PubMed · 10339170
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B M Gustafson. 1999. Organization under the upside-down revenue cycle processing model.. https://pubmed.ncbi.nlm.nih.gov/10339170/
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Based on the "Trauma Registry" of the German Society of Trauma Surgery, an interclinical quality management (QM) system was implemented. The principles of the QM system as well as the differences in the quality of outcome and treatment are presented. The analysis uses the data on 2,069 severely injured (ISS = 22 +/- 14) patients from 20 hospitals collected prospectively and anonymously between 2/93 and 12/97. Outcome quality was analyzed by the TRISS method and Z-statistics. The Z-value of the whole series was -0.24. There were three hospitals with more than 150 patients that had a Ps value calculated by the TRISS method. Clinic A had a good (-2.49), clinic B an average (-0.3) and clinic C (3.62) an adverse Z-value. The assessment of treatment quality was performed by criteria concerning both preclinical and acute clinical phases. Clinic C had a prolonged preclinical treatment time (90 min vs 62 min in clinic A) for severely injured (ISS > 15) patients. At the same time, the preclinical intubation rate for severe thoracic trauma (AIS > 3) was lower (44 %) in clinic C than in A (62 %). With 14 min clinic A had the shortest time until basic radiological and ultrasound diagnostics were completed (X-rays of chest and pelvis and abdominal ultrasound) in cases of severe blunt trauma (ISS > 15), compared to 54 min in clinic B or 31 min in clinic C. Also, cranial computed tomography for severe traumatic brain injury (GCS < 9) was applied significantly faster in clinic A (after 36 min) than in clinic C (after 62 min). Delayed diagnoses were defined as the difference between the ISS at discharge and the ISS at completion of diagnostics in the emergency department; this criterion was met best by clinic A with an ISS difference of two patients compared to five in clinic B and four in clinic C. The hospitals participating in the Trauma Registry receive an annual analysis of their preclinical and acute clinical performance. Thus, every hospital can analyze and improve the quality of treatment based on reliable data that show which parts of the process have to be optimized. Furthermore, the data allow a comparison of the average and optimal results of the whole series.
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OBJECTIVE: Interface design is a key element in the efficient use of a picture archiving and communication system (PACS) workstation. In many cases, multiple mouse clicks or keyboard commands are required to open and close a case, to mark it as complete, and to retrieve and allocate screen positions to the next case. We evaluated the work flow effect of software designed for automated image display in which all of these operations are consolidated in a single mouse click. CONCLUSION: Automated image display increases efficiency in image interpretation and remedies the normally cluttered presentation environment. At our institution, acceptance of automated image display has been overwhelmingly positive. In fact, automated image display has improved radiologist productivity.