised provider order entry (CPOE) is rapidly becoming the mainstay in clinical care and has the potential to improve provider efficiency and accuracy. However, this hinges on careful planning and implementation. Poorly planned CPOE order sets can lead to undetected errors and waste. In our emergency department (ED), lactate dehydrogenase (LDH) was bundled into various blood work panels but had little clinical value.ObjectivesThis quality improvement initiative aimed to reduce unnecessary LDH testing in the ED.MethodsA group of ED physicians reviewed CPOE blood work panels and uncoupled LDH in conditions where it was deemed not to provide any clinically useful information. We measured the daily number of LDH tests performed before and after its removal. We tracked the frequency of other serum tests as controls. We also analysed the number of add-on LDH (ie, to add LDH to samples already sent to the lab) as a balancing measure, since this can disrupt work flow and delay care.ResultsThrough this intervention, we reduced the number of LDH tests performed by 69%, from an average of 75.1 tests per day to 23.2 (P<0.0005). The baseline controls did not differ after the intervention (eg, a complete blood count was performed 197.7 and 196.1 times per day preintervention and postintervention, respectively (P=0.7663)). There was less than one add-on LDH per day on average.ConclusionsCPOE care templates can be powerful in shaping behaviours and reducing variability. However, close oversight of these panels is necessary to prevent errors and waste.

scholarly journals P019: The path of least resistance: how computerized provider order entry can lead to (and reduce) wasteful practices

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S63-S63
Author(s):  
J. Choi
Keyword(s):  
Complete Blood Count ◽  
Clinical Care ◽  
Cost Savings ◽  
Quality Improvement Initiative ◽  
Order Entry ◽  
Clinical Value ◽  
Post Intervention ◽  
Computerized Provider Order Entry ◽  
Order Sets ◽  
Before And After

Introduction: Background Computerized provider order entry (CPOE) is rapidly becoming the mainstay in clinical care and has the potential to improve provider efficiency and accuracy. However, this hinges on careful planning and implementation. Poorly planned CPOE order sets can lead to undetected errors and waste. In our emergency department (ED), lactate dehydrogenase (LDH) was bundled into various blood work panels, but had little clinical value. Aim Statement This quality improvement initiative aimed to reduce unnecessary LDH testing in the ED. Methods: Methods A group of ED physicians reviewed CPOE blood work panels and uncoupled LDH in conditions where it was deemed not to provide any clinically useful information. We measured the daily number of LDH tests performed before and after its removal. We tracked the frequency of other serum tests as controls. We also analyzed the number of add-on LDH (i.e. to add LDH to samples already sent to the lab) as a balancing measure, since this can disrupt work flow and delay care. Results: Results Through this intervention, we reduced the number of LDH tests performed by 69%, from an average of 75.1 tests per day to 23.2 (p<0.0005). The baseline controls did not differ after the intervention (e.g. a complete blood count was performed 197.7 and 196.1 times per day pre- and post-intervention, respectively [p=0.7663]). There was less than 1 add-on LDH per day on average. This translates to a cost savings of $33,340.65 at our institution. Conclusion: Conclusions CPOE care templates can be powerful in shaping behaviours and reducing variability. However, close oversight of these panels is necessary to prevent errors and waste.

Implementation of Computerized Provider Order Entry (CPOE) Does Not Impact Provider Work Time in An Inpatient Malignant Hematology Service

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4704-4704
Author(s):  
David A Hanauer ◽  
Sung W Choi ◽  
Robert W Beasley ◽  
Ronald B Hirschl ◽  
Douglas W Blayney
Keyword(s):  
Patient Care ◽  
Training Session ◽  
Direct Patient Care ◽  
Order Entry ◽  
Time And Motion Study ◽  
Time And Motion ◽  
Motion Study ◽  
Order Sets ◽  
Before And After ◽  
The Impact

Abstract No data are available concerning the impact of CPOE on inpatient leukemia and lymphoma care. CPOE may improve patient safety, reduce time between order entry and medication administration, and reduce medication and transcription errors. However, concerns have arisen about potential increased time required to enter electronic orders compared to handwritten orders. Our hypothesis was that CPOE would require more order-related time from caregivers, and reduce the amount of time for direct patient care. We studied the work patterns of three Physician Assistants (PAs) who worked under the supervision of faculty physicians, and were the exclusive inpatient care providers. The PA-staffed hematology service was chosen to minimize the impact of rotating house staff on our results. Faculty, who were not studied, entered the few chemotherapy orders necessary, while PAs entered orders for hydration, antibiotics, supportive care and other medications, and for consultations and diagnostic tests. The UMHS Institutional Review Board reviewed the study protocol and waived the requirement for patient informed consent. We performed a direct observation time and motion study pre- and post-implementation of a commercial CPOE system (Sunrise Clinical Manager™ 4.5, Eclipsys, Boca Raton, Florida) on one inpatient hematology service at the UMHS University Hospital. The same three PAs were shadowed pre- and post-implementation. We also closely matched morning and afternoon observation times in order to reduce variability in activities taking place at different times of the day. Prior to CPOE implementation the PAs had a 4 hour general training session and a 1 hour chemotherapy training session. Pre-built order sets were routinely used by the PAs. A portable tablet computer was used by an independent observer to record data, using a data entry interface containing 63 individual activity categories modified from the Time and Motion database under “IT Tools” at http://www.ahrq.gov. Data were grouped into subcategories for analysis. We grouped 12 activities as ordering-related (e.g. writing orders, writing forms, clarifying orders, etc.) We observed the same three PAs for 85.4 hours (over 2 weeks) pre, and for 75.8 hours (over 4 weeks) starting 3 months post-CPOE. Mean patient census was 11.3 per day pre- and 9.2 per day post implementation observation periods. Overall time for order-related activities was unchanged, requiring 7.7% of total time pre- and 8.1% of total time post-CPOE even though actual order writing took longer with CPOE compared to written (4.9% pre vs. 7.0% post). CPOE had almost no impact on direct patient care time (Figure), with PAs spending 38.2% total time on direct patient care pre-CPOE compared to 38.4% post. A minimal difference was also found with the overall total for indirect patient care activities (37.1% pre vs. 38.7% post). Our results suggest that using CPOE on a busy hematology inpatient service has minimal impact on time spent by trained PAs using standard order sets 3 months after implementation. The decision to adopt CPOE for a busy hematology service should not be based on the hypothesis that there will be a change in workflow or task organization. More study is needed to determine if CPOE for hematology patients results in a change in the quality of patient care or safety. Figure. Percentage of total time spent in 6 analysis categories both before and after implementation of a commercial CPOE system for an inpatient hematology service. These 6 categories represent 63 individual activities categories that were recorded in the time and motion study. Error bars represent 95% confidence intervals. Figure. Percentage of total time spent in 6 analysis categories both before and after implementation of a commercial CPOE system for an inpatient hematology service. These 6 categories represent 63 individual activities categories that were recorded in the time and motion study. Error bars represent 95% confidence intervals.

scholarly journals The Efficiency of Rectal Fluid Therapy in Moderately Dehydrated Horses

2018 ◽  
Vol 75 (1) ◽  
pp. 73
Author(s):  
Patricia AȘTELEAN ◽  
Eva DIUGAN ◽  
Cristian MOLNAR ◽  
Orsolya SÁRPATAKI ◽  
Răzvan CODEA ◽  
...  
Keyword(s):  
Fluid Therapy ◽  
Blood Count ◽  
Animal Species ◽  
Complete Blood Count ◽  
Rectal Administration ◽  
Response To Therapy ◽  
Blood Samples ◽  
Before And After ◽  
Life Threatening ◽  
Laboratory Investigations

Dehydration and hydro-electrolytic imbalances are relatively common and life threatening conditions in many animal species including horses. In the present study, we highlighted the efficacy of rectal rehydration in horses, nowadays less commonly used. The study was performed on eight non-pregnant mares (Romanian semigreus and Lipiţan breeds), from Beclean horse stud farm, affected by mild dehydration. The method consists in rectal administration in the form of a high enema of a balanced polyionic solution by using an esophageal tube; the solution contains water, sodium chloride and potassium chloride. Blood samples were collected on EDTA and procoagulant vacutainers, before and after fluid therapy. Laboratory investigations include complete blood count and electrolytes measurement, total protein, albumin, and creatinine. Expectedly, dehydrated animals shown borderline elevated hematocrit associated with mild relative hyperproteinemia and hypernatremia, and elevated uremia levels. In all cases, the parameters were restored in response to therapy, and no side effects were recorded.

scholarly journals Investigating the genetic architecture of disease resilience in pigs by genome-wide association studies of complete blood count traits collected from a natural disease challenge model

BMC Genomics ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xuechun Bai ◽  
Tianfu Yang ◽  
Austin M. Putz ◽  
Zhiquan Wang ◽  
Changxi Li ◽  
...  
Keyword(s):  
Blood Cell ◽  
Genetic Architecture ◽  
Blood Count ◽  
Complete Blood Count ◽  
Association Studies ◽  
Genome Wide Association ◽  
Genome Wide Association Studies ◽  
Genome Wide ◽  
Before And After ◽  
Genomic Regions

Abstract Background Genetic improvement for disease resilience is anticipated to be a practical method to improve efficiency and profitability of the pig industry, as resilient pigs maintain a relatively undepressed level of performance in the face of infection. However, multiple biological functions are known to be involved in disease resilience and this complexity means that the genetic architecture of disease resilience remains largely unknown. Here, we conducted genome-wide association studies (GWAS) of 465,910 autosomal SNPs for complete blood count (CBC) traits that are important in an animal’s disease response. The aim was to identify the genetic control of disease resilience. Results Univariate and multivariate single-step GWAS were performed on 15 CBC traits measured from the blood samples of 2743 crossbred (Landrace × Yorkshire) barrows drawn at 2-weeks before, and at 2 and 6-weeks after exposure to a polymicrobial infectious challenge. Overall, at a genome-wise false discovery rate of 0.05, five genomic regions located on Sus scrofa chromosome (SSC) 2, SSC4, SSC9, SSC10, and SSC12, were significantly associated with white blood cell traits in response to the polymicrobial challenge, and nine genomic regions on multiple chromosomes (SSC1, SSC4, SSC5, SSC6, SSC8, SSC9, SSC11, SSC12, SSC17) were significantly associated with red blood cell and platelet traits collected before and after exposure to the challenge. By functional enrichment analyses using Ingenuity Pathway Analysis (IPA) and literature review of previous CBC studies, candidate genes located nearby significant single-nucleotide polymorphisms were found to be involved in immune response, hematopoiesis, red blood cell morphology, and platelet aggregation. Conclusions This study helps to improve our understanding of the genetic basis of CBC traits collected before and after exposure to a polymicrobial infectious challenge and provides a step forward to improve disease resilience.

scholarly journals Investigating the genetic architecture of disease resilience in pigs by genome-wide association studies of complete blood count traits collected from a natural disease challenge model

2020 ◽  
Author(s):  
Xuechun Bai ◽  
Tianfu Yang ◽  
Austin Putz ◽  
Zhiquan Wang ◽  
Changxi Li ◽  
...  
Keyword(s):  
Blood Cell ◽  
Genetic Architecture ◽  
Blood Count ◽  
Complete Blood Count ◽  
Association Studies ◽  
Genome Wide Association ◽  
Genome Wide Association Studies ◽  
Genome Wide ◽  
Before And After ◽  
Genomic Regions

Abstract BackgroundGenetic improvement for disease resilience is anticipated to be a practical method to improve efficiency and profitability of the pig industry, as resilient pigs maintain a relatively undepressed level of performance in the face of infection. However, multiple biological functions are known to be involved in disease resilience and this complexity means that the genetic architecture of disease resilience remains largely unknown. Here, we conducted genome-wide association studies (GWAS) of 465,910 autosomal SNPs for complete blood count (CBC) traits that are important in an animal’s disease response. The aim was to identify the genetic control of disease resilience.ResultsUnivariate and multivariate single-step GWAS were performed on fifteen CBC traits measured from the blood samples of 2743 crossbred (Landrace × Yorkshire) barrows drawn at 2-weeks before, and at 2 and 6-weeks after exposure to a polymicrobial infectious challenge. Overall, at a genome-wise false discovery rate of 0.05, five genomic regions located on Sus scrofa chromosome (SSC) 2, SSC4, SSC9, SSC10, and SSC12, were significantly associated with white blood cell traits in response to the polymicrobial challenge, and nine genomic regions on multiple chromosomes (SSC1, SSC4, SSC5, SSC6, SSC8, SSC9, SSC11, SSC12, SSC17) were significantly associated with red blood cell and platelet traits collected before and after exposure to the challenge. By functional enrichment analyses using Ingenuity Pathway Analysis (IPA) and literature review of previous CBC studies, candidate genes located nearby significant single-nucleotide polymorphisms were found to be involved in immune response, hematopoiesis, red blood cell morphology, and platelet aggregation.ConclusionsThis study helps to improve our understanding of the genetic basis of CBC traits collected before and after exposure to a polymicrobial infectious challenge and provides a step forward to improve disease resilience.

scholarly journals Reducing redundant creatine kinase testing in cardiac injury

2020 ◽  
Vol 9 (4) ◽  
pp. e001182
Author(s):  
Sheharyar Raza ◽  
Andre C Amaral ◽  
Jeffrey Pang ◽  
Fuad Moussa ◽  
Dominick Shelton ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Low Cost ◽  
Cardiac Injury ◽  
Cost Savings ◽  
High Volume ◽  
Quality Improvement Initiative ◽  
Successful Implementation ◽  
Clinical Value ◽  
Root Cause ◽  
Order Sets

BackgroundCreatine kinase (CK) testing in the setting of suspected cardiac injury is commonly performed yet rarely provides clinical value beyond troponin testing. We sought to evaluate and reduce CK testing coupled with troponin testing by 50% or greater.MethodsWe performed root cause analysis to study prevailing processes and patterns of CK testing. We developed new institutional guidelines, removed CK from high-volume paper and electronic order bundles and conducted academic detailing for departments with highest ordering frequency. We evaluated consecutive patients at Sunnybrook Health Sciences Centre between 1 January 2018 and 31 March 2020 who had either a CK or troponin level measured. We prespecified successful implementation as a reduction of 50% in total CK orders and a decrease in the ratio of CK-to-troponin tests to one-third or less. We retained additional data beyond our study period to assess for sustained reductions in testing.ResultsTotal CK tests decreased over the study period from 3963 to 2111 per month, amounting to a 46.7% reduction (95% CI 33.2 to 60.2; p<0.001) equalling 61 fewer tests per hospital day. Troponin testing did not significantly change during the intervention. Ratio of CK-to-troponin tests decreased from 0.91 to 0.49 (p<0.001). The reduction coincided with changes to order-sets, was observed across all clinical units and was sustained during additional months beyond the study period. These reductions in testing resulted in a projected annual cost savings of C$28 446.ConclusionsWe demonstrate that a low-cost and feasible quality improvement initiative may lead to significant reduction in unnecessary CK testing and substantial savings in healthcare costs for patients with suspected cardiac injury.

scholarly journals Complete Blood Count before and after Total Hip or Knee Arthroplasty

2015 ◽  
Vol 23 (2) ◽  
pp. 209-212 ◽  
Author(s):  
Devin M Jagow ◽  
Shahan V Yacoubian ◽  
Stephan V Yacoubian
Keyword(s):  
Knee Arthroplasty ◽  
Blood Count ◽  
Complete Blood Count ◽  
Total Hip ◽  
Before And After

scholarly journals Evaluation of Complete Blood Count Parameters Before and After Appendectomy

2019 ◽  
Vol 35 (3) ◽  
pp. 143-146
Author(s):  
Burak Katipoğlu ◽  
Togay Evrin ◽  
Ayhan Sümer Yaman
Keyword(s):  
Blood Count ◽  
Complete Blood Count ◽  
Before And After

scholarly journals The Effect of Extreme Cold on Complete Blood Count and Biochemical Indicators: A Case Study

2021 ◽  
Vol 19 (1) ◽  
pp. 424
Author(s):  
Aneta Teległów ◽  
Valerjan Romanovski ◽  
Beata Skowron ◽  
Dawid Mucha ◽  
Łukasz Tota ◽  
...  
Keyword(s):  
Blood Count ◽  
Cold Water ◽  
Complete Blood Count ◽  
Circulatory System ◽  
Cold Temperatures ◽  
Blood Indices ◽  
Before And After ◽  
Negative Effect ◽  
The Subject ◽  
Extreme Cold

Regular exposure to a cold factor—cold water swimming or ice swimming and cold air—results in an increased tolerance to cold due to numerous adaptive mechanisms in humans. Due to the lack of scientific reports on the effects of extremely low outdoor temperatures on the functioning of the human circulatory system, the aim of this study was to evaluate complete blood count and biochemical blood indices in multiple Guinness world record holder Valerjan Romanovski, who was exposed to extremely cold environment from −5 °C to −37 °C for 50 days in Rovaniemi (a city in northern Finland). Valerjan Romanovski proved that humans can function in extremely cold temperatures. Blood from the subject was collected before and after the expedition. The subject was found to have abnormalities for the following blood indices: testosterone increases by 60.14%, RBC decreases by 4.01%, HGB decreases by 3.47%, WBC decreases by 21.53%, neutrocytes decrease by 17.31%, PDW increases by 5.31%, AspAT increases by 52.81%, AlAT increase by 68.75%, CK increases by 8.61%, total cholesterol decreases by 5.88%, HDL increases by 28.18%. Percentage changes in other complete blood count and biochemical indices were within standard limits. Long-term exposure of the subject (50 days) to extreme cold stress had no noticeable negative effect on daily functioning.

scholarly journals Hemoglobin, Hematocrit, Leukocyte, and Platelet Changes Due To Ultrafiltrationhemodialysis in Chronic Kidney Disease Patients

2020 ◽  
Vol 26 (3) ◽  
Author(s):  
Nathalya Dwi Kartikasari ◽  
Paulus Budiono Notopuro ◽  
Widodo Widodo ◽  
Yetti Hernaningsih
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Blood Count ◽  
Complete Blood Count ◽  
Proper Time ◽  
Cross Sectional Study ◽  
Blood Sampling ◽  
Sectional Study ◽  
Cross Sectional ◽  
Before And After

Managing anemia in Chronic Kidney Disease (CKD) patients with hemodialysis (HD) is a challenge to physicians. The present consensus does not address the proper time of blood sampling in HD patients, but higher ultrafiltration (UF) volume (a process of removing fluid excess during HD) may alter hematologic parameters. The objective of this study was to compare some parameters of the Complete Blood Count (CBC); hemoglobin (Hb), hematocrit (Hct), leukocyte (WBC), and platelet counts (Plt) before and after HD. This method was a cross-sectional study performed in the HD Unit, Dr.Soetomo Hospital, including 51 CKD patients selected consecutively, divided into two groups based on the UF volume (2 L and >2 L). Complete blood count pre- and post-HD were measured using Sysmex XN 1000. The results were 25 males and 26 females in this study, age ranged from 20 to 74-year-old, and 36 patients with UF volume >2 L. Only HD with UF >2 L showed significant increases for Hb (9.35g/dL to 10.00 g/dL), Hct (29.80% to 31.15 %), and Plt (209.00x103/µL to 213.00x103/µL) but WBC did not change significantly. These changes were believed to be caused by ultrafiltration. The conclusion was Hb, Hct, and Plt increased significantly with UF ≥2 L in HD CKD patients.

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