scholarly journals Root cause analysis of delays to discharge for patients held for serial cardiac troponin levels

CJEM ◽  
2014 ◽  
Vol 16 (01) ◽  
pp. 20-24 ◽  
Author(s):  
Julian James Owen ◽  
Andrew Worster ◽  
Barbara Marie Waines ◽  
James Ward ◽  
Peter Kavsak ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Median Number ◽  
Turnaround Time ◽  
Blood Collection ◽  
Time Intervals ◽  
Root Cause ◽  
St Elevation ◽  
Event Times ◽  
Component Event ◽  
Causes Of Delays

ABSTRACTObjective:Emergency department (ED) patients with symptoms of cardiac ischemia often require a second cardiac troponin (cTn) measurement to rule out non–ST elevation myocardial infarction. We measured the total turnaround time and the component event times following the ordering of the second cTn level to ED discharge to identify root causes of delays.Methods:We reviewed a random sample of ED discharges following a second normal cTn measurement and recorded associated event times. The central tendency of time intervals is reported as median and mean number of minutes with interquartile ranges (IQRs) and 95% confidence intervals, respectively.Results:From 9,656 eligible cases, we randomly selected 226 for data collection. The median number of minutes for each event are as follows: from ordering the second cTn measurement to the time of ED discharge was 90 minutes (IQR 65–120); for blood collection from the time the collection was ordered for was 0 minutes (IQR 212–0); from blood collection to the time the blood was transported to the laboratory was 9 minutes (IQR 2–19); laboratory process duration was 44 minutes (IQR 39–52); from when the results were available to the time the patient was discharged was 30 minutes (IQR 15–52).Conclusions:For ED patients discharged following two normal cTn levels, the laboratory processing time and time from the result being available to the time of ED discharge represent the longest modifiable time periods to reduce ED length of stay.

scholarly journals Root cause analysis of laboratory turnaround times for patients in the emergency department

CJEM ◽  
2004 ◽  
Vol 6 (02) ◽  
pp. 116-122 ◽  
Author(s):  
Christopher M.B. Fernandes ◽  
Andrew Worster ◽  
Stephen Hill ◽  
Catherine McCallum ◽  
Kevin Eva
Keyword(s):  
Processing Time ◽  
Tertiary Care ◽  
Root Cause Analysis ◽  
Turnaround Time ◽  
Time Data ◽  
Cause Analysis ◽  
Order Processing ◽  
Root Cause ◽  
Event Times ◽  
Causes Of Delays

ABSTRACT Introduction: Laboratory investigations are essential to patient care and are conducted routinely in emergency departments (EDs). This study reports the turnaround times at an academic, tertiary care ED, using root cause analysis to identify potential areas of improvement. Our objectives were to compare the laboratory turnaround times with established benchmarks and identify root causes for delays. Methods: Turnaround and process event times for a consecutive sample of hemoglobin and potassium measurements were recorded during an 8-day study period using synchronized time stamps. A log transformation (ln [minutes + 1]) was performed to normalize the time data, which were then compared with established benchmarks using one-sample t tests. Results: The turnaround time for hemoglobin was significantly less than the established benchmark (n = 140, t = –5.69, p < 0.001) and that of potassium was significantly greater (n = 121, t = 12.65, p < 0.001). The hemolysis rate was 5.8%, with 0.017% of samples needing recollection. Causes of delays included order-processing time, a high proportion (43%) of tests performed on patients who had been admitted but were still in the ED waiting for a bed, and excessive laboratory process times for potassium. Conclusions: The turnaround time for hemoglobin (18 min) met the established benchmark, but that for potassium (49 min) did not. Root causes for delay were order-processing time, excessive queue and instrument times for potassium and volume of tests for admitted patients. Further study of these identified causes of delays is required to see whether laboratory TATs can be reduced.

Advancement in Data Engineering and Feature Processing Workflow by Using Deep Learning Techniques for the Automation of ESP Failure Root Cause Analyses

2021 ◽  
Author(s):  
Saniya Karnik ◽  
Navya Yenuganti ◽  
Bonang Firmansyah Jusri ◽  
Supriya Gupta ◽  
Prasanna Nirgudkar ◽  
...  
Keyword(s):  
Deep Learning ◽  
Failure Analysis ◽  
Language Processing ◽  
Turnaround Time ◽  
Process Efficiency ◽  
Root Cause ◽  
Feature Processing ◽  
Learning Techniques ◽  
Electrical Submersible Pump ◽  
Root Cause Identification

Abstract Today, Electrical Submersible Pump (ESP) failure analysis is a tedious, human-intensive, and time-consuming activity involving dismantle, inspection, and failure analysis (DIFA) for each failure. This paper presents a novel artificial intelligence workflow using an ensemble of machine learning (ML) algorithms coupled with natural language processing (NLP) and deep learning (DL). The algorithms outlined in this paper bring together structured and unstructured data across equipment, production, operations, and failure reports to automate root cause identification and analysis post breakdown. This process will result in reduced turnaround time (TAT) and human effort thus drastically improving process efficiency.

scholarly journals Autoantibodies to Cardiac Troponin Associate with Higher Initial Concentrations and Longer Release of Troponin I in Acute Coronary Syndrome Patients

2009 ◽  
Vol 55 (5) ◽  
pp. 938-945 ◽  
Author(s):  
Kim Pettersson ◽  
Susann Eriksson ◽  
Saara Wittfooth ◽  
Emilia Engström ◽  
Markku Nieminen ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Myocardial Damage ◽  
Prognostic Impact ◽  
Serum Samples ◽  
Igg Antibody ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Autoantibody Formation

Abstract Background: Cardiac troponin (cTn) is an established marker of myocardial infarction. Pronounced heterogeneity and the minute amounts released into the circulation constitute significant challenges for cTn detection. Recently, autoantibody formation to cTn was shown to be common and to interfere with immunoassay performance. In this study, we investigated cTn autoantibodies and cardiac troponin I (cTnI) in acute coronary syndrome (ACS) patients over a 1-year period after the index event. Methods: We used a second-generation cTnI assay designed to reduce the interference of cTn autoantibodies. The assay for cTn autoantibodies used 2 anti-cTnI antibodies to capture the ternary cTnI-complex, enabling unrestricted binding of the autoantibodies, which were detected with a labeled antihuman IgG antibody. We analyzed serum samples from 81 non–ST-elevation ACS patients taken at admission and after 1 week and 3 and 12 months. Results: We found 14 cTn autoantibody–positive patients (21%) among the 67 cTnI-positive and none among the 14 cTnI-negative patients. Nine were autoantibody-positive at admission, and 5 became positive at 1 week. Autoantibody signals significantly increased in the 1-week and 3-month samples. At all time points, cTnI was significantly increased in the autoantibody-positive group relative to the negative group. Persistent cTnI elevations at 3 and 12 months were seen in the patients already autoantibody positive at admission. Conclusions: During ACS, patients with cTn autoantibodies have higher cTnI release and therefore larger myocardial damage than patients without autoantibodies. Their cTnI release also lasts longer, at least months. The possible prognostic impact of these observations must be evaluated in larger clinical cohorts.

scholarly journals Incremental Prognostic Value of Biomarkers beyond the GRACE (Global Registry of Acute Coronary Events) Score and High-Sensitivity Cardiac Troponin T in Non-ST-Elevation Acute Coronary Syndrome

2013 ◽  
Vol 59 (10) ◽  
pp. 1497-1505 ◽  
Author(s):  
Christian Widera ◽  
Michael J Pencina ◽  
Maria Bobadilla ◽  
Ines Reimann ◽  
Anja Guba-Quint ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Troponin T ◽  
Model Performance ◽  
High Sensitivity ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Coronary Events ◽  
Incremental Prognostic Value ◽  
Global Registry ◽  
Grace Score

BACKGROUND Guidelines recommend the use of validated risk scores and a high-sensitivity cardiac troponin assay for risk assessment in non-ST-elevation acute coronary syndrome (NSTE-ACS). The incremental prognostic value of biomarkers in this context is unknown. METHODS We calculated the Global Registry of Acute Coronary Events (GRACE) score and measured the circulating concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and 8 selected cardiac biomarkers on admission in 1146 patients with NSTE-ACS. We used an hs-cTnT threshold at the 99th percentile of a reference population to define increased cardiac marker in the score. The magnitude of the increase in model performance when individual biomarkers were added to GRACE was assessed by the change (Δ) in the area under the receiver-operating characteristic curve (AUC), integrated discrimination improvement (IDI), and category-free net reclassification improvement [NRI(>0)]. RESULTS Seventy-eight patients reached the combined end point of 6-month all-cause mortality or nonfatal myocardial infarction. The GRACE score alone had an AUC of 0.749. All biomarkers were associated with the risk of the combined end point and offered statistically significant improvement in model performance when added to GRACE (likelihood ratio test P ≤ 0.015). Growth differentiation factor 15 [ΔAUC 0.039, IDI 0.049, NRI(>0) 0.554] and N-terminal pro–B-type natriuretic peptide [ΔAUC 0.024, IDI 0.027, NRI(>0) 0.438] emerged as the 2 most promising biomarkers. Improvements in model performance upon addition of a second biomarker were small in magnitude. CONCLUSIONS Biomarkers can add prognostic information to the GRACE score even in the current era of high-sensitivity cardiac troponin assays. The incremental information offered by individual biomarkers varies considerably, however.

scholarly journals In-vitro hemolysis and its financial impact using different blood collection systems

2015 ◽  
Vol 0 (0) ◽  
Author(s):  
Janne Cadamuro ◽  
Georg Martin Fiedler ◽  
Cornelia Mrazek ◽  
Thomas Klaus Felder ◽  
Hannes Oberkofler ◽  
...  
Keyword(s):  
Financial Impact ◽  
Blood Collection ◽  
Laboratory Diagnostics ◽  
Time Interval ◽  
Time Intervals ◽  
Mean Values ◽  
The Past ◽  
Collection Tube ◽  
Blood Collection Tube

AbstractHemolytic specimens are among the most challenging preanalytical issues in laboratory diagnostics. The type of blood collection tube in use is claimed to influence in vitro hemolysis. We aimed to examine this hypothesis and estimate the respective financial impact, evaluating routine blood samples from the past 4 years.A total of 47,820 hemolysis index (HI) values from five different time intervals (IV1–IV5) were compared against each other, representing the following tubes: IV1-Sarstedt Monovette; IV2-8 mL/16×100 mm Greiner BioOne (GBO) Vacuette; IV3/IV4-5 mL/16×100 mm GBO Vacuette; IV5-4.5 mL/13×75 mm GBO Vacuette. For estimation of the economic impact, material, personnel and analytical costs were calculated.HI mean values in time interval IV2 were significantly higher than in all other intervals, while mean values amongst all other intervals were comparable. The number of moderately and severely hemolyzed samples increased with incrementing vacuum. Overall comparable costs between intervals IV1 and IV5 were €11,370, €14,045, €12,710, €11,213 and €8138 per 10,000 samples, respectively.Aspiration tubes and low vacuum tubes show comparable hemolysis rates. Increasing vacuum levels are associated with higher hemolysis rates. By decreasing in vitro hemolysis, financial savings up to €5907 per 10,000 samples could be gained.

Sign in / Sign up

Export Citation Format

Share Document