Chemistry and haematology sample rejection and clinical impact in a tertiary laboratory in Cape Town

2011 ◽  
Vol 49 (12) ◽  
Author(s):  
Lourens A. Jacobsz ◽  
Annalise E. Zemlin ◽  
Mark J. Roos ◽  
Rajiv T. Erasmus
Keyword(s):  
Patient Care ◽  
Clinical Care ◽  
Rejection Rate ◽  
Turnaround Time ◽  
Sample Volume ◽  
Clinical Impact ◽  
Phase Identification ◽  
Laboratory Errors ◽  
Retrospective Audit ◽  
The Impact

AbstractRecent publications report that up to 70% of total laboratory errors occur in the pre-analytical phase. Identification of specific problems highlights pre-analytic processes susceptible to errors. The rejection of unsuitable samples can lead to delayed turnaround time and affect patient care.A retrospective audit was conducted investigating the rejection rate of routine blood specimens received at chemistry and haematology laboratories over a 2-week period. The reasons for rejection and potential clinical impact of these rejections were investigated. Thirty patient files were randomly selected and examined to assess the impact of these rejections on clinical care.A total of 32,910 specimens were received during the study period, of which 481 were rejected, giving a rejection rate of 1.46%. The main reasons for rejection were inappropriate clotting (30%) and inadequate sample volume (22%). Only 51.7% of rejected samples were repeated and the average time for a repeat sample to reach the laboratory was about 5 days (121 h). Of the repeated samples, 5.1% had results within critical values. Examination of patient folders showed that in 40% of cases the rejection of samples had an impact on patient care.The evaluation of pre-analytical processes in the laboratory, with regard to sample rejection, allowed one to identify problem areas where improvement is necessary. Rejected samples due to factors out of the laboratory’s control had a definite impact on patient care and can thus affect customer satisfaction. Clinicians should be aware of these factors to prevent such rejections.

The effect of automated hemolysis index measurement on sample and test rejection rates

2019 ◽  
Vol 44 (5) ◽  
pp. 630-634
Author(s):  
Fazıla Atakan Erkal ◽  
Güzin Aykal ◽  
Hayriye Melek Yalçınkaya ◽  
Nihal Aksoy ◽  
Murat Özdemir
Keyword(s):  
Biochemical Analysis ◽  
Rejection Rate ◽  
Public Health Care ◽  
Sample Number ◽  
Laboratory Errors ◽  
Index Measurement ◽  
Preanalytical Phase ◽  
The Impact ◽  
Rejection Rates

Abstract Objective Vast majority of laboratory errors occurs in preanalytical phase and in vitro hemolysis is the most common among preanalytical errors. Automated serum index measurement is being used in routine biochemical analysis in Antalya Public Health Care Laboratory, since June 2014. Our aim in this study is to reveal the impact of serum index usage on rejected samples and rejected test rates due to hemolysis. Materials and methods Hemolysis, icterus and lipemia (HIL) spectral interference reagent and program have been used in our laboratory since June 2014. In the current study, the number of samples and tests that were rejected due to hemolysis in June–August 2014 were compared with those rejected in the same period of 2013. Results In 2014, the sample rejection rate was 2.53% and the rejected test rate was 0.48%. In 2013, the sample rejection rate was 0.56% and the rejected test rate was 0.55%. When compared two periods, statistically significant increase in rejected sample number due to hemolysis in 2014 is result of, visually undetectable hemolyzed samples previously can be identified by HIL method (p<0.05). Conclusion Usage of hemolysis index program in automated systems for detecting hemolysis was evaluated as a method which is standardized, semi-quantitative, with high reproducibility and allows test based rejection.

Improving Patient Safety through the Use of Nursing Surveillance

2017 ◽  
Vol 51 (s2) ◽  
pp. 34-43 ◽  
Author(s):  
Karen K. Giuliano
Keyword(s):  
Patient Care ◽  
Clinical Care ◽  
Warning System ◽  
Rapid Response Team ◽  
Hospital Length ◽  
Rapid Response ◽  
Hospital Length Of Stay ◽  
Clinical Implications ◽  
Response Team ◽  
The Impact

Surveillance and monitoring each represent a distinct process in patient care. Monitoring involves observation, measurement, and recording of physiological parameters, while surveillance is a systematic, goal-directed process based on early detection of signs of change, interpretation of the clinical implications of such changes, and initiation of rapid, appropriate interventions. Through use of an illustrative clinical example based on Early Warning System scoring and rapid response teams, this article seeks to distinguish between nurse monitoring and surveillance to demonstrate the impact of surveillance on improving both care processes and patient care. Using a clinical example, differences between surveillance and monitoring as a trigger for deployment of the rapid response team were reviewed. The use of surveillance versus monitoring resulted in a mean reduction in rapid response team deployment time of 291 minutes. The median hospital length of stay for patients whose clinical care included using surveillance to initiate the deployment of the rapid response team was reduced by 4 days. Monitoring relies on observation and assessment while nursing surveillance incorporates monitoring with recognition and interpretation of the clinical implications of changes to guide decisions about subsequent actions. The clinical example described here supports that the use of an automated surveillance system versus monitoring had a measurable impact on clinical care.

scholarly journals Comparing the Efficiency of Software-Based Speech Recognition Versus Traditional Telephone Transcription in an Outpatient Physical Medicine and Rehabilitation Practice

2020 ◽  
Vol 185 (7-8) ◽  
pp. e1183-e1186
Author(s):  
Amir Minerbi ◽  
Markus Besemann ◽  
Tom Kari ◽  
Christina Gentile ◽  
Gaurav Gupta
Keyword(s):  
Speech Recognition ◽  
Health Services ◽  
Clinical Care ◽  
Armed Forces ◽  
Turnaround Time ◽  
Report Generation ◽  
Significance Level ◽  
Written Text ◽  
Canadian Armed Forces ◽  
The Impact

ABSTRACT Introduction Speech recognition (SR) uses computerized word recognition software that automatically transcribes spoken words to written text. Some studies indicate that SR may improve efficiency of electronic charting as well as associated cost and turnaround time1,2, but it remains unclear in the literature whether SR is superior to traditional transcription (TT). This study compared the impact of report generation efficiency of SR to TT at the Canadian Armed Forces Health Services Centre. Materials and Methods Dragon Medical Dictation™ SR software and traditional telephone dictation TT were used for two prespecified clinical days per week. In order to adjust for note length, total transcription efficacy was calculated as follows: word count/[dictation time + correction time]. The means and standard deviations were then separately calculated for TT visits and for SR visits. Differences in transcription efficacy and in visit measures, including patient demographics, visit duration, number of issues raised during the visit, and interventions performed, were compared using ANOVA, with the significance level set to 0.05. Results A total of 340 consecutive visits were analyzed; 198 were dictated over the phone using TT and 142 were transcribed using SR software. Dictation efficacy was significantly higher (p &lt; 0.0001) for TT as compared to SR, while turnaround times were shorter for SR (0.12 versus 4.75 days). Conclusions In light of these results, the Canadian Forces Health Services Centre in Ottawa has returned to use of TT because the relative inefficiency of report generation was deemed to have a greater impact on clinical care when compared to slower dictation turnaround time.

scholarly journals 1717. The Impact of Routine Molecular Point-of-care Testing for Gastrointestinal Pathogens in Adults Hospitalized With Suspected Gastroenteritis: Results of a Pragmatic Randomized Controlled Trial (GastroPOC)

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S51-S51
Author(s):  
Ahalya Malachira ◽  
Kate Beard ◽  
Nathan Brendish ◽  
Tristan Clark
Keyword(s):  
Infection Control ◽  
Point Of Care ◽  
Controlled Trial ◽  
Clinical Care ◽  
Infection Control Measure ◽  
Group Versus ◽  
Antibiotic Use ◽  
Turnaround Time ◽  
Control Group ◽  
The Impact

Abstract Background Adults hospitalised with diarrhoea are routinely isolated as an infection control measure, but many have non-infectious etiology. Side room facilities are a limited resource in hospitals. Routine laboratory testing takes several days to generate results but rapid molecular platforms can test comprehensively for GI pathogens and generate a result in 1 hour, making them deployable as point-of-care tests (POCT). POCT could reduce unnecessary isolation facility use in addition to other benefits. Methods In this pragmatic, pilot randomised controlled trial, adults hospitalised with suspected gastroenteritis were recruited and randomised 1:1 to receive either POCT (using the FilmArray GI panel) or routine clinical care. Results of POCT were communicated directly to clinical and infection control teams. The primary outcome was duration of time in a side room and secondary outcomes included turnaround time, proportion of patients with a pathogen detected, proportion of patients correctly de-isolated, time to de-isolation, antibiotic use and length of hospital stay. Results 140 patients were recruited. Groups (n = 70) were well matched in terms of baseline characteristics. The median [IQR] turnaround time for results was 1.7 [1.6–2.3] hours in the POCT group and 61 [49–84] hours in the control group, P &lt; 0.0001. Pathogens were detected in 44% of patients in the POCT group and 23% in the control group; P = 0.012. Overall the duration of side room isolation was 1.9 [1.0–2.9] days in the POCT group compared with 2.7 [1.8–5.1] days in the control group; P = 0.001. For those testing negative for pathogens this was 1.3 [0.8–2.5] days in the POCT group versus 2.7 [1.8–5.0] days in the control group, P &lt; 0.0001. 63% of pathogen-negative patients were correctly de-isolated in the POCT group versus 28% in the control group, P = 0.0012. Antibiotic use and length of stay data will be available subsequently. Conclusion POCT using the FilmArray GI panel resulted in a substantially reduced turnaround time for results and an increase in the proportion of patients with pathogens correctly detected. POCT was associated with a reduction in the duration of unnecessary side room use. If these benefits are confirmed in further studies and cost effectiveness is demonstrated, molecular POCT for GI pathogens should replace current diagnostic pathways. Disclosures T. Clark, BioFire LLC: Collaborator, Research support and Speaker honorarium. NIHR: Grant Investigator, Grant recipient.

scholarly journals Hospital Libraries Have a Positive Impact on Clinical Decision Making and Patient Care

2007 ◽  
Vol 2 (4) ◽  
pp. 104 ◽  
Author(s):  
Martha I. Preddie
Keyword(s):  
Decision Making ◽  
Rural Communities ◽  
Patient Care ◽  
Sample Size ◽  
Clinical Decision Making ◽  
Positive Impact ◽  
Clinical Care ◽  
Clinical Decision ◽  
Sources Of Information ◽  
The Impact

A review of: Marshall, Joanne Gard. “The Impact of the Hospital Library on Clinical Decision Making: the Rochester Study.” Bulletin of the Medical Library Association 80.2 (1992): 169-78. Objective – To determine the impact of hospital library services on clinical decision making. Design – A descriptive survey. Setting – Fifteen hospitals in the Rochester area of New York, United States of America. Seven hospitals were in the city of Rochester, and eight were in surrounding rural communities. Subjects – Active physicians and residents affiliated with the Rochester hospitals. Methods – This study built upon the methodology used in an earlier study by D. N. King of the contribution of hospital libraries to clinical care in Chicago. Lists were compiled of all the active physicians and residents who were affiliated with the Rochester hospitals. In order to ensure that there was a reasonable number of participants from each hospital, and that librarians in hospitals with larger numbers of staff were not overburdened with requests, predetermined percentages were set for the sample: 10% of active physicians from hospitals with more than 25 medical staff members, 30% from hospitals with less staff, and 30% of residents and rural physicians. This resulted in a desirable sample size of 448. A systematic sample with a random start was then drawn from each hospital’s list, and physicians and residents were recruited until the sample size was achieved. Participants were asked to request information related to a clinical case from their hospital library, and to evaluate its impact on patient care, by responding to a two-page questionnaire. Main results – Based on usable questionnaires, there was an overall response rate of 46.4% (208 of 448). Eighty percent of the respondents stated that they probably (48%) or definitely (32.4%) handled a clinical situation differently due to the information received from the library. In terms of the specific aspects of care for which changes were made, 71.6% reported a change in advice given to the patient, 59.6% cited a change in treatment, 50.5% a change in diagnostic tests, 45.2% a change in drugs, and 38.5% a change in post-hospital care or treatment. Physicians credited the information provided by the library as contributing to their ability to avoid additional tests and procedures (49%), additional outpatient visits (26.4%), surgery (21.2%), patient mortality (19.2%), hospital admission (11.5%), and hospital-acquired infections (8.2%). In response to a question about the importance of several sources of information, the library received the highest rating amidst other sources including lab tests, diagnostic imaging, and discussions with colleagues. Conclusion – This study validates earlier research findings that physicians view the information provided by hospital libraries as having a significant impact on clinical decision making. Library supplied information influences changes to specific aspects of care as well as the avoidance of adverse events for patients. The significance of this influence is underscored by the finding that relative to other sources, information obtained from the hospital library was rated more highly.

Utility of Schwartz Center Rounds in fostering compassion, communication, teamwork, and caregiver support

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20640-e20640
Author(s):  
P. Mann ◽  
L. Schapira ◽  
T. Lynch ◽  
R. Penson
Keyword(s):  
Patient Care ◽  
Social Issues ◽  
Clinical Care ◽  
Cancer Center ◽  
Clinical Aspects ◽  
Structured Interviews ◽  
Caregiver Support ◽  
Emotional Issues ◽  
The Impact ◽  
Insight Into

e20640 Background: Schwartz Center Rounds are a multidisciplinary forum where clinicians discuss difficult emotional and social issues that arise in caring for patients with the goal of improving the patient-caregiver relationship. Rounds were initiated at the MGH Cancer Center in 1997 and have since grown to include 165 sites including 24 cancer centers nationwide. We report on a recent evaluation of the impact of Rounds. Methods: The Schwartz Center Rounds evaluation focused on three major research questions: 1) Do professional caregivers have increased insight into the non-clinical aspects of care after attendance at Rounds? 2) Is there increased teamwork among caregivers after attendance? 3) Do caregivers perceive increased support after attendance at Rounds? The evaluation included a retrospective survey of 256 caregivers at six sites where Rounds had existed for ≥ 3 years; 44 semi-structured interviews with participants at these sites; and pre/post surveys of 222 caregivers from ten hospitals newly implementing Rounds. Results: The highest percentage of attendees were nurses (35%), followed by physicians (23%), social workers (15%), psychologists (4%), physical therapists (6%) and clergy (5%). After attending Rounds, participants reported increased insight into psychosocial aspects of care; enhanced compassion; increased ability to respond to patients’ social and emotional issues; enhanced communication amongst caregivers; greater appreciation of colleagues’ roles and contributions. Attendees reported decreased feelings of stress and isolation and a greater sense of teamwork. Participants reported that Rounds discussions led to changes in institutional practices or policies. Conclusions: Schwartz Center Rounds provide a forum for discussion of challenging psychosocial and emotional issues arising during clinical care. Evaluation data suggests this educational strategy may enhance compassion, professional support, communication, teamwork, and instigate institutional changes that enhance patient care. We are currently exploring other outcomes, including but not limited to the impact of rounds on quality of patient care and patient safety. [Table: see text]

Frozen Section Diagnosis in Pediatric Surgical Pathology: A Decade's Experience in a Children's Hospital

2005 ◽  
Vol 129 (12) ◽  
pp. 1619-1625 ◽  
Author(s):  
Cheryl M. Coffin ◽  
Krista Spilker ◽  
Holly Zhou ◽  
Amy Lowichik ◽  
Theodore J. Pysher
Keyword(s):  
Lymph Node ◽  
Patient Care ◽  
Ganglion Cell ◽  
Children And Adolescents ◽  
Hirschsprung Disease ◽  
Turnaround Time ◽  
Clinical Impact ◽  
Tumor Classification ◽  
Surgical Pathology ◽  
Children's Hospital

Abstract Context.—Intraoperative consultations, including frozen sections (FSs), are essential for patient care and are a key quality component in anatomic pathology. Little data exists about the use, frequency, and type of discrepancies and deferral rates of FS diagnoses in pediatric and adolescent surgical pathology. Objective.—The purpose of this study was to analyze indications, discrepancies, and deferrals for all FSs performed at a children's hospital during a 10-year period. Design.—All FSs for 1995–2004 were reviewed for indications, discrepancies, deferred diagnoses, and turnaround time. Discrepancies were categorized into major and minor subtypes according to potential impact on patient care. Results.—A total of 35 611 surgical pathology cases were accessioned, with 2839 intraoperative consultations, which included 2783 FSs and 56 nonmicroscopic consultations. Most frequent indications included questions related to neoplasms (tumor detection, specimen adequacy, triage, classification, and margins) and suspected Hirschsprung disease. In these consultations, 115 discrepancies (4%) were identified, of which 7 (0.2%) were major, with potentially significant clinical impact, and 108 (3.9%) were minor. The major discrepancies included tumor, ganglion cell, or organism detection. The minor discrepancies involved sampling error, reclassification of benign or malignant neoplasms without clinical consequences, tumor typing or grading, and ganglion cell identification without clinical impact. Deferrals in 718 FSs (25% deferral rate) included tumor classification from generic to specific, identification of organisms, and evaluation of lymph node biopsies for lymphoma. Turnaround time exceeded 20 minutes in 403 cases (14%). Conclusions.—The FS rate of 7.8% overall and 5% of surgical pathology cases is similar in children's and general hospitals. The major discrepancy (discordance) rate is lower, which may reflect the different indications for FS in children and adolescents. Evaluation of colonic biopsies for ganglion cells is a diagnostic pitfall. The deferral rate of 25% reflects the definition of a deferred diagnosis. Traditional definitions of deferred and discordant FS diagnoses should be refined to reflect the increasing use of adjunct techniques, especially in tumor classification. These findings emphasize that, in children and adolescents, most FSs are performed for tumor classification, triage, detection, and specimen adequacy, and for possible Hirschsprung disease. In children and adolescents, FSs are used infrequently to identify normal or unknown tissue, to analyze a lesion in a radiographically directed specimen, or to detect lymph node metastases. The differences in pediatric and adolescent FS indications and use underscore the importance of focused education in pediatric surgical pathology.

scholarly journals Molecular Detection of Mycobacterium tuberculosis: Impact on Patient Care

2001 ◽  
Vol 47 (8) ◽  
pp. 1553-1558 ◽  
Author(s):  
Karen L Kaul
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Patient Care ◽  
Molecular Detection ◽  
Clinical Care ◽  
Antibiotic Sensitivity ◽  
Cost Of Care ◽  
Pcr Assay ◽  
Smear Negative ◽  
Pcr Assays ◽  
The Impact

Abstract Background: Nucleic acid amplification technologies such as PCR are revolutionizing the detection of infectious pathogens such as tuberculosis (TB). Amplification technology offers the potential for the diagnosis of TB in a few hours with a high degree of sensitivity and specificity. However, molecular assays neither replace nor reduce the need for conventional smear and culture, speciation, and antibiotic sensitivity assays. Methods: We undertook prospective studies of sputum samples to assess the performance of two PCR-based assays for the detection of TB as well as the impact of more rapid availability of test results on patient care. Results: The sensitivity of both the in-house and Amplicor PCR assays was 100% for smear-positive sputa. For smear-negative sputa (two sputum samples collected during the first 24 h of hospitalization), the sensitivity was 85% for our in-house PCR assay and 74% for the Roche PCR assay. Approximately 10% of the smear- and culture-negative sputa yielded positive PCR results; however, more than one-half of these were positive with both the in-house and Amplicor assays, suggesting the presence of TB DNA or organisms. Several of these came from patients whose other samples grew Mycobacterium tuberculosis during the same admission, and others came from patients who had previously treated TB. Overall, the specificities of the in-house and Amplicor PCR assays in smear-negative patients were 86% and 93%, respectively. Conclusions: Molecular detection of slow-growing pathogens such as M. tuberculosis have the potential to improve clinical care through a dramatic reduction in the time required for detection and may provide substantial savings in the overall cost of care of a patient compared with conventional smear, culture, and speciation alone, despite the fact that conventional assays must still be performed for speciation of nontuberculous mycobacteria and for full assessment of antibiotic sensitivity.

scholarly journals Clinical impact of the etoposide injection shortage

2019 ◽  
Vol 26 (1) ◽  
pp. 187-192
Author(s):  
Hualy Li ◽  
Sarah K Cimino
Keyword(s):  
Adverse Events ◽  
Patient Care ◽  
Disease Progression ◽  
Medication Errors ◽  
The United States ◽  
Clinical Impact ◽  
Drug Shortage ◽  
Treatment Delays ◽  
Drug Shortages ◽  
The Impact

Purpose Drug shortages have become a constant challenge in patient care over the past two decades. In 2018, there was a shortage of etoposide injection in the United States. The purpose of this study was to analyze the impact of the etoposide injection shortage. Methods This single-center, retrospective chart review included patients prescribed an etoposide-containing chemotherapy regimen between January 2018 and August 2018. The primary objective was to determine the percentage of patients who required a change in treatment due to the etoposide injection drug shortage. For the secondary objectives, the following was compared between patients who received etoposide injection versus alternative etoposide formulations (etopophos injection or oral etoposide): adverse events, medication errors, treatment delays, disease progression, and drug costs. Results Twenty-two patients were included in this study. Overall, seven (32%) patients required a change in treatment due to the etoposide injection shortage. Of the seven patients, six required the use of an alternative etoposide formulation and one patient had etoposide omitted in at least one treatment cycle. There were no significant differences in adverse events, medication errors, treatment delays, or disease progression when comparing patients who received etoposide injection versus alternative etoposide formulations. The average drug cost per cycle was significantly higher in the patients who required a change in treatment. Conclusions To our knowledge, this is the first study to characterize the clinical impact of the etoposide injection shortage. Results from this study highlight the direct impact that drug shortages have on patient care.

The impact of a post-operative clinical care pathway on head and neck microvascular free tissue transfer outcomes

2020 ◽  
Vol 134 (2) ◽  
pp. 150-158 ◽  
Author(s):  
R Mhawej ◽  
B M Harmych ◽  
J J Houlton ◽  
M E Tabangin ◽  
J Meinzen-Derr ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Patient Care ◽  
Head And Neck ◽  
Care Pathway ◽  
Clinical Care ◽  
Length Of Hospital Stay ◽  
Free Tissue Transfer ◽  
Tissue Transfer ◽  
Clinical Care Pathway ◽  
The Impact

AbstractObjectiveTo study the impact of a clinical care pathway and computerised order set on short-term post-operative outcomes for patients undergoing head and neck free tissue transfer.MethodsIn this retrospective cohort study, patients who underwent head and neck free tissue transfer by a single reconstructive surgeon between January 2007 and July 2009 were assigned to one of two cohorts based on the timing of their surgery: pre- or post-clinical care pathway implementation. Measured outcomes included peri-operative complications and mortality, length of hospital stay and costs, unplanned reoperations, and readmissions within 30 days of discharge.ResultsThe pre-clinical care pathway cohort included 81 patients and the post-clinical care pathway cohort comprised 46. Implementation of the clinical care pathway was associated with decreased variability in length of hospital stay (median (interquartile range) = 8 (6, 11) vs 7 (6, 9) days). The post-clinical care pathway cohort also had a significantly lower unplanned reoperation rate (15.2 vs 35.8 per cent, p = 0.01).ConclusionA clinical care pathway is a successful means of standardising and improving complex patient care. In this study, care pathway implementation in head and neck free tissue transfer patients improved efficiency and the quality of patient care.

Sign in / Sign up

Export Citation Format

Share Document