Background Interpretative commenting constitutes an important aspect of the I post-analytical phase in chemical pathology, but has only recently been the subject of quality assessment. The Royal College of Pathologist...
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Background Interpretative commenting constitutes an important aspect of the I post-analytical phase in chemical pathology, but has only recently been the subject of quality assessment. The Royal College of Pathologists of Australasia (RCPA)Australasian Association of Clinical Biochemists (AACB) Chemical Pathology Patient Report Comments Program is currently in its third year, having started in 2000 as a pilot program. We present a review of the pilot program. Methods The program is aimed at individuals rather than laboratories. Two cases were circulated to participants of the Chemical Pathology Quality Assurance Program every month over a 6-month period. The case report contained the age and sex of the patient, together with brief clinical notes, the biochemistry results for commenting and other information of relevance. Three lines of space were given for the comment. The comments received from participants were broken down into their components and translated into common key phrases for the purpose of summarization and analysis. A histogram of the frequency of use of the common key phrases was generated. The comments or the key phrases were not given scores or marks, nor was any other indication given as to the appropriateness of their comments. Results This approach of simple peer-group comparison of comments without any assessment of the appropriateness of the comments was found to be inadequate;thus, when the program continues, key phrases will be classified according to degree of appropriateness and a suggested comment for each case will be proposed by an 'expert' panel. Conclusions The program can serve a useful role in continuing education. Clinical biochemists and trainees who add interpretative comments to results produced by their laboratory, or give interpretative advice over the telephone, may potentially benefit from participating in this program.
Increased intensive care for low birth weight and premature infants has made it essential to establish a well-organized plan for neonatal discharge and follow up. The preventive medical goal is improved care and outco...
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Increased intensive care for low birth weight and premature infants has made it essential to establish a well-organized plan for neonatal discharge and follow up. The preventive medical goal is improved care and outcome and in this article the organization of such a plan is discussed.
Objective: To assess the impact on ordering errors when physicians stopped handwriting patient identifiers on requests for blood transfusion. Material and Methods: Physicians, frustrated by the amount of time required...
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Objective: To assess the impact on ordering errors when physicians stopped handwriting patient identifiers on requests for blood transfusion. Material and Methods: Physicians, frustrated by the amount of time required to complete paper forms to order blood, asked if the requirement for handwritten patient identifiers, which were in addition to such information "stamped" on blood requests, could be eliminated. We acquiesced to the request, modified the blood ordering forms accordingly, and continued to monitor ordering errors. Results: After elimination of the handwritten identifiers in 1997, ordering errors increased from an annual rate of 1 in 10,000 to 6 in 10,000 blood requests by late 1999. We alerted the clinicians by newsletter, and the rate decreased somewhat (3 in 10,000 requests). However, the error rate did not decrease to its previous level of 1 in 10,000 requests until mid-2001, about 2 1/2 years after reinstitution of the requirement for handwritten patient identifiers. Conclusion: An obligatory second entry of demographic identifiers on a blood order requires ordering physicians to carefully consider the identity of the patient receiving a transfusion and reduces the likelihood of transfusion of. an unintended recipient. Error management tools, such as a predetermined method for planning, reviewing, and documenting all changes, facilitate detection of trends and responses to corrective actions.
Background: Little is known about the accuracy of diagnostic and procedural codes for common gastrointestinal (GI) conditions and endoscopic procedures. Methods: Eight hundred eighty-two patients with upper GI hemorrh...
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Background: Little is known about the accuracy of diagnostic and procedural codes for common gastrointestinal (GI) conditions and endoscopic procedures. Methods: Eight hundred eighty-two patients with upper GI hemorrhage admitted in 1994 to 1 of 13 regional hospitals were studied. Based on endoscopy reports, the source of hemorrhage, performance of upper endoscopy and use of endoscopic therapy were determined, and we assessed the sensitivity and positive predictive value of discharge codes for measuring the source of hemorrhage and use of upper endoscopy. Results: The sensitivity and positive predictive value of principal diagnosis coding for source of hemorrhage were typically 85% to 95%. The sensitivity and predictive value of coding for upper endoscopy were 97.7% and 99.9%, respectively, and were 72.3% and 99.4%, respectively, for endoscopic therapy. Accuracy did not differ between the 4 major teaching and 9 other hospitals. Conclusions: Hospital-based diagnostic and procedural codes are a reasonably accurate source of data for clinical and outcomes analyses of upper GI hemorrhage. In particular, it is possible to discern from these data the source of hemorrhage and the overall use of upper endoscopy.
Management Case Studies describe approaches to real-life management problems in health systems. Each installment is a brief description of a problem and how it was dealt with. The cases are intended to help readers de...
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Management Case Studies describe approaches to real-life management problems in health systems. Each installment is a brief description of a problem and how it was dealt with. The cases are intended to help readers deal with similar experiences in their own work sites. Problem solving, not hypothesis testing, is emphasized. Successful resolution of the management issue is not a criterion for publication-important lessons can be learned from failures, too.
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