PubMed Health⌕ Search

Biomedical subjects

P Garnerin

Publications and source records attributed to P Garnerin.

At least 19 recordsLinked to original sources
PubMed1999

Outpatient preoperative evaluation clinic can lead to a rapid shift from inpatient to outpatient surgery: a retrospective review of perioperative setting and outcome.

STUDY OBJECTIVE: To report the rapid shift from inpatient to outpatient surgery that occurred after opening an outpatient preoperative evaluation clinic and the perioperative complications and mortality rates before and after this intervention. DESIGN: Monthly variations of total volume of procedures and percentages of outpatient procedures were analyzed retrospectively using control charts over two consecutive 10-month periods before and after the intervention. For each type of procedure (inpatient vs. outpatient), the perioperative complications and 30-day mortality rates were compared between periods. SETTING: The Veterans Affairs Palo Alto Health Care System, Palo Alto, California. PATIENTS: Patients who underwent 3,159 inpatient or outpatient procedures in the main operating room suite during the control period were compared with patients who underwent 3,190 procedures in the same operating room suite during the intervention period. INTERVENTION: The establishment of an outpatient preoperative evaluation clinic. MEASUREMENTS AND MAIN RESULTS: For each period, the total monthly surgical volume (inpatient and outpatient), perioperative complications, deaths within 30 days of surgery, and the number of procedures performed on patients classified as ASA physical status III, IV, or V were analyzed. The monthly total number of procedures was stable over both periods, but the monthly percentage of outpatient procedures departed from its baseline immediately after establishing the clinic (control period: 24.7%; study period: 45.4%; p << 0.0001). Finally, the perioperative complication rate did not change for outpatient procedures but increased for inpatient procedures (control period: 2.31%; study period: 3.50%; p < 0.05). The 30-day mortality rate remained unchanged for inpatient and outpatient procedures. CONCLUSIONS: Establishing an outpatient preoperative evaluation clinic can lead to a rapid shift from inpatient to outpatient surgery at a government funded hospital without a concomitant increase in perioperative morbidity or mortality.

Aged↗
PubMed1998

SHARE: a tool to analyze and assess strategies in health care organization management.

In health care organizations, management of both human and material resources implies decision making. When seemingly equivalent strategies are possible, simulation can help to make a decision on better grounds. The SHARE workframe was designed to address the specificities of health care and to provide a comprehensive environment for modelling and simulating health care processes. The typology of objects is defined as Actors, subdivided in Clients and Resources and Elementary Operations. Graphical tools allow us to build processes from these objects and to create their relationships. Various strategies based on either clinical or managerial changes may be investigated. After a simulation, graphical tools allow us to display summary information on the utilization of all actors, waiting times, and goodness of execution. The use of SHARE is exemplified with the analysis and simulation of changes in the Pulmonary Function Testing Laboratory of the Saint-Antoine Hospital, Paris.

Computer Simulation↗
PubMed1998

Modelling health care processes with SHARE.

This paper describes the "SHARE" workframe, designed to provide a comprehensive environment for modeling and simulating health care processes. The objects defined within SHARE are Actors, subdivided in Clients and Resources, and Elementary Operations. Graphical tools allow to build processes from these objects, and to specify their relationships. Various strategies based on either clinical or managerial changes may be investigated. Summary information on the utilization of all actors, on waiting times and goodness of execution may be displayed after a simulation. Better description of processes, and their study a priori will improve reliability, quality of care and satisfaction of patients.

Appointments and Schedules↗
PubMed1997

AUDILAB: a knowledge-based quality audit simulator for testing laboratories.

In order to obtain an accreditation, a laboratory must be prepared to provide a point-by-point check of various activities against the chosen reference standard, both from a general point of view and in relation to details of application. This paper describes AUDILAB, a computerized simulator accessible by network, able to provide testing laboratories with realistic quality audits performed in a customized way. AUDILAB establishes a detailed list of strengths (compliance with corresponding requirements of established standards) and weaknesses (improvements needed for laboratory's accreditation). The standard used by AUDILAB is the EN 45001 "General criteria for the operation of testing laboratories". A preliminary validation has already been completed. AUDILAB became operational in September 1993.

Artificial Intelligence↗
PubMed1997

Use of outpatient preoperative evaluation to decrease length of stay for vascular surgery.

UNLABELLED: Interventions that decrease perioperative length of stay can result in considerable cost-savings. This study assesses the impact of same-day admission using outpatient preoperative evaluation on the lengths of stay and hospital costs for patients who underwent carotid end-arterectomy (CEA) or lower extremity revascularization (LER). Patient characteristics and length of stay were compared for two 1-yr periods before and after outpatient preoperative evaluation had been implemented. There were no significant differences before and after the initiation of outpatient preoperative evaluation in the CEA and LER groups in mean age and ASA physical status distributions. The average preoperative length of stay decreased significantly from 7.0 to 1.9 days in the CEA group and from 9.0 to 2.8 days in the LER group. This reduction in the length of stay was associated with a cost-savings of $900 per patient and did not have an adverse effect on patient outcome. We conclude that outpatient preoperative evaluation clinics reduce the cost and length of stay in vascular surgery patients. IMPLICATIONS: We found that outpatient preoperative evaluation and same-day admission were associated with a decrease of 4.5 days in the preoperative length of stay for carotid endarterectomy and lower-extremity revascularization. This was not accompanied by increased mortality and led to hospital cost-savings of approximately $900 per patient.

Aged↗
PubMed1996

A sequential procedure to test the progressive decrease of rare adverse events.

A program to construct the Rapid Sequential Test (R-ST), a sequential procedure to test the decrease of the rate of rare adverse events, is described. This sequential procedure is constructed with the Sequential Probability Ratio method. It relies on a model for the progressive decrease in the rate of adverse events from a given initial rate to a target rate, during a transition period. The program allows one to calculate the bounds of rejection of the R-ST, and to study its power under various types of decrease. It is shown that the R-ST gives a conclusion faster than standard sequential procedures for the same type I and II error, saving at least one quarter of the trials completed during the transition period. The use of the software to construct R-STs is discussed with respect to the specification of the model.

Blood Transfusion↗
PubMed1996

[Quality assurance and prevention of immuno-hemolytic incidents in blood transfusion].

Direct and indirect measures of the reliability of the transfusion process are described. These measures can be used to assess the improvement of the transfusion process with a view to preventing hemolytic incidents. Quality assurance arrangements required by their use are made clear. The stress is put upon four points: processes must be formalized and standardised; quality audits must become a routine part of the transfusion process; the system of error reporting must be extended to include all failures; anonymity must be insured to improve reporting.

Anemia, Hemolytic↗
PubMed1996

[Improvement of transfusion safety in a health care service through the implementation of a quality program].

The quality policy brings with it an efficient method as well as relevant tools to improve transfusion safety in health care services. This article illustrates the details of the approach through the presentation of a project developed in the East Picardie region throughout several hospitals. It underlines the importance of the choice of a good reference system, of a pertinent method and the necessity of a real project management. Furthermore, the follow-up of the project has enabled us to identify a certain number of success criteria in the steering of the changing process.

France↗
PubMed1996

Status of electronic reporting of notifiable conditions in the United States and Europe.

OBJECTIVE: To improve the computer connectivity and network strategies to connect U.S. county health departments (CHDs), state health departments (SHDs), and the Centers for Disease Control (CDC) for reporting notifiable conditions. METHODS: HSPNET-L mailing list discussions and individual Internet communications were used to compare selected features of notifiable conditions networking in the United States, France, and the United Kingdom. RESULTS: In the US, the CHD is the agency that first responds to an infectious disease outbreak on receiving notifications from physicians. Prompt recognition by the SHD that a widespread outbreak has occurred depends on the way in which county data are received, the "age" of the data, and the time taken to analyze them. Similarly, the recognition of the national scale of the outbreak depends on the promptness with which SHDs report to the CDC and the age of the data. An analysis of the French Communicable Disease Network suggests that an expansion of electronic links between US CHDs and SHDs will improve timeliness. Electronic data exchange allows CHDs to set up a local database and reduces transcription errors, mailing costs, and telephone costs. CONCLUSION: A fuller use of e-mail or other electronic communication by US CHDs will allow them to use a local database as a tool for managing local disease outbreaks more effectively and independently. Federal and state agency access to the CHD databases will enable early reporting of epidemic outbreaks. Periodic posting of public health information on Internet servers is recommended for immediate access to the public health data by Internet users worldwide.

Centers for Disease Control and Prevention, U.S.↗
PubMed1995

SITIE: a health care workstation integration architecture for epidemiologists.

SITIE is a workstation devoted to epidemiological data selection, analysis, and representation. Epidemiological data are collected using the French Communicable Diseases computer Network and stored in an Oracle database. Disease selection and spatial and temporal representations can be done using a user friendly graphic interface. SITIE automatically generates SQL requests to the Oracle database, extracts the data, processes it according to the user's choice, and represents the data. SITIE is built upon the AVS graphic package and allows the creation of new applications using previously developed modules linked together to form a network. SITIE can be viewed as a tool box for epidemiological data representations. Three example applications are detailed in order to make clear the way a new application can be built using SITIE. The reusability of modules is exemplified by a compound application.

Computer Communication Networks↗
PubMed1995

AUDILAB: quality audit simulation to prepare biomedical testing laboratories for accreditation.

In order to prepare biomedical laboratories for accreditation a quality audit simulator has been developed. By means of a dialogue with the laboratory, AUDILAB simulates the process by which the auditor identifies deviations or assesses conformity to the standard. AUDILAB is based on a knowledge processing system accessible via Minitel (French videotex terminal). With reference to the EN 45001 standard which is the European standard concerning the "General criteria for the operation of testing laboratories", it provides an assessment of the laboratory's degree of conformity and prompts it to take corrective action.

Accreditation↗
PubMed1994

[Preventing deficiencies in the transfusion process].

The methods of system reliability analysis represent an interesting set of tools used to follow the so-called "transfusion process", defined as all the steps from donors sensitization to recipients follow-up. FMECA, (Failure Mode Effects and Criticality Analysis), can be used as a prevention tool, independently of any dysfunction in the process. Of course, it can equally be used following a failure, in order to analyse the causes and to apply the specific corrections. Quality insurance, system reliability analysis, epidemiologic surveillance and safety monitoring operate in synergy. These three issues pertaining to transfusion safety constitute a dynamic system.

Blood Banks↗
PubMed1994

[Blood transfusion and quality assurance].

Administrating safe blood products and being able to produce the evidence of procedures correctly employed, is today vital for healthcare professionals. Industrial quality assurance is an appropriate answer to this problem. Indeed, this approach allows the mastering of a processing system thanks to the combination of three elements: a detailed description of processes, control mechanisms and corrective measures. It relies on an information system and must be applied to all steps of blood transfusion.

Blood Banks↗
PubMed1994

[Immunologic risks of blood transfusion and public health].

The general objective is the study, through scientific approaches, of the main components of immunological risks linked to red blood cell transfusions, as well as their consequences, in order to define precise rules for prevention, taking into account that 2,700,000 units were transfused in 1992. To reach this general aim, five intermediary objectives have to be achieved: 1) The sentinel study of the methodology used to collect information about transfusion accidents, as well as their identification and their early clinical expression; 2) The analysis of the occurrence mechanisms of incompatibilities and transfusion accidents; 3) The up-date definition of post-transfusion alloimmunization, in particular regarding 3 parameters: a) the immunogenicity of the different erythrocyte antigens, that will have to be reassessed; b) the modes of occurrence of post-transfusion anti-erythrocyte alloimmunization; c) the different types of chronology in the appearance and the persistence of anti-erythrocyte antibodies. 4) The search for significant criteria in order to assess the immunopathological correlations of the consequences of antigen-antibody conflicts; 5) The elaboration of the principles for tests evaluation and identification of the techniques linked to blood groups and the study of anti-erythrocyte antibodies.

Blood Group Incompatibility↗
PubMed1993

Computerised surveillance of communicable diseases in France.

The French National Department of Health and National Institute of Health and Medical Research decided to develop a powerful, computerised, national information system in order to improve the surveillance of communicable disease in France. The French Communicable Diseases Computer Network (FCDN), which went into operation in 1984, allows for the collection and dissemination of data on seven communicable diseases. The epidemiological database is updated by 500 sentinel general practitioners using home terminals. Data on notifiable diseases are submitted to the National Department of Health by the departmental health offices via FCDN.

Communicable Diseases↗