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Biomedical subjects

P Valenstein

Publications and source records attributed to P Valenstein.

At least 19 recordsLinked to original sources
PubMed1999

Outpatient order accuracy. A College of American Pathologists Q-Probes study of requisition order entry accuracy in 660 institutions.

CONTEXT: Laboratory test order entry errors potentially delay diagnosis, consume resources, and cause patient inconvenience. OBJECTIVE: To evaluate the frequency and causes of computer order entry errors in outpatients. DESIGN: Cross-sectional survey and prospective sample of errors. Participants answered questions about their test order entry policies and practices. They then examined a sample of outpatient requisitions and compared information on the requisition with information entered into the laboratory computer system. Order entry errors were divided into 4 types: tests ordered on the requisition, but not in the computer; tests performed but not ordered on the requisition; physician name discrepancies; and test priority errors. PARTICIPANTS: Six hundred sixty laboratories enrolled in the College of American Pathologists Q-Probes program. MAIN OUTCOME MEASURE: Overall order entry error rate. RESULTS: A total of 5514 (4.8%) of 114 934 outpatient requisitions were associated with at least 1 order entry error. The median participant reported 1 or more order errors on 6.0% of requisitions; 10% of institutions reported errors with at least 18% of requisitions. Of the 4 specific error types, physician name discrepancies had the highest error rate, and test priority errors the lowest error rate. Four institutional factors were significantly associated with higher overall error rates: orders verbally communicated to the laboratory; no policy requiring laboratory staff to compare a printout or display of ordered tests with the laboratory requisitions to confirm that orders had been entered correctly; failure to monitor the accuracy of outpatient order entry on a regular basis; and a higher percentage of occupied beds (ie, a busier hospital). CONCLUSIONS: Computer order entry errors are common, involving 5% of outpatient requisitions. Laboratories may be able to decrease error rates by regularly monitoring the accuracy of order entry, substituting written and facsimile orders for verbal orders, and instituting a policy in which orders entered into computer systems are routinely rechecked against orders on requisitions.

Ambulatory Care↗
PubMed1998

Urine culture contamination: a College of American Pathologists Q-Probes study of contaminated urine cultures in 906 institutions.

OBJECTIVE: To examine the frequency and causes of urine culture contamination in outpatients. METHODS: Nine hundred six institutions, ranging in size from less than 50 to more than 600 beds, each examined 250 consecutively ordered urine cultures from outpatients and identified specimens that met the study definition of contamination. Participants also answered questions about the practices used to collect, transport, and process urine specimens. In all, data relating to more than 200,000 urine cultures were analyzed. RESULTS: The median institution reported that 18.1% of urine cultures specimens collected from outpatients were contaminated. The top 10% of institutions (90th percentile) reported that 5.6% or fewer of their cultures were contaminated. In contrast, the bottom 10% of institutions (10th percentile) reported that 36.8% or more of their urine specimens were contaminated. Institutions with lower contamination rates tended to process a lower proportion of specimens from female patients. Pediatric hospitals also reported lower contamination rates in specimens from children than general hospitals. Other factors, including the use of central processing areas, refrigeration, urine screening systems, specimen preservatives, provision of written collection instructions or special collection kits, and thermally insulated specimen transport containers, were not found to be associated with low specimen contamination rates in a multivariate analysis. CONCLUSION: Contamination of outpatient urine cultures is a common occurrence, and facilities differ significantly in their overall frequency of urine culture contamination. Many interventions commonly assumed to reduce contamination were not demonstrably effective in this study.

Female↗
PubMed1996

Duplicate laboratory orders: a College of American Pathologists Q-Probes study of thyrotropin requests in 502 institutions.

OBJECTIVE: To examine the frequency and cause of duplicate thyrotropin (TSH) testing. METHODS: Five hundred two institutions, ranging in size from fewer than 100 to more than 600 beds, examined consecutively processed TSH assays to identify duplicate orders. Duplicates were defined as two or more TSH tests performed within 7 days. All together, participants submitted data on 221,476 TSH orders. RESULTS: The median institution reported that 1.5% of TSH tests duplicated a TSH order that had been received from the same patient within the previous 7 days. Ten percent of institutions reported that 4.5% or more of their TSH tests were duplicates. Institutions with higher duplicate rates tended to be larger (ie, they had a greater number of occupied beds) and to have duplicate tests that were more likely to be ordered by a physician other than the one who ordered the initial test. Participants reported that for 19% of duplicate orders, physicians were unaware that the first test had been ordered. Physicians also indicated that duplicate assays were ordered to see if a previous result had changed (15%) or to check on the accuracy of a previous result (13%). Participants reported that 11% of duplicate TSH assays that their laboratory performed had apparently never been ordered. CONCLUSIONS: A large number of institutions are performing duplicate TSH tests that, in most cases, appear to be medically unnecessary. Institutions aiming to reduce the frequency of duplicate testing should consider policies that decrease the opportunity for different physicians to order tests on a single patient and should increase the accuracy with which physician orders are transmitted to the laboratory.

Clinical Laboratory Techniques↗
PubMed1996

The use and abuse of routine stool microbiology: a College of American Pathologists Q-probes study of 601 institutions.

OBJECTIVE: To examine the efficiency with which physicians use routine stool microbiology tests. DESIGN: Questionnaire and structured review of 100 consecutive stool bacteriology and parasitology examinations at each participating institution. SETTING: Six hundred one institutions enrolled in the College of American Pathologists Q-probes Program. RESULTS: Of 59500 bacteriology specimens, 3808 (6.4%) contained a pathogen. The vast majority (99%) of bacterial pathogens were detected in either the first or second specimen submitted. Almost 40% of inpatient specimens were collected after the third day of hospitalization, but only 0.6% of these specimens were positive for enteric pathogens that had not been previously recovered. More than half of the laboratories reported having no limits on the number of bacteriology specimens per patient that could be submitted for testing, and fewer than 8% of laboratories rejected specimens from inpatients after a certain number of days in the hospital. The frequency with which laboratories performed tests for Clostridium difficile varied widely. Of 58500 parasitology specimens, 1463 (2.5%) contained a pathogen; 97.6% of pathogens were detected by the second stool specimen, and 99.8% were detected by the third specimen. Only 0.7% of specimens from inpatients hospitalized more than 4 days contained a new pathogen. CONCLUSIONS: We recommend that no more than two bacteriology specimens and no more that two or three parasitology specimens be processed per patient without consultation. Standard stool examination for a bacterial pathogens has a low yield and should not be performed after 3 days of hospitalization. Likewise, parasitology examinations should not be performed after 4 days of hospitalization.

Clostridioides difficile↗
PubMed1996

Laboratory computer availability: a College of American Pathologists Q-probes study of computer downtime in 422 institutions.

OBJECTIVE: To determine the frequency, duration, and impact of computer downtime on laboratory operations. METHODS: Four hundred twenty-two laboratories monitored the frequency of computer system downtime and other computer malfunctions over a period of 30 days. Participants classified each instance of unavailability according to its cause, duration, and consequences. In all, data from 11 967 instances were submitted for analysis. RESULTS: During the 30-day study period, the participating institutions experienced a median of eight episodes in which all or a primary computer function was unavailable. The cumulative median duration of downtime during these 30 days was 14.3 hours. The most unfortunate 10% of participants reported having 44 or more episodes in which all or a primary computer function was lost during the 30 days, for a cumulative duration of 77.7 or more hours of system unavailability. Computer installations that served two or more full-service laboratories were significantly more likely to experience unscheduled loss of all or a primary computer function than were sites that served only one laboratory, and unscheduled events were more likely to be of longer duration. Participants reported that 1.3% of downtime events required the use of staff overtime to perform required work. Overtime was more likely with longer-than-average periods of downtime and losses that had not been scheduled. Of all the downtime instances, 0.2% led to the release of inaccurate results, and 0.1% led to an adverse clinical outcome. These events were associated with software failure, unscheduled downtime, a site's overall frequency of downtime, particular software vendors, and not having installed a software patch in the previous 1000 days. CONCLUSIONS: The frequency of laboratory computer downtime varies widely among institutions and is occasionally associated with adverse clinical outcomes or additional staff expense.

Chi-Square Distribution↗
PubMed1996

Managing physician use of laboratory tests.

The active management of laboratory test utilization appears to be a practical approach to addressing the financial pressures imposed by managed care and capitated reimbursement, and can complement efforts already underway in most laboratories to reduce the unit cost of testing. Managing laboratory utilization takes time that is often in short supply; however, the literature suggests that the savings from a well-focused effort can easily exceed the costs of a utilization management program. Individuals and institutions that commit themselves to active utilization management need to realize (1) how laboratory utilization is measured, (2) benchmarks within the industry, and (3) the stubborn structural and psychological constraints that are likely to limit progress. Some approaches to reducing utilization, such as education, have poor track records and are best avoided. Other avenues, such as providing financial feedback and making specific changes to the environment in which tests are ordered, have demonstrated moderate success in the past and hold considerably more promise.

Clinical Laboratory Techniques↗
PubMed1989

Standardization of yeast inocula with an electronic impedance counter.

The standardization of yeast inocula has been identified as an important variable in the performance of reproducible in vitro fungal susceptibility testing. We investigated the precision and accuracy of an electronic particle counter in preparing yeast inocula, with quantitative culture used as a "gold standard." Suspensions of Candida albicans and Torulopsis glabrata standardized with a particle counter at 10(6) counts per ml were highly reproducible when cultured quantitatively (coefficients of variation, 6.7 and 6.8%, respectively). Accuracies of particle counts, compared with those of quantitative culture, were -8.5 and +2.8% for the two species, respectively. Electronic cell counts were highly linear between 5 X 10(6) and 5 X 10(4) CFU/ml (R2 greater than 0.99). Multiple electronic counts of a single suspension of C. albicans had less variation than did multiple quantitative cultures of a suspension of the same organism (coefficients of variation, 2.4 versus 8.9%; P less than 0.01), suggesting that impedance counting is probably more precise than quantitative culture. Electronic particle counters can be used to prepare accurate, reproducible yeast inocula. The method may be more accurate and is more precise than other techniques commonly used to standardize yeast suspensions.

Colony Count, Microbial↗
PubMed1989

Prevalence of Campylobacter pylori in esophagitis, gastritis, and duodenal disease.

The relationship between the presence of Campylobacter pylori and esophagitis was studied in patients undergoing paired biopsies of distal esophagus and gastric antrum during esophagogastroduodenoscopy. Biopsy specimens were examined for urease activity and for the presence of C pylori by culture and by histologic examination of hematoxylin-eosin- and Warthin-Starry-stained sections. Sixty-two patients were entered into the study. All esophageal biopsy specimens, regardless of histologic findings, were negative for the presence of C pylori by urease test, culture, and histologic examination. Of 35 patients with normal esophageal biopsy specimens, 11 (31%) had antral specimens that were positive for C pylori, while 11 (41%) of the 27 patients with esophagitis had antral specimens that were positive for the organism. Campylobacter pylori was detected in 14 (70%) of 20 patients with chronic gastritis, in 8 (67%) of 12 patients with endoscopically documented duodenal ulcers and erosions, but in only 3 (33%) of 9 patients with endoscopically defined duodenitis. We conclude that histologic esophagitis is not associated with increased prevalence of either gastric or esophageal C pylori. The well-described association of chronic gastritis and duodenal ulcers with C pylori was present in our study population.

Adult↗
PubMed1988

Corynebacterium xerosis septic arthritis.

A 62-year-old man developed acute septic arthritis due to Corynebacterium xerosis. The patient was treated with ampicillin and rapidly recovered. To the authors' knowledge this is the only reported case of septic arthritis due to C. xerosis. Clinical features of this case and the five previously reported cases of diphtheroid arthritis are discussed.

Acute Disease↗
PubMed1988

Test-ordering by multiple physicians increases unnecessary laboratory examinations.

In modern teaching hospitals, patients typically receive direct care from a succession of different physicians, each of whom may order diagnostic tests on the same patient. We examined the association of test-ordering by multiple physicians with unnecessary duplication of 20-test chemistry profiles in 198 consecutively admitted patients. In a multivariate regression model, the number of duplicate chemistry profiles ordered for a patient was significantly correlated with the number of physicians ordering profiles after controlling for the overall intensity of profile testing. In a case-control analysis comparing duplicate with nonduplicate profiles, redundant tests were significantly more likely to have been ordered by a new physician who had not ordered a patient's previous profile than by the same physician who had ordered the previous chemistry panel. We conclude that test ordering by multiple physicians, the prevalent pattern in almost all teaching hospitals, predisposes to unnecessary laboratory examinations.

Clinical Laboratory Techniques↗
PubMed1986

Primary intranasal Fusarium infection. Potential for confusion with rhinocerebral zygomycosis.

Fusarium species are saprophytic fungi that may colonize human skin and nails and may rarely cause invasive infections in traumatized tissue and in debilitated and immunocompromised patients. We report herein a case of invasive intranasal Fusarium oxysporum infection in a diabetic patient. This unusual presentation potentially can be confused with early rhinocerebral zygomycosis clinically and histologically. Distinguishing morphologic features and the possible role of diabetes in promoting this infection are discussed.

Adenocarcinoma↗
PubMed1983

Pseudomonas alcaligenes endocarditis.

Pseudomonas alcaligenes is a common soil and water inhabitant that has rarely been proven a human pathogen. We describe a fatal case of Pseudomonas alcaligenes endocarditis. The need for accurate identification of unusual organisms isolated in a clinical setting are discussed.

Endocarditis, Bacterial↗