K F Malbin | PubMed Health

PubMed1997

Implementation of practice guidelines.

Memorial Sloan-Kettering Cancer Center staff, in conjunction with Cambridge Technology Partners, has designed, developed, and begun to implement a disease management system (DMS) as a means of standardizing the care of the center's patients with cancer. The disease management system is centrally coordinated through disease management teams, which include physicians from each of the major oncology disciplines--radiation, medicine, and surgery--as well as specialists and other professionals involved in patient care. The system is comprised of four modules: system administration, treatment pathways, patient management, and outcomes analysis. In July 1966, the gynecology team began to pilot this program, and the remaining 16 disease management teams were incorporated, in phases, during the rest of 1996. The regional sites are being incorporated in 1997. After a brief summary of the basic features of the disease management system, this article describes the implementation process and the accomplishments to date.

Databases, Factual↗

PubMed1996

Autologous bone marrow harvesting in outpatients.

STUDY OBJECTIVE: To assess the experience with autologous bone marrow harvesting in outpatients. DESIGN: Retrospective analysis of outpatients who underwent autologous bone marrow harvesting from 1990 to 1992. SETTING: University-affiliated surgical day hospital. SUBJECTS: 235 outpatients who underwent 264 autologous bone marrow harvests. Patients are candidates for autologous bone marrow harvesting on an outpatient basis if they are Karnofsky performance status of 80-100 and ASA status I, II or III. MEASUREMENTS AND MAIN RESULTS: The incidence of perioperative complications and hospital admission from the Surgical Day Hospital, the duration of the harvesting procedure and postanesthesia care unit (PACU) stay, details of the postoperative pain management, and costs and charges of the outpatient procedure compared with the same procedure performed on inpatients were assessed. Mean age was 37.7 years +/- 10.5 SD; + 7.7% patients were male and 52.3% were female. The disease process included non-Hodgkin's lymph/ma (30.3%), leukemia (24.3%), metastatic breast cancer (18.4%), Hodgkin's disease (17.3%), testicular carcinoma (6.5%) and other (1.6%). The patients were ASA status II (54.5%) or ASA III (45.5%) and received general endotracheal anesthesia. Each patient had 10.7 ml/kg +/- 2.8 SD of marrow harvested over a period of 110.7 minutes + 30.4 SD and total recovery room time of 233.7 minutes +/- 85.5 SD. Of 251 harvest, only three (1.1%) required hospital admission. PACU complaints included transient hypotension and dizziness (5.3%), nausea (3.8%), vomiting (3.4%), and (1.9%) temperature elevation. 83.7% of patients were reached at home the following day and 4.1% complained of nausea and/or vomiting at home. 6.8% of patients experienced temperature elevation at home. Only 27.1% of patients took the acetaminophen with codeine that was prescribed. The reminder required no opioid at home. Outpatient charge/ inpatient charge was 51.1%, and outpatient cost/inpatient was 74.4%. CONCLUSION: Autologous bone marrow harvesting is an acceptable ambulatory surgical procedure that results in a very law postanesthesia complication rate. Postoperative pain is easily controlled. The outpatient setting offers cost and time advantages to the patient.

Adult↗