scholarly journals The type and screen method of blood requisition in General Hospital Zrenjanin

2013 ◽  
Vol 66 (1-2) ◽  
pp. 58-63
Author(s):  
Ivana Tesic ◽  
Dusan Velisavljev ◽  
Dobrivoje Martinov
Keyword(s):  
General Hospital ◽  
Blood Products ◽  
High Quality ◽  
Screen Method ◽  
Whole Process ◽  
Exact Data ◽  
Number Of Patients ◽  
Before And After ◽  
Transfusion Ratio ◽  
Surgical Operations

Introduction. The basic principle of patient?s chemotherapy is that its performance is rational, safe and of high quality. In order to rationalize the whole process, the Transfusiology Committee has decided to introduce the Type and Screen method (typifying of blood types and screening of antibodies) in pre-transfusion testing in General Hospital ?Djordje Joanovic? in Zrenjanin. The method represents the strategy of clear defining and standardizing of the blood requirement process during various elective surgical operations. Material and Methods. In order to record chemotherapy efficiency, the following parameters are used: crossmatch/ transfusion ratio, transfusion probability and transfusion index. These parameters give us exact data that enable us to understand whether adequate blood requisition is made. The aforementioned parameters are followed both before and after the introduction of the Type and Screen method. Results. Since the Type and Screen method was introduced, the percentage of the reserved blood has been used more efficiently, i.e. the number of patients taken off the reservations list has been reduced, which can be seen from the correction of transfusion probability from 44.96 to 61.28 and transfusion index from 0.36 to 0.60. Crossmatch/transfusion ratio has changed from 2.33 to 1.81 after the Type and Screen method was introduced, which implies that deplasmatised erythrocytes reservation has been rationalized. Conclusion. By following the above parameters, data have been obtained which point to the rationalization in blood reservations, resulting in greater number of blood units available. The ?Type and Screen? list has become a standard in our hospital when it comes to blood products requisition.

scholarly journals Transfusion Medicine Informatics: Analysis of User Burden from Clinical Decision Support Alerts in Promoting Patient Blood Management

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S123-S124
Author(s):  
H C Tsang ◽  
P Mathias ◽  
N Hoffman ◽  
M B Pagano
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Blood Product ◽  
Clinical Decision ◽  
Blood Products ◽  
Blood Management ◽  
Before And After ◽  
Blood Utilization ◽  
Transfusion Ratio ◽  
Major Project

Abstract Introduction/Objective To increase efficiency of blood product ordering and delivery processes and improve appropriateness of orders, a major project to implement clinical decision support (CDS) alerts in the electronic medical record (EMR) was undertaken. A design team was assembled including hospital and laboratory medicine information technology and clinical informatics, transfusion services, nursing and clinical services from medical and surgical specialties. Methods Consensus-derived thresholds in hemoglobin/hematocrit, platelet count, INR, and fibrinogen for red blood cell (RBC), platelet, plasma, and cryoprecipitate blood products CDS alerts were determined. Data from the EMR and laboratory information system were queried from the 12-month period before and after implementation and the data was analyzed. Results During the analysis period, 5813 RBC (avg. monthly = 484), 1040 platelet (avg. monthly = 87), 423 plasma (avg. monthly = 35), and 88 cryoprecipitate (avg. monthly = 7) alerts fired. The average time it took for a user to respond was 5.175 seconds. The total amount of time alerts displayed over 12 months was 5813 seconds (~97 minutes of user time) compared to 56503 blood products transfused. Of active CDS alerts, hemoglobin/RBC alerts fired most often with ~1:5 (31141 RBC units) alert to transfusion ratio and 4% of orders canceled (n=231) when viewing the alert, platelet alerts fired with ~1:15 (15385 platelet units) alert to transfusion ratio and 6% orders canceled (n=66), INR/plasma alerts fired with ~1:21 (8793 plasma units) alert to transfusion ratio and 10% orders canceled (n=41), cryoprecipitate alerts fired with ~1:13 (1184 cryoprecipitate units) alert to transfusion ratio and 10% orders canceled (n=9). Overall monthly blood utilization normalized to 1000 patient discharges did not appear to have statistically significant differences comparing pre- versus post-go-live, except a potentially significant increase in monthly plasma usage at one facility with p = 0.34, although possibly due to an outlier single month of heavy usage. Conclusion Clinical decision support alerts can guide provider ordering with minimal user burden. This resulted in increased safety and quality use of the ordering process, although overall blood utilization did not appear to change significantly.

scholarly journals Role of clinical pharmacists in epilepsy management at a general hospital in Vietnam: a before-and-after study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Hong Tham Pham ◽  
Minh-Hoang Tran ◽  
Ngoc Quy Nguyen ◽  
Van Tan Vo ◽  
Manh Hung Tran
Keyword(s):  
General Hospital ◽  
Good Control ◽  
World Health ◽  
Secondary Outcome ◽  
Healthcare Team ◽  
Clinical Pharmacists ◽  
Drug Concentrations ◽  
Number Of Patients ◽  
Before And After ◽  
Before And After Study

Abstract Background Clinical pharmacists have an important role in inter-professional healthcare collaboration for epilepsy management. However, the pharmacy practices of managing epilepsy are still limited in Vietnam, deterring pharmacists from routine adjustments of antiepileptic drugs, which could decrease the patients’ quality of life. This study aimed to assess the effectiveness of pharmacist interventions in epilepsy treatment at a Vietnamese general hospital. Methods A before-and-after study was conducted from January 2016 to December 2018. All patients with a diagnosis of epilepsy and being treated at the investigated hospital were recruited and screened for eligibility and exclusion criteria. The primary outcome was the proportion of patients in good control of their epilepsy (with two seizures or less in a year). The secondary outcome was the number of patients maintaining optimized concentrations within the therapeutic range of carbamazepine (4–12 mg/L), phenytoin (10–20 mg/L), or valproic acid (50–100 mg/L). Collected data were analyzed using two proportions Z-test or Chi-square test. Results A total of 141 participants were enrolled in the study. While most patients were given lower prescribed daily doses than the recommendations from the World Health Organization, over 56% of the participants still experienced adverse drug effects. More than half of the patients received at least one pharmacists’ intervention, which increased by 25.0% the effectiveness of the therapy (p < 0.001) and by 14.6% the number of patients with optimized drug concentrations (p = 0.018). Conclusion Epilepsy management requires a multiple-stepped and comprehensive approach, with a focus on the health and safety of the patients. As part of the healthcare team, pharmacists need to engage at every stage to monitor the patient’s response and determine the most effective treatment with the fewest adverse drug reactions. Trial registration ClinicalTrials.gov, NCT04967326. Registered July 19, 2021—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04967326

Hemostatic Challenges In Patients Treated with Eltrombopag

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2511-2511 ◽  
Author(s):  
Michael D. Tarantino ◽  
Patrick F. Fogarty ◽  
Bhabita Mayer ◽  
Sandra Y. Vasey ◽  
Andres Brainsky
Keyword(s):  
Clinical Trials ◽  
Platelet Count ◽  
Research Funding ◽  
Bleeding Complications ◽  
Blood Products ◽  
Invasive Procedures ◽  
Platelet Counts ◽  
Chronic Itp ◽  
Number Of Patients ◽  
Before And After

Abstract Abstract 2511 Introduction: Chronic immune thrombocytopenia (ITP) is an autoimmune disease in which antiplatelet-antibodies induce platelet destruction and impair platelet production, resulting in chronically low platelet counts. Patients with chronic ITP may require invasive procedures associated with bleeding (hemostatic challenges) that cannot be undertaken if the platelet count is unacceptably low. Eltrombopag is an oral, nonpeptide, thrombopoietin receptor (TPO-R) agonist developed to increase platelet counts in various conditions associated with thrombocytopenia; its use may facilitate undertaking invasive procedures in patients with chronic ITP, reducing the need for additional supportive requirements including cellular blood products. Methods: Across the eltrombopag ITP clinical trials, information about hemostatic challenges was collected retrospectively (TRA100773A and B) and prospectively (REPEAT, RAISE, EXTEND). Basic demographic information, platelet counts before and after the procedures, type of procedure, need for additional treatment to increase platelet counts (one week before and after the intervention), use of blood products, and where possible, assessment of bleeding and bleeding complications were recorded. For the purpose of this analysis, minor invasive procedures (eg, dental cleaning, endoscopy, bone marrow biopsy) were distinguished from major invasive procedures (splenectomy, laparotomy, hip replacement, aortic aneurysm repair, arthroplasty). Results: Seventy-seven patients underwent 120 invasive procedures while enrolled in clinical trials with eltrombopag. The median age of patients undergoing invasive procedures was 54 years; the median duration of treatment at the time of all procedures was 131 days. 112 invasive procedures were performed in patients while receiving eltrombopag, compared to 8 procedures among patients while receiving placebo. 65 (54%) were considered to be major and 55 (46%) were considered to be minor. The median platelet count closest to minor or major invasive procedures in patients receiving eltrombopag was higher than in those receiving placebo (Table). For minor procedures, rescue ITP medication was required in 9/52 (17%) procedures in patients treated with eltrombopag and in 1/3 (33%) procedures in patients receiving placebo. For major procedures, rescue ITP medication was required in 14/60 (23%) procedures in patients treated with eltrombopag and 3/5 (60%) procedures in patients receiving placebo. One bleeding complication was reported in an eltrombopag-treated patient with colon cancer who, on the first post-operative day after a colectomy, experienced a pulmonary embolism requiring anticoagulation and had an intra-abdominal hemorrhage on post-operative day 2. Conclusions: No difference in use of periprocedural blood products between groups was discernable, possibly due to the low frequency of bleeding events reported. Although the number of patients who did not undergo procedures due to thrombocytopenia was not captured, data from 77 patients undergoing 120 invasive procedures suggest that by achieving a sustained platelet increase in patients with chronic ITP, eltrombopag facilitates the undertaking of medical and surgical procedures associated with bleeding. Disclosures: Tarantino: GlaxoSmithKline, Novo Nordisk, Talecris, Baxter, Cangene: Honoraria, Research Funding, Speakers Bureau. Fogarty: GlaxoSmithKline: Honoraria, Research Funding. Mayer: GlaxoSmithKline: Employment, Equity Ownership. Vasey: GlaxoSmithKline: Employment. Brainsky: GlaxoSmithKline: Employment.

scholarly journals AUDIT SYSTEM FOR USAGE OF BLOOD PRODUCT IN SANGLAH GENERAL HOSPITAL DENPASAR BALI

2019 ◽  
Vol 25 (3) ◽  
pp. 257
Author(s):  
Kadek Mulyantari ◽  
Teguh Triyono ◽  
Usi Sukorini
Keyword(s):  
Internal Medicine ◽  
General Hospital ◽  
Intervention Study ◽  
Blood Product ◽  
Blood Products ◽  
Prospective Audit ◽  
Audit System ◽  
Before And After ◽  
Post Test

Blood transfusion is one of very important therapy components. One indicator of the blood services quality in Sanglah  General Hospital Denpasar Bali Indonesia is achieving the target of unused blood order ≤ 10% per month. However, these targets have not been achieved. The number of unused blood orders reached 6,719 bags per year (600 bags per month or 21.5%). Unused blood orders is mostly from Department of Internal Medicine (40.9%), followed by Department of Surgical (35.6%),  Department of Obstetrics and Gynecology (15.5%) , and Department of Pediatrics (8%). The high number of unused blood orders can causes several problems such as the disorder of blood supply, inefficiency of pre-transfusion testing and decreased quality of blood product. Considering the consequences of high unused blood order, it is necessary to conduct a research on audit system for usage of blood product in Sanglah Hospital.The aim of study are to analyze the influence of audit system to reduce unused blood order and to decrease the number of C/T ratio. The study design was a pre and post test intervention study. The population in this study were all forming of blood requests in Sanglah Hospital. The sample is blood request form Department of Internal Medicine of the last two months. Intervention in this study was the development and dissemination of guidelines for usage of blood products, followed by concurrent audit and prospective audit of the sample.The study show there are decline of unused blood orders and C/T ratio before and after implementation of the audit system for usage of blood products. Reduction of unused blood order in Sanglah Hospital is 5.4%, and in the Department of Internal Medicine is 5.2%. The causes of unused blood orders were patient died, overestimation of blood order, transfusion delays because waiting for the schedule of hemodialysis, the patient has a fever, blood product has expired, and the occurrence of administration errors. Reduction of C/T ratio in Sanglah Hospital is 0,094 and in the Department of Internal Medicine is 0,072. Audit system for usage of blood products can reduce unused blood orders and decrease C/T ratio.

Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

2020 ◽  
pp. 1-6
Author(s):  
Paul Park ◽  
Victor Chang ◽  
Hsueh-Han Yeh ◽  
Jason M. Schwalb ◽  
David R. Nerenz ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Spinal Surgery ◽  
Readmission Rate ◽  
Rating Scale ◽  
Short Term ◽  
Readmission Rates ◽  
Opioid Prescribing ◽  
Number Of Patients ◽  
Before And After ◽  
The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

Real Earnings Management before and after Reporting SOX 404 Material Weaknesses

2015 ◽  
Vol 30 (1) ◽  
pp. 119-141 ◽  
Author(s):  
Tuukka Järvinen ◽  
Emma-Riikka Myllymäki
Keyword(s):  
Earnings Management ◽  
Internal Control ◽  
Internal Controls ◽  
Real Earnings Management ◽  
Public Disclosure ◽  
High Quality ◽  
The Public ◽  
Material Weaknesses ◽  
Internal Control System ◽  
Before And After

SYNOPSIS The purpose of this study is to investigate whether SOX Section 404 material weaknesses manifest in real earnings management behavior. The empirical findings indicate that, compared to companies with effective internal controls, companies with existing material weaknesses in their internal controls engage in more manipulation of real activities (particularly inventory overproduction). This implies that the weak commitment by management to provide effective internal control system and high-quality financial information relates to a tendency to use real earnings management methods. Moreover, we find evidence suggesting that companies employ real earnings management (overproduction and reduction of discretionary expenses) after disclosing previous year's material weaknesses. We conjecture that the public disclosure of material weaknesses induces management to strive to mitigate the expected negative reactions of stakeholders to the disclosure by engaging in real earnings management, which is not easily detected or constrained by outsiders. Overall, this study suggests that material weaknesses in internal controls signal an environment where management is more inclined to employ real earnings management.

Improving Genetics Clinic Efficiency and Capacity Using Design and Human Factors Methods

2021 ◽  
Vol 10 (1) ◽  
pp. 204-210
Author(s):  
Maryam Attef ◽  
Mireille Cloutier ◽  
Meredith Gillespie ◽  
Chantal Trudel ◽  
Kym Boycott
Keyword(s):  
Human Factors ◽  
Task Analysis ◽  
Healthcare Providers ◽  
Time On Task ◽  
Prenatal Genetics ◽  
Factors Influencing ◽  
Number Of Patients ◽  
Clinic Efficiency ◽  
Before And After ◽  
Improve Access

This quality improvement study focused on developing an understanding of factors influencing the ability of prenatal genetics counsellors (GCs) to efficiently see patients during the COVID-19 pandemic and strategies to improve their workflow using techniques from human factors and design. The demand for Prenatal Genetics Clinics is rising which has increased pressure on GCs to become more efficient. Genetics counsellors can improve access to their services by reducing the time spent on the tasks performed before and after a genetic counselling encounter, thereby increasing the number of patients they see. We were limited to certain methods to understand the differences in workflow before and during the COVID-19 pandemic. This study involved a literature review, archival analysis of workflow studies conducted before the pandemic, stakeholder meetings and mapping, a brainstorming session, as well as documenting time-on-task in a diary and naturalistic observation sessions. A task analysis was developed to identify factors influencing efficiency related to the design of the space, processes and the use of artefacts. Virtual and on-site workflows show that GCs spend at least half of their time on tasks before and/or after the patient’s appointment. Looking at potential inefficiencies or bottlenecks in workflow formed the development of a strategic plan for improving GC workflows at the prenatal Genetics Clinic. Improvements suggested through this analysis were constrained to support the current number of healthcare providers working within the existing space configuration.

Coronary Care in a General Hospital

1971 ◽  
Vol 16 (3) ◽  
pp. 173-182 ◽  
Author(s):  
Gavin Shaw ◽  
Bernard Groden ◽  
Evelyn Hastings
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
General Hospital ◽  
First Year ◽  
Duration Of Stay ◽  
Before And After ◽  
The Mean ◽  
Coronary Care ◽  
Made In

The establishment, staffing and structure and observations made in the first year of the existence of coronary care in an intensive care unit in a general hospital are recorded. Two hundred and twenty eight patients were admitted during the year in whom the diagnosis of myocardial infarction was confirmed. There were 29 deaths in the unit and 14 deaths occurred in the wards of the hospital after discharge from the unit. 49.1 per cent of the patients were admitted within 4 hours of the onset of symptoms and the mean duration of stay in the unit was 86.5 hours. The type of arrhythmia detected in the unit, and the treatment given to the patients both before and after admission to the intensive care unit are described.

Evaluating a bereavement support group

2008 ◽  
Vol 6 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Nancy C. Maruyama ◽  
Clarisa V. Atencio
Keyword(s):  
General Hospital ◽  
Support Group ◽  
Negative Emotions ◽  
Hospital Setting ◽  
Bereavement Support ◽  
Men And Women ◽  
Before And After ◽  
Bereavement Support Group

ABSTRACTObjective:To assess the feasibility of an 8-week bereavement support group in a general hospital setting.Methods:We assessed grief and mood before and after an 8-week bereavement support group and compared dropouts to completers. Forty-seven participants filled out mood and grief questionnaires. Scores were compared with norms, then baseline and follow-up scores were analyzed by paired t tests. Fifteen dropouts' scores were compared with completers' baseline scores.Results:Participants' grief improved, as did depression in women but not men. Women dropouts scored significantly higher on Anger, Tension/Anxiety.Significance of results:Findings suggest men and women respond differently to bereavement groups. Bereaved individuals with high anger and tension may require interventions addressing their particular needs, with a focus on acceptance of negative emotions.

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