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E Silfen

Publications and source records attributed to E Silfen.

5 recordsLinked to original sources
PubMed1994

Quality improvement and public health--tetanus immunization in the emergency department.

The administration of tetanus toxoid vaccine to both adults and children represents an often neglected, but medically necessary procedure for patients who receive traumatic injuries to nature's natural surface barrier, the skin. While performing retrospective chart reviews, the collaborative practice environment fostered in the Emergency Department at Reston Hospital Center, (wherein the physician and nursing staff are schooled in Deming's Quality Improvement-FOCUS-PDCA-methodology, and the concepts of "patient care clinical process ownership," and "professional job enlargement and job enrichment" diffuse throughout the Emergency Services Systems design), identified a potential problem with tetanus immunization related to existing standing orders. Initial data collection utilized count-between methodology. Over a 31-day period, 216 patients who required tetanus immunization were identified. Appropriate tetanus toxoid administration was "missed" 20 times, with a median of 9 appropriate tetanus immunizations before an administration was "missed." Flow chart analysis of the tetanus toxioid administration process identified the sources of variation of that process. A pilot PDCA cycle was instituted to redefine the process, control the variability, and measure the results. Upon completion of the third PDCA cycle of 31 days, 367 patients were identified who required tetanus immunization. Appropriate tetanus toxoid administration was "missed" 3 times with a median of 120 appropriate tetanus immunizations before an administration was "missed." Conclusions include: a) The appearance of special cause variation, (diaster situations), must be recognized as having the potential to disrupt healthcare process improvements.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Theoretical and generic considerations for hospital life-sustaining treatment policies.

Paralleling the expansion of the complexity of our society, medical decision making has become intensely intricate. Given this technological explosion that geometrically multiplied the possibilities and nuances of end-of-life decisions, the processes for making fully informed decisions became overwhelmed. The interest in end-of-life, medical decisions encompasses the patient, his or her physicians and family, health care administrators, and all parties engaged in protecting the public welfare. At one narrow window in time all parties must have a clear, personal understanding of: 1) the importance and meaning of informed consent; 2) the content of and process for advance directives; 3) the legal status of patient surrogates; 4) the economic issues involved in medical care; 5) the circumstances surrounding medical futility; 6) the spectrum of euthanasia; and 7) the perception of panic at the moment of acute emergency. For the patient and those who care, it is only when these concepts gel that the toughest decisions one will ever have to make can become conceivable.

Advance Directives↗