Morning Rounds Inpatient Test Availability

2000 ◽  
Vol 124 (4) ◽  
pp. 499-503 ◽  
Author(s):  
David A. Novis ◽  
Jane C. Dale
Keyword(s):  
The United States ◽  
Early Morning ◽  
Physician Satisfaction ◽  
Test Results ◽  
Improvement Program ◽  
Public And Private ◽  
Laboratory Service ◽  
Practice Characteristics ◽  
Laboratory Services ◽  
Laboratory Test Results

Abstract Objectives.—To determine the success with which laboratories were able to report morning test results on time, the laboratory practice characteristics associated with improved success, and the degree of satisfaction among clinicians with the timeliness of laboratory service. Design.—Hospital laboratories participating in the College of American Pathologist Q-Probes laboratory quality improvement program prospectively calculated the percentages of morning-run complete blood cell count (CBC) and electrolyte results that were reported on or before predetermined reporting deadlines, completed questionnaires concerning their departments' practice characteristics as they related to performing morning blood work, and distributed to physician utilizers of morning laboratory services questionnaires evaluating physician satisfaction with laboratory services. Setting and Participants.—A total of 367 public and private institutions located in the United States (355), Canada (5), Australia (2), and 1 each in the United Kingdom, Spain, Brazil, Korea, and Guam. Main Outcome Measure.—The percentages of morning-run CBC and electrolyte results reported on or before predetermined reporting deadlines. Results.—Participants submitted data on 40 256 CBC and 39 604 electrolyte specimens. In aggregate, a total of 88.9% of these tests (90.2% of CBCs and 87.6% of electrolytes) were reported on or before the reporting deadlines that the participating laboratories set for themselves. Half of the participants reported 94.6% of their CBC results and 95.5% of their electrolyte results on or before their self-imposed reporting deadlines. No specific demographic features or departmental practice characteristics were associated with higher or lower rates of institutional reporting compliance. Most physician utilizers of early-morning laboratory test results believed that the laboratory is sensitive to and meets the needs of clinicians for timely reporting of early-morning test results. Conclusions.—Most laboratories are capable of reporting 95% of their routine morning laboratory tests on time, and most physicians are satisfied with their laboratories' morning testing service.

Solitary Blood Cultures

2001 ◽  
Vol 125 (10) ◽  
pp. 1290-1294
Author(s):  
David A. Novis ◽  
Jane C. Dale ◽  
Ron B. Schifman ◽  
Stephen G. Ruby ◽  
Molly K. Walsh
Keyword(s):  
Blood Culture ◽  
The United States ◽  
Blood Cultures ◽  
Private Institutions ◽  
Improvement Program ◽  
Institutional Practices ◽  
Public And Private ◽  
Control Programs ◽  
Practice Characteristics ◽  
Hospital Practices

Abstract Objective.—To determine the frequency with which solitary blood culture samples were submitted to laboratories serving small hospitals and to ascertain whether certain hospital practices relating to the performance of blood cultures were associated with lower solitary blood culture rates (SBCRs). Design.—Participants in the College of American Pathologists Q-Probes laboratory quality improvement program collected data prospectively on the numbers of solitary blood culture sets from adult patients submitted to their laboratories and answered questions about their institutions' practice characteristics relating to the collection of blood culture specimens. Setting and Participants.—Three hundred thirty-three public and private institutions with a median occupied bed size of 57. Participants were located in the United States (n = 329), Canada (n = 3), and Australia (n = 1). Main Outcome Measure.—The solitary blood culture rate was defined as the number of instances in which only 1 blood culture venipuncture was performed on an individual patient during a 24-hour period divided by the total number of blood culture venipunctures that were performed during the study period. Results.—Participants submitted data on 132 778 adult patient blood culture sets. The SBCRs were 3.4% or less in the top-performing 10% of participating institutions (90th percentile and above), 12.7% in the midrange of participating institutions (50th percentile), and 42.5% or more in the bottom-performing 10% of participating institutions (10th percentile and below). In half the participating institutions, the SBCRs for inpatients were 8.3% or less and for outpatients, 22% or less. Solitary blood culture rates were lower for institutions in which phlebotomists rather than nonphlebotomists routinely collected blood culture specimens, in which internal policies required drawing at least 2 blood culture sets, in which hospital personnel contacted clinicians when their laboratories received requests for solitary blood culture sets, and in which quality control programs monitored SBCRs routinely. Conclusions.—Hospitals can achieve SBCRs under 5%. Those hospitals with particularly high SBCRs may lower their rates by altering certain institutional practices.

Determining Customer Satisfaction in Anatomic Pathology

2006 ◽  
Vol 130 (5) ◽  
pp. 645-649 ◽  
Author(s):  
Richard J. Zarbo
Keyword(s):  
Customer Satisfaction ◽  
The United States ◽  
Physician Satisfaction ◽  
Assessment Tools ◽  
Satisfaction Survey ◽  
Specific Information ◽  
Improvement Program ◽  
Anatomic Pathology ◽  
Laboratory Services ◽  
Customer Satisfaction Survey

Abstract Context.—Measurement of physicians' and patients' satisfaction with laboratory services has become a standard practice in the United States, prompted by national accreditation requirements. Unlike other surveys of hospital-, outpatient care–, or physician-related activities, no ongoing, comprehensive customer satisfaction survey of anatomic pathology services is available for subscription that would allow continual benchmarking against peer laboratories. Pathologists, therefore, must often design their own local assessment tools to determine physician satisfaction in anatomic pathology. Objective.—To describe satisfaction survey design that would elicit specific information from physician customers about key elements of anatomic pathology services. Design.—The author shares his experience in biannually assessing customer satisfaction in anatomic pathology with survey tools designed at the Henry Ford Hospital, Detroit, Mich. Benchmarks for physician satisfaction, opportunities for improvement, and characteristics that correlated with a high level of physician satisfaction were identified nationally from a standardized survey tool used by 94 laboratories in the 2001 College of American Pathologists Q-Probes quality improvement program. Results.—In general, physicians are most satisfied with professional diagnostic services and least satisfied with pathology services related to poor communication. Conclusions.—A well-designed and conducted customer satisfaction survey is an opportunity for pathologists to periodically educate physician customers about services offered, manage unrealistic expectations, and understand the evolving needs of the physician customer. Armed with current information from physician customers, the pathologist is better able to strategically plan for resources that facilitate performance improvements in anatomic pathology laboratory services that align with evolving clinical needs in health care delivery.

Physician Satisfaction With Clinical Laboratory Services: A College of American Pathologists Q-Probes Study of 138 Institutions

2009 ◽  
Vol 133 (1) ◽  
pp. 38-43
Author(s):  
Bruce A. Jones ◽  
Leonas G. Bekeris ◽  
Raouf E. Nakhleh ◽  
Molly K. Walsh ◽  
Paul N. Valenstein
Keyword(s):  
Quality Improvement ◽  
Clinical Laboratory ◽  
Turnaround Time ◽  
Physician Satisfaction ◽  
Reliability Of Results ◽  
Improvement Program ◽  
Valuable Component ◽  
Laboratory Services ◽  
Survey Results ◽  
High Level

Abstract Context.—Monitoring customer satisfaction is a valuable component of a laboratory quality improvement program. Objective.—To survey the level of physician satisfaction with hospital clinical laboratory services. Design.—Participating institutions provided demographic and practice information and survey results of physician satisfaction with defined aspects of clinical laboratory services, rated on a scale of 1 (poor) to 5 (excellent). Results.—One hundred thirty-eight institutions participated in this study and submitted a total of 4329 physician surveys. The overall satisfaction score for all institutions ranged from 2.9 to 5.0. The median overall score for all participants was 4.1 (10th percentile, 3.6; 90th percentile, 4.5). Physicians were most satisfied with the quality/reliability of results and staff courtesy, with median values of excellent or good ratings of 89.9%. Of the 5 service categories that received the lowest percentage values of excellent/good ratings (combined scores of 4 and 5), 4 were related to turnaround time for inpatient stat, outpatient stat, routine, and esoteric tests. Surveys from half of the participating laboratories reported that 96% to 100% of physicians would recommend the laboratory to other physicians. The category most frequently selected as the most important category of laboratory services was quality/reliability of results (31.7%). Conclusions.—There continues to be a high level of physician satisfaction and loyalty with clinical laboratory services. Test turnaround times are persistent categories of dissatisfaction and present opportunities for improvement.

Vaccine Passport - A blockchain based architecture for secure, tamper-resistant, privacy-enhanced credentialing mechanism of vaccination and verification of test results (Preprint)

2021 ◽  
Author(s):  
Hsiu An Lee ◽  
Hsin-Hua Kung ◽  
Wei-Chen Wu ◽  
Jai Ganesh Udayasankaran ◽  
Yu-Chih Wei ◽  
...  
Keyword(s):  
Data Protection ◽  
Low Cost ◽  
Vaccination Rate ◽  
Data Accuracy ◽  
Test Results ◽  
Public And Private ◽  
Global Pandemic ◽  
Laboratory Test Results ◽  
Encryption And Decryption ◽  
International Data

BACKGROUND The coronavirus disease 2019 (COVID-19) is an ongoing global pandemic caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). The prevention and treatment methods for COVID-19 are not yet clear. At present, there are at least 287 preventive vaccines against COVID-19 in the world, of which 5 vaccines are available for emergency use as of June 2021, but none has completed clinical trial. Nevertheless, with the development of vaccines, disease conditions in various countries are gradually controlled. OBJECTIVE The vaccination rate has increased in time, and activities in various countries have gradually recovered. Therefore, the focus of the next stage is confirming and proving that everyone is vaccinated to ensure that those without vaccines will not become a breach in the next wave of diseases. The vaccination or RT-PCR test results are all certified and verified by paper documents issued by hospitals or testing institutions. Meanwhile, falsified documents are a major risk factor in confirming the vaccination status and laboratory test results. Although the Vaccine Passport (VP) may become an important key to future global activities based on the current strategy, the problems of document verification and data use among countries have not yet been resolved. METHODS The blockchain architecture proposed in this research can be applied together by public and private entities and be rapidly expanded. Furthermore, the open ledger of blockchain achieves transparency and data accuracy. On the other hand, smart contracts (SCs) achieve authorization and authentication, while the encryption and decryption mechanisms achieve data protection. In order to make it globally available, the international data standard “Fast Healthcare Interoperability Resource (FHIR)” is adopted into this research. In general, this blockchain architecture can achieve global vaccine passport verification accurately and at a low cost. RESULTS The open nature of the blockchain contributes to establishing transparency and data accuracy. Total three entities are included in this blockchain architecture. All of the authorization are public in the open ledger. The smart certificate enables authorization and authentication, while the encryption and decryption mechanism ensure data protection. This proof of concept demonstrates the design of blockchain architecture which, when adopted, can achieve global vaccine passport verification accurately and at a cost country can afford. An actual vaccine passport case was established and demonstrated in this study. Open blockchain, individually authorized authentication mechanisms, and international standard vaccine passports were adopted. CONCLUSIONS Blockchain architecture is used to build the authentication process of an executable international vaccine passport, with advantages of low cost, high interoperability, effectiveness, security and verifiability.

Customer Satisfaction in Anatomic Pathology

2003 ◽  
Vol 127 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Richard J. Zarbo ◽  
Raouf E. Nakhleh ◽  
Molly Walsh
Keyword(s):  
Customer Satisfaction ◽  
Performance Improvement ◽  
Relevant Information ◽  
The United States ◽  
Physician Satisfaction ◽  
Satisfaction Survey ◽  
Pathology Laboratory ◽  
Anatomic Pathology ◽  
Laboratory Services ◽  
High Level

Abstract Context.—Measurement of physicians' and patients' satisfaction with laboratory services has recently become a requirement of health care accreditation agencies in the United States. To our knowledge, this is the first customer satisfaction survey of anatomic pathology services to provide a standardized tool and benchmarks for subsequent measures of satisfaction. Objective.—This Q-Probes study assessed physician satisfaction with anatomic pathology laboratory services and sought to determine characteristics that correlate with a high level of physician satisfaction. Design.—In January 2001, each laboratory used standardized survey forms to assess physician customer satisfaction with 10 specific elements of service in anatomic pathology and an overall satisfaction rating based on a scale of rankings from a 5 for excellent to a 1 for poor. Data from up to 50 surveys returned per laboratory were compiled and analyzed by the College of American Pathologists. A general questionnaire collected information about types of services offered and each laboratory's quality assurance initiatives to determine characteristics that correlate with a high level of physician satisfaction. Setting.—Hospital-based laboratories in the United States (95.8%), as well as others from Canada and Australia. Participants.—Ninety-four voluntary subscriber laboratories in the College of American Pathologists Q-Probes quality improvement program participated in this survey. Roughly 70% of respondents were from hospitals with occupied bedsizes of 300 or less, 65% were private nonprofit institutions, just over half were located in cities, one third were teaching hospitals, and 19% had pathology residency training programs. Main Outcome Measures.—Overall physician satisfaction with anatomic pathology and 10 selected aspects of the laboratory service (professional interaction, diagnostic accuracy, pathologist responsiveness to problems, pathologist accessibility for frozen section, tumor board presentations, courtesy of secretarial and technical staff, communication of relevant information, teaching conferences and courses, notification of significant abnormal results, and timeliness of reporting). Results.—The database of 3065 physician surveys was derived from 94 laboratories. An average of 32.6 surveys (median 30) was returned per institution, with a range of 5 to 50 surveys per institution. The mean response rate was 35.6% (median 32.5%). The median (50th percentile) laboratory had an overall median satisfaction score of 4.4. The lowest satisfaction scores that were obtained all related to poor communication, which included timeliness of reporting, communication of relevant information, and notification of significant abnormal results. Statistically significant associations of customer satisfaction with certain institutional characteristics and laboratory performance improvement activities were identified. Conclusions.—The importance of this satisfaction survey lies not in its requirement as an exercise for accrediting agencies but in understanding the needs of the customer (in this case the physician) to direct performance improvement in the delivery of quality anatomic pathology laboratory services.

scholarly journals LabRS: A Rosetta stone for retrospective standardization of clinical laboratory test results

2017 ◽  
Vol 25 (2) ◽  
pp. 121-126 ◽  
Author(s):  
Ronald George Hauser ◽  
Douglas B Quine ◽  
Alex Ryder
Keyword(s):  
Laboratory Tests ◽  
Standardized Test ◽  
Clinical Laboratory ◽  
Secondary Data ◽  
The United States ◽  
Test Results ◽  
Original Result ◽  
Clinical Laboratories ◽  
Laboratory Test Results ◽  
Standardization Process

Abstract Objective Clinical laboratories in the United States do not have an explicit result standard to report the 7 billion laboratory tests results they produce each year. The absence of standardized test results creates inefficiencies and ambiguities for secondary data users. We developed and tested a tool to standardize the results of laboratory tests in a large, multicenter clinical data warehouse. Methods Laboratory records, each of which consisted of a laboratory result and a test identifier, from 27 diverse facilities were captured from 2000 through 2015. Each record underwent a standardization process to convert the original result into a format amenable to secondary data analysis. The standardization process included the correction of typos, normalization of categorical results, separation of inequalities from numbers, and conversion of numbers represented by words (eg, “million”) to numerals. Quality control included expert review. Results We obtained 1.266 × 109 laboratory records and standardized 1.252 × 109 records (98.9%). Of the unique unstandardized records (78.887 × 103), most appeared <5 times (96%, eg, typos), did not have a test identifier (47%), or belonged to an esoteric test with <100 results (2%). Overall, these 3 reasons accounted for nearly all unstandardized results (98%). Conclusion Current results suggest that the tool is both scalable and generalizable among diverse clinical laboratories. Based on observed trends, the tool will require ongoing maintenance to stay current with new tests and result formats. Future work to develop and implement an explicit standard for test results would reduce the need to retrospectively standardize test results.

Outpatient Phlebotomy Success and Reasons for Specimen Rejection

2002 ◽  
Vol 126 (4) ◽  
pp. 416-419 ◽  
Author(s):  
Jane C. Dale ◽  
David A. Novis
Keyword(s):  
The United States ◽  
Blood Collection ◽  
Success Rates ◽  
Missing Information ◽  
Improvement Program ◽  
Practice Characteristics ◽  
Clinical Laboratories ◽  
Specimen Collection ◽  
Patient Preparation ◽  
Test Ordering

Abstract Objectives.—To determine the rate with which blood collection is successful on the initial phlebotomy encounter, the rate with which laboratory personnel judge specimens unsuitable for analysis, and the practice characteristics associated with fewer unsuccessful collections and fewer rejected specimens. Design.—Clinical laboratories participating in the College of American Pathologists Q-Probes laboratory improvement program prospectively characterized the outcome of outpatient phlebotomies for 3 months or until 20 unsuccessful phlebotomy encounters occurred. By questionnaire, participants provided information about test ordering, patient preparation, and specimen collection. Setting and Participants.—Institutions in the United States (n = 202), Canada (n = 4), Australia (n = 3), and South Korea (n = 1). Main Outcome Measures.—Percentage of successful encounters and percentage of unsuitable specimens. Results.—Of 833289 encounters, 829723 were successful. Phlebotomies were unsuccessful because patients were not fasting as directed (32.2%), phlebotomy orders were missing information (22.5%), patients specimens were difficult to draw (13.0%), patients left the collection area before specimens were collected (11.8%), patients were improperly prepared for reasons other than fasting (6.3%), patients presented at the wrong time (3.1%), or for other reasons (11.8%). Only 2153 specimens (0.3%) were unsuitable; these samples were hemolyzed (18.1%), of insufficient quantity (16.0%), clotted (13.4%), lost or not received in the laboratory (11.5%), inadequately labeled (5.8%), at variance with previous or expected results (4.8%), or unacceptable for other reasons (31.1%). Facilities staffed by laboratory-administered phlebotomists reported higher success rates than facilities staffed by nonlaboratory-administered phlebotomists (P = .002). Conclusions.—Most outpatient phlebotomy encounters are successful and result in specimens suitable for laboratory analysis.

Physician Satisfaction With Clinical Laboratory Services: A College of American Pathologists Q-Probes Study of 81 Institutions

2016 ◽  
Vol 140 (10) ◽  
pp. 1098-1103 ◽  
Author(s):  
Shannon J. McCall ◽  
Rhona J. Souers ◽  
Barbara Blond ◽  
Larry Massie
Keyword(s):  
Clinical Laboratory ◽  
Challenge Test ◽  
Physician Satisfaction ◽  
Clinical Report ◽  
Order Entry ◽  
Improvement Program ◽  
Quality Of Results ◽  
Laboratory Services ◽  
Electronic Order

Context.—Assessment of customer satisfaction is a vital component of the laboratory quality improvement program.Objective.—To survey the level of physician satisfaction with hospital clinical laboratory services.Design.—Participating institutions provided demographic information and survey results of physician satisfaction, with specific features of clinical laboratory services individually rated on a scale of 5 (excellent) to 1 (poor).Results.—Eighty-one institutions submitted 2425 surveys. The median overall satisfaction score was 4.2 (10th percentile, 3.6; 90th percentile, 4.6). Of the 16 surveyed areas receiving the highest percentage of excellent/good ratings (combined scores of 4 and 5), quality of results was highest along with test menu adequacy, staff courtesy, and overall satisfaction. Of the 4 categories receiving the lowest percentage values of excellent/good ratings, 3 were related to turnaround time for inpatient “STAT” (tests performed immediately), outpatient STAT, and esoteric tests. The fourth was a new category presented in this survey: ease of electronic order entry. Here, 11.4% (241 of 2121) of physicians assigned below-average (2) or poor (1) scores. The 5 categories deemed most important to physicians included quality of results, turnaround times for inpatient STAT, routine, and outpatient STAT tests, and clinical report format. Overall satisfaction as measured by physician willingness to recommend their laboratory to another physician remains high at 94.5% (2160 of 2286 respondents).Conclusions.—There is a continued trend of high physician satisfaction and loyalty with clinical laboratory services. Physician dissatisfaction with ease of electronic order entry represents a new challenge. Test turnaround times are persistent areas of dissatisfaction, representing areas for improvement.

Type and Screen Completion for Scheduled Surgical Procedures

2003 ◽  
Vol 127 (5) ◽  
pp. 533-540 ◽  
Author(s):  
Richard C. Friedberg ◽  
Bruce A. Jones ◽  
Molly K. Walsh
Keyword(s):  
The United States ◽  
Private Institutions ◽  
Improvement Program ◽  
Public And Private ◽  
Specific Protocol ◽  
Positive Antibody ◽  
Compromise Patient Safety ◽  
Clinically Significant ◽  
Surgery Delay ◽  
Time Type

Abstract Context.—Market-driven changes in the timing of elective surgeries and admissions have introduced barriers to completing pretransfusion testing in a timely manner. Consequently, blood bank personnel may not have adequate time to identify appropriate blood products for scheduled surgeries. Incomplete pretransfusion testing can delay surgery and significantly compromise patient safety. Objectives.—To identify the incidence of avoidable problems associated with obtaining timely samples for adequate pretransfusion type and screen (T&S) testing, to identify the practices and characteristics associated with improved rates of pretransfusion testing completed prior to surgery, and to determine the likelihood of antibody identification problems that affect the availability of blood. Design.—Participants in the College of American Pathologists (CAP) Q-Probes laboratory quality improvement program were asked to collect data on when a T&S was collected in anticipation of elective scheduled surgery, when the T&S was completed, when the surgery started, and the results of those T&S tests. Participants also completed questionnaires describing their facilities, procedures, and practices. Setting and Participants.—One hundred eight public and private institutions participated in this Q-Probes Study, 97% of which were located in the United States. Main Outcome Measures.—Type and screen collection and completion relative to the start of surgery, and the results of those tests. Results.—Of the 8941 T&Ss, 64.6% were collected prior to the day of surgery. The median laboratory completed approximately 69% of their T&S testing for scheduled surgeries at least 1 day prior to the surgery. Of those T&S tests that were collected on the day of surgery, the median laboratory completed almost 23% after the start of surgery. For 10% of participants, more than 75% of all T&Ss collected on the same day as surgery were not complete until after the start of surgery. When red blood cell–directed antibodies were identified, 78.7% were considered clinically significant, and 95.2% were alloantibodies. Positive antibody screens were significantly associated with delayed surgery and special efforts needed to obtain blood. Of those institutions with a specific protocol in place to collect T&S samples prior to hospital admission, the median laboratory completed the T&S at least 1 day prior to surgery 74% of the time. When the institution coupled the T&S collection protocol with T&S collection earlier than 3 days prior to surgery, the median laboratory completed the T&S at least 1 day prior to surgery almost 87% of the time. Type and screen collection less than 3 days prior to surgery resulted in special efforts needed to obtain blood more than 1% of the time. Type and screen collected on the same day as surgery directly resulted in a surgery delay 0.8% of the time. Conclusions.—Patients are unnecessarily being placed at risk by inadequate mechanisms to ensure available blood for surgery. All T&Ss were collected for scheduled surgeries with adequate opportunity for a T&S to be completed in advance of the surgery. Specific protocols helped improve the performance in terms of completing the T&S prior to surgery, as did mechanisms that permitted T&S collections in advance of the admission. Type and screen collection time relative to surgery was significantly associated with the incidence of surgery delay due to unavailable blood; the less time between collection and surgery, the less likely blood was available.

Quality Improvement on an Academic Autopsy Service

2001 ◽  
Vol 125 (2) ◽  
pp. 237-245 ◽  
Author(s):  
John H. Sinard ◽  
Deborah J. Blood
Keyword(s):  
Quality Improvement ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Physician Satisfaction ◽  
Quality Improvement Program ◽  
Autopsy Rate ◽  
Quality Of Data ◽  
Improvement Program

Abstract Context.—Autopsy rates continue to decline in the United States. Objective.—Although many of the causes of this decline are external to pathology departments, we hypothesized that intradepartmental efforts to improve the quality of the service we provide to our clinical colleagues could increase our autopsy rate. Method.—We developed a multifaceted quality improvement program for our autopsy service aimed at increasing the visibility of the service, improving the service's reporting, and increasing the amount and quality of data available from the service. Setting.—A large academic medical center that performs approximately 250 autopsies each year. Results.—After implementation of our quality improvement program, the decline in our autopsy rate has not only stopped, but rates have even begun to increase. Additionally, physician satisfaction surveys conducted before and after implementation of our quality improvement initiatives showed an across-the-board improvement in clinician perception of the service. Conclusion.—Pathologists can and should be proactive in addressing the declining autopsy rate, rather than viewing it as someone else's problem or hoping that someone else will protect this important quality assurance tool for medical care.

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