Biomedical subjects

P K Makens

Publications and source records attributed to P K Makens.

4 recordsLinked to original sources

PubMed1991

Quality improvement: an imperative for medical care.

For continuous process improvement to be successful at the site of care, an organizational structure for quality improvement should be in place. Quality improvement requires (1) an environment for quality improvement and (2) tools for improvement, including statistical and meeting tools. Physicians and all other care givers and support personnel must cooperate for process knowledge to be complete and usable. Perhaps there is no such thing as a purely "clinical" system, because the contiguous systems influence clinical behavior so completely they are almost inseparable. Process improvement specifications are not the same thing as standards as we now understand them. Process improvement specification are process based. They expect, are designed for, and handle divergent pathophysiologic conditions by focusing on processes. Individual institutions define and measure their outputs, but these outputs are judged against their customers' needs and expectations (thereby becoming outcomes) for performance, features, reliability, conformance, durability, serviceability, aesthetics, and perceived quality. Outcomes research as known today can help us understand the needs and expectations of our customers. Moreover, any team can improve the framework of quality improvement.

Contract Services↗

PubMed1990

Early detection of acute myocardial infarction in patients presenting with chest pain and nondiagnostic ECGs: serial CK-MB sampling in the emergency department.

STUDY OBJECTIVES: Patients presenting to the emergency department with chest discomfort are a difficult problem for emergency physicians. Nearly 50% of patients with acute myocardial infarction (AMI) will initially have nondiagnostic ECGs on ED presentation. The purpose of this study was to determine if patients with AMI having nondiagnostic ECGs could be identified using new immunochemical assays for serial CK-MB sampling in the ED. DESIGN: Chest pain patients, more than 30 years old, with pain not caused by trauma or explained by radiographic findings, were eligible for the study. Serial serum samples were drawn on ED presentation (zero hours) and three hours after presentation, then analyzed for CK-MB using four immunochemical methods and electrophoresis. Standard World Health Organization criteria were used to establish the diagnosis of AMI, including new Q-wave formation or elevation of standard in-hospital serum cardiac enzyme markers. SETTING: A tertiary cardiac care community hospital. MEASUREMENTS AND MAIN RESULTS: The serum from 183 patients hospitalized for possible ischemic chest pain was collected and analyzed. Thirty-one of 183 patients (17%) were found to have AMI by standard in-hospital criteria. Sixteen of the 31 patients (52%) with AMI had nondiagnostic ECGs on presentation. Immunochemical determination of serial CK-MB levels provided a sensitive and specific method for detecting AMI in patients within three hours after ED presentation compared with standard electrophoresis. The four immunochemical methods demonstrated a range in sensitivity from 50% to 62.1% on ED presentation versus 92% to 96.7% three hours later. The immunochemical tests demonstrated specificities ranging from 83.0% to 96.4% at three hours, with three of the four tests having specificities of 92% or greater. Electrophoresis had a sensitivity of 34.5% on ED presentation, increasing to 76.9% at three hours, with a specificity of 98.6%. CONCLUSIONS: Immunochemical CK-MB methods allowed rapid, sensitive detection of AMI in the ED. Early detection of AMI offers many potential advantages to the emergency physician. Early detection of AMI, while the patient is in the ED, could direct disposition of this potentially unstable patient to an intensive care setting. Such information may prevent the ED discharge of patients with AMI having nondiagnostic ECGs. The diagnosis of AMI within a six-hour period after symptom onset may allow thrombolytic therapy to be given to patients with AMI not having diagnostic ECGs. This study served as a pilot trial for a multicenter study of the Emergency Medicine Cardiac Research Group, which is currently ongoing.

Adult↗

PubMed1990

Applications of industrial quality improvement in health care.

Quality in medical care traditionally has been regarded as the professionally defined optimum that brings about the greatest improvement in health. That definition has been modified somewhat to include patient preferences for different treatment alternatives and costs. The question then arises how we can improve the efficiency of the health care system while maintaining or improving the quality of care. The answer is a focus on improvement in the process of care and, as needed, monitoring of all aspects of the process, not just untoward outcomes.

Consumer Behavior↗

PubMed1989

Modeling emergency department operations using advanced computer simulation systems.

We developed a computer simulation model of emergency department operations using simulation software. This model uses multiple levels of preemptive patient priority; assigns each patient to an individual nurse and physician; incorporates all standard tests, procedures, and consultations; and allows patient service processes to proceed simultaneously, sequentially, repetitively, or a combination of these. Selected input data, including the number of physicians, nurses, and treatment beds, and the blood test turnaround time, then were varied systematically to determine their simulated effect on patient throughput time, selected queue sizes, and rates of resource utilization. Patient throughput time varied directly with laboratory service times and inversely with the number of physician or nurse servers. Resource utilization rates varied inversely with resource availability, and patient waiting time and patient throughput time varied indirectly with the level of patient acuity. The simulation can be animated on a computer monitor, showing simulated patients, specimens, and staff members moving throughout the ED. Computer simulation is a potentially useful tool that can help predict the results of changes in the ED system without actually altering it and may have implications for planning, optimizing resources, and improving the efficiency and quality of care.

Appointments and Schedules↗