Where is my sample? Investigating pre-analytical pathology sampling errors in a psychiatric hospital

AimsErrors in the pathology sampling process can be costly for all stakeholders in any clinical setting; however, this process is often overlooked within psychiatry. Over the space of just a few short months at Hollins Park Psychiatric Hospital (HPH) such errors were reported to be numerous with staff raising multiple issues relating to the pathology sampling process. These issues often had a negative impact on patient care, leading to outcomes such as as re-bleeding of patients and delays in interventions. Here, we aim to identify the predominant sources of error in this process and suggest possible improvements to minimise these errors in the future.MethodInitially, we mapped and analysed each step of the sampling process as it is currently performed in order to identify areas of possible improvement. We then distributed questionnaires to all junior doctors - who are responsible for the handling of samples within the clinical setting – in order to establish error type and frequency. Questions also assessed individual confidence and familiarity with the sampling process.ResultWhen mapping the sampling process, we identified all key steps required when sending samples from HPH to Warrington and Halton Hospitals laboratory. This included one pathway for sending routine bloods, and one pathway for urgent bloods. The process for sending routine bloods required more steps and ultimately took longer for samples to reach the laboratory – as expected. Of the issues identified during mapping of the pre-analytical phase, a majority of 77.7% of clinicians reported samples had gone missing or were unreported – with the reasons for this being undetermined in most cases – and 55.5% reported their samples never reached the lab. While on the whole participants were comfortable with the steps involved in sending samples to the laboratory, 77.7% were not aware of the requirement to log samples as they were being sent.ConclusionThe reasons underlying errors in the sampling process at HPH were multifactorial and included a lack of clinician familiarity with correct procedure, poor sample recording/tracking and lengthy transit times between the patient and laboratory. Here we outline some simple evidence-based recommendations (including education of staff and improved tracking through an electronic requesting system) to help reduce errors and streamline the sampling process in the hopes of improving both efficiency and accuracy, reducing the financial and clinical impact.

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PRACTICALAPPLICATION OF SIX SIGMA DMAIC METHODOLOGY IN EVALUATION OF PRE-ANALYTICAL QUALITY INDICATORS IN LABORATORY SETTINGS

10.36106/ijar/5300443 ◽

2021 ◽

pp. 1-3

Author(s):

Shailesh Gahukar ◽

Gitika Gitika ◽

Ashok Kumar

Keyword(s):

Quality Indicators ◽

Six Sigma ◽

Rejection Rate ◽

Visual Aids ◽

Sampling Errors ◽

Analytical Quality ◽

Form Errors ◽

Phase Errors ◽

Sampling Process ◽

Analytical Phase

The Six Sigma is a global management methodology that empowers clinical laboratories by better understanding of the quality in their laboratories and helps in improving quality and subsequently reducing laboratory costs. The objective of this prospective study was to practically apply Six Sigma on pre-analytical quality indicators i.e. pre-analytical phase errors of “Total Testing Process” in laboratory at PGIMER Satellite Centre, Sangrur (Punjab). In this study Six Sigma DMAIC ( Dene, Measure, Analyse, Improvement and Control) methodology was applied on routine Outpatient Department (OPD) samples received in hematology and biochemistry laboratory from May, 2020 to July, 2020 after institutional ethical committee permission. Pre-analytical phase errors were taken as pre-analytical quality indicators and were broadly classied in to requisition form and sampling errors. Sigma values and frequencies were calculated using Westgard formula present online at (www. westgard.com > six sigma calculators) for pre-analytical phase errors. After that Improvement phase of DMAIC methodology was done by training of laboratory technicians or personell involved in pre-analytical phase by audio-visual aids. Six Sigma values were calculated again after improvement phase. A total of 787 requisition forms and 1105 samples were studied before improvement phase and 889 requisition forms and 1400 samples were studied after improvement phase. Before improvement phase, overall requisition form errors were working at 2.9 sigma and sampling process was working at 3.1 sigma but after improvement phase, requisition form errors were working at 3.3 sigma and sampling process was working at 3.5 sigma. Before and after improvement phase the sample rejection rate in laboratory improved from 1.90% to 0.93% highlighting the benecial concept of six sigma in laboratory in pre-analytical phase leading to increased clinicians and patients'satisfaction and prevents unusual delaying of reports.

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Analysis of False-Negative and Underreported Smears in the Florence District Screening Program for Cervical Carcinoma

Tumori Journal ◽

10.1177/030089169708300602 ◽

1997 ◽

Vol 83 (6) ◽

pp. 880-883 ◽

Cited By ~ 3

Author(s):

Massimo Confortini ◽

Stefano Ciatto ◽

Lucia Bonardi ◽

Paolo Bulgaresi ◽

Maria Paola Cariaggi ◽

...

Keyword(s):

Quality Control ◽

Screening Program ◽

False Negative ◽

Population Based ◽

Sampling Errors ◽

Error Type ◽

Interpretation Errors ◽

Cellular Abnormalities ◽

Screening Errors ◽

Study Setting

Aims and background To review false-negative or underreported (reactive changes, squamous or glandular atypia) smears performed in women developing histologically proven CIN2 or more severe lesions within 24 months and evaluate error causes. The study setting was the Florence District cervical cancer population-based screening: about 60,000 women age 25–60 years screened per year. Methods 118 false-negative or underreported cases were identified at screening files-cancer Registry matching, and the original smears were reviewed by six independent readers to judge smear adequacy and error type. Results Sampling errors (reported as inadequate, negative or less severe than CIN1 at review) accounted for 74% and screening/interpretation errors (reported as CIN1 or more severe at review) accounted for 26% of studied cases. Screening/interpretation errors were more likely ascribed to misinterpretation and underreporting than to mis-perception of cellular abnormalities. Conclusions Quality control should above all address the problem of sampling adequacy. Due to the rarity of misperceived abnormalities (true screening errors), manual or automated rescreening of negative smears would not be an effective procedure for quality control.

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No negative impact of word retraining on vocabulary use or clarity of communication in Semantic Dementia

10.31234/osf.io/74sx2 ◽

2021 ◽

Author(s):

Sharon Savage ◽

Leonie F. Lampe ◽

Lyndsey Nickels

Keyword(s):

Picture Naming ◽

Target Item ◽

Negative Impact ◽

Semantic Dementia ◽

Group Level ◽

Post Intervention ◽

Error Type ◽

Consistent Change ◽

Negative Impacts ◽

Omission Errors

Word retraining techniques can improve picture naming of treated items in people with semantic dementia (SD). The utility of this, however, has been questioned given the propensity for under- and overgeneralisation errors in naming in SD. Few studies have investigated the occurrence of such errors. This study examined whether, following tailored word retraining: 1) misuse of words increases, 2) the type of naming errors changes, and/or 3) clarity of communication is reduced. Performance on trained and untrained word naming from nine participants with SD who completed a word retraining program were analysed. Responses from baseline and post-intervention assessments were coded for misuse (i.e., trained word produced for another target item), error type, and communication clarity. All participants showed significant improvement for trained vocabulary. There was no significant increase in misuse of words, with such errors occurring rarely. At a group level, there was an increased tendency toward omission errors for untrained items, and a reduction in semantically related responses. However, this did not impact on clarity scores with no consistent change across participants. In sum, we found no negative impacts following tailored word retraining, providing further evidence of the benefit of these programs for individuals with SD.

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Emerging Trends in English among Youths in Nigeria – An Exploratory Study

International Journal of Applied Linguistics & English Literature ◽

10.7575/aiac.ijalel.v.8n.4p.70 ◽

2019 ◽

Vol 8 (4) ◽

pp. 70

Author(s):

Chinomso P. Dozie ◽

Ijeoma C. Ojilere

Keyword(s):

Social Media ◽

English Language ◽

Negative Impact ◽

Questionnaire Data ◽

Tertiary Institutions ◽

Sampling Process ◽

Emerging Trends ◽

Validated Questionnaire ◽

Deliberate Learning ◽

Potential Impact

The study explored the potential impact of emerging trends in the formal written English language of youths which hitherto is uninvestigated in South-east Nigeria. Through a random sampling process, 2000 copies of pretested and validated questionnaire written in English were administered to undergraduates at five federal universities in south-east Nigeria. In addition, print-out of a couple of group conversations on Facebook and WhatsApp and Key Person Interview (KPI) was used to supplement the questionnaire data. In all, 1940 copies of questionnaire representing 97.00% were completed and returned for analysis. Results showed that emerging trends in written English conversation as social media convention is common among students in tertiary institutions. Findings revealed that 98.87% of participants used emerging trends during classes which indicates a massive infiltration of formal written English with social media trivialities while a statistically significant 34.54% have had to use these emerging trends though unconsciously during exams which reflects their deep and deliberate learning of these most potentially contentious tools of informal written conversation. Ultimately, the study confirmed that activities on social media was taking its toll on the students’ performance in written English as they can no longer tell the appropriateness of one variety or another. In conclusion, the study established that emerging trends have profound negative impact on written English and recommends that teachers/instructors must make purposeful efforts to unteach that which has been wrongly learned by insisting that students begin to imbibe the culture of standard and formal writing regardless of the purpose of the writing.

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The effect of the EWTD on training in general surgery: an analysis of electronic logbook records

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363507x177045 ◽

2007 ◽

Vol 89 (3) ◽

pp. 106-109 ◽

Cited By ~ 28

Author(s):

T Bates ◽

E Cecil ◽

I Greene

Keyword(s):

Negative Impact ◽

Junior Doctors ◽

Training Time ◽

Duty Hours ◽

Hands On ◽

Hours Of Work ◽

The Hours ◽

Electronic Logbook ◽

The Uk ◽

The New Deal

The introduction of time-limited surgical training in the UK in 1994 following the Calman report raised concerns over the hands-on experience of trainees, heightened by the hours reduction demanded by the New Deal. From 1994, junior doctors' on-duty hours of work for hard-pressed posts were targeted to a limit of 56 hours but SpRs were allowed a voluntary extension from 73 on-duty hours to a maximum of 83 hours per week. By 1995 concern was being expressed at the reduction in training time and continuity of patient care and although calls for more targeted training were made, evidence of a negative impact on training has continued to surface.

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Materials Properties: Heterogeneity and Appropriate Sampling Modes

Journal of AOAC International ◽

10.5740/jaoacint.14-234 ◽

2015 ◽

Vol 98 (2) ◽

pp. 269-274 ◽

Cited By ~ 4

Author(s):

Kim H Esbensen

Keyword(s):

Sampling Error ◽

Special Section ◽

Heterogeneous Materials ◽

Heterogeneous Material ◽

Project Managers ◽

Sampling Errors ◽

Sampling Process ◽

Food And Feed ◽

Theory Of Sampling ◽

Regulatory Bodies

Abstract The target audience for this Special Section comprises parties related to the food and feed sectors, e.g., field samplers, academic and industrial scientists, laboratory personnel, companies, organizations, regulatory bodies, and agencies who are responsible for sampling, as well as project leaders, project managers, quality managers, supervisors, and directors. All these entities face heterogeneous materials,and the characteristics of heterogeneous materials needs to be competently understood by all of them. Before delivering analytical results for decision-making, one form or other of primary sampling is always necessary, which must counteract the effects of the sampling target heterogeneity. Up to five types of sampling error may arise as a specific sampling process interacts with a heterogeneous material; two sampling errors arise because of the heterogeneity of the sampling target, and three additional sampling errors are produced by the sampling process itself—if not properly understood, reduced, and/or eliminated, which is the role of Theory of Sampling. Thispaper discusses the phenomenon and concepts involvedin understanding, describing, and managing the adverse effects of heterogeneity in sampling.

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What are the non-technical skills required by junior doctors in the NHS to manage medical emergencies? A scoping review

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-139285 ◽

2021 ◽

pp. postgradmedj-2020-139285

Author(s):

Ying Xin Tan ◽

Arif Hanafi Bin Jalal ◽

Victoria Ngai ◽

Nivetha Manobharath ◽

Terrence Chi Fang Soh

Keyword(s):

Thematic Analysis ◽

Negative Impact ◽

Current Knowledge ◽

Technical Skills ◽

Medical Emergency ◽

Junior Doctors ◽

Handling Stress ◽

Scoping Reviews ◽

Medical Emergencies ◽

Meta Analyses

Many junior doctors have reported a lack of confidence in managing emergency conditions. However, there is insufficient literature summarising the current knowledge about the non-technical skills needed by junior doctors to tackle medical emergencies. This paper aims to identify the non-technical skills necessary for the management of medical emergencies by junior doctors. Three databases were systematically searched to identify relevant articles published between January 2000 and March 2020. In total, 8707 unique articles were identified and independently screened by at least two authors, using predetermined inclusion and exclusion criteria. A coding framework was applied to extract relevant data and for thematic analysis of the included studies. These methods have been performed following the PRISMA-ScR Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. There were a total of 13 articles included in the thematic analysis. The result of this review was the identification of several key non-technical skills: teamwork, communication, asking for help, challenging seniority, task prioritisation, decision-making, leadership and handling stress. In conclusion, lack of non-technical skills in junior doctors has a negative impact on patient care in a medical emergency. The training of junior doctors can be re-evaluated and designed to reflect the importance of these non-technical skills.

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Protocol for the Implementation and Evaluation of a Mindfulness-Based Intervention for Caregivers of Children with Mental Disorders in a Clinical Setting

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182010777 ◽

2021 ◽

Vol 18 (20) ◽

pp. 10777

Author(s):

Ana Pizarro-Carmona ◽

Sofía Baena ◽

Patricia Jiménez ◽

Lucía Jiménez

Keyword(s):

Mental Health ◽

Stress Reduction ◽

Clinical Setting ◽

Intervention Program ◽

Mental Health Problems ◽

Negative Impact ◽

Psychological Impact ◽

Health Problems ◽

Mindfulness Based Stress Reduction ◽

Structured Program

Being a parent is complicated in typical circumstances, with a great psychological impact as well as feelings and experiences of great intensity. This impact is greater in families in vulnerable situations, such as those with children with mental health problems, receiving treatment in a clinical setting. Due to these challenges, parenting in these circumstances is often accompanied by experiences of stress. An approach that has shown evidence of effectiveness in mitigating the negative impact of stress is mindfulness-based interventions, including the Mindfulness-Based Stress Reduction intervention program. The Mindfulness-Based Stress Reduction intervention program is designed as a psychoeducational, instructional, multimodal, and structured program whose main objective is to provide strategies for the management, coping, and awareness of stress in order to reduce it. In this paper, a protocol for the implementation and evaluation of the original Mindfulness-Based Stress Reduction intervention program with the added positive parenting component is presented, in order to systematize the incorporation of a parenting component in the Mindfulness-Based Stress Reduction intervention program, analyze its effectiveness for parents whose children have mental health problems (in terms of stress, mindfulness, emotional intelligence, general health, and parental role), explore the mechanisms of change operating in this intervention as perceived by the participants, and examine the application of acquired strategies to daily life.

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Smartphone Usage Amongst Doctors In The Clinical Setting: A Cross-Sectional Comparative Study Between Two Culturally Distinct Countries (Preprint)

10.2196/preprints.22599 ◽

2020 ◽

Author(s):

Anjali Ajay Nair ◽

Samreen Afroz ◽

Bushra Urooj Ahmed ◽

Uzma Urooj Ahmed ◽

Chi Chung Foo ◽

...

Keyword(s):

Clinical Setting ◽

Online Survey ◽

University Hospital ◽

Western World ◽

Medical Applications ◽

Junior Doctors ◽

Patient Privacy ◽

Ethical Guidelines ◽

Cross Sectional ◽

Medical Apps

BACKGROUND Smartphone and medical applications have seen a surge in popularity in recent years which has also been reflected in the healthcare system. Despite increased reliance amongst clinicians however, limited research has been conducted on the uptake and impact of smartphone usage in the medical practice especially outside the Western world. OBJECTIVE This study aims to identify the usage of smartphones and medical apps by doctors in the clinical setting in two culturally distinct countries, King Hamad University Hospital (KHUH), Bahrain and Queen Mary Hospital (QMH), Hong Kong. METHODS A cross-sectional study was conducted where doctors in both hospitals were asked to take part in a 15-item online survey. The questions were categorized into the following groups: the demographics of the study population, ownership and main use of smartphones, the number and names of medical apps currently owned, rating usage of smartphones for medical purposes, time spent on a smartphone related to clinical use, clinical reliance of smartphones, and views on further integration of smartphones. The results were then tabulated and analyzed using SPSS Statistics 25 for Mac (IBM, USA). RESULTS A total of 200 doctors were surveyed with a total of 99% (99/100) of the doctors owning a smartphone in both KHUH and QMH. 57.6% (57/99) and 54.5% (54/99) of the doctors from KHUH and QMH respectively identified communication as their main use of smartphones in the clinical setting (P= .004). Doctors from KHUH were likely to spend more time on medical apps than doctors from QMH (P = .002). According to the overall result of both the hospitals, 47.8% (32/67) of the junior doctors claimed high reliance on smartphones whereas only 32.3% (41/127) of the seniors said the same (P = .03). 78% (78/100) and 69% (69/100) of doctors in KHUH and QMH either strongly agreed or agreed that smartphones need to be integrated into the clinical setting. In terms of preferences for future apps, 48% and 56% of the doctors in KHUH and QMH respectively, agreed that more medical applications need to be created in order to support smartphone use in the clinical setting. CONCLUSIONS These results suggest a substantial acceptance of smartphone technology by doctors in clinical settings. This brings up the need to establish policies to integrate this technology officially in accordance with ethical guidelines. With more emphasis placed on creating medical applications that aid healthcare professionals in attaining their information from accurate sources and also regulate a system to monitor the usage of mobile devices within hospitals to prevent the breach of patient privacy and confidentiality.

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