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PubMed2004

The development of the Stroke Physiotherapy Intervention Recording Tool (SPIRIT).

PURPOSE: To develop a recording system that describes physiotherapy interventions for the rehabilitation of postural control post-stroke. METHODS DESIGN: A draft recording tool was developed using the method described by Edwards et al, involving literature searches and collaboration with senior clinicians. It was piloted with stroke physiotherapists using a cross-sectional survey design to assess validity, utility and completeness. Participants used the recording tool to record five treatment sessions. Feedback regarding the utility and completeness of the system was obtained via short semi-structured interviews. SETTING: 11 NHS Trusts. PARTICIPANTS: 35 stroke physiotherapists working in acute and rehabilitation settings recorded the treatment of 120 patients in 590 treatment sessions. RESULTS: A double-sided A4 form with a checklist of 79 physiotherapy interventions in 9 categories was produced: the Stroke Physiotherapy Intervention Recording Tool (SPIRIT). The participants found it quick and easy to use and reflective of clinical practice. There were a few missing interventions and some confusion regarding definition of terms. Revisions were to include the omitted interventions and to produce a user's booklet defining the categories and interventions. CONCLUSIONS: SPIRIT provides a system for recording physiotherapy treatment for stroke patients which reflects current clinical practice in acute and rehabilitation settings.

Adult↗

PubMed1994

Converting data into information.

Transforming data into information is a challenge to all professionals working in the quality arena. Reams of data do not provide the answers being sought to challenging questions. Several continuous quality improvement tools, including run charts, control charts, and Pareto charts, can be used to visually display data and provide further ideas for analysis. This article describes in detail when to use these tools and how to construct and use them. Examples from hospital settings further illustrate their benefit in converting data to information.

Data Display↗

PubMed1991

Productivity: a context for excellence.

Inductively created measures of the sort described above enable the ambulatory care manager to make a crucial decision: Are the outcomes worth the cost involved? As Collins (1988, p. 235) notes, "Our nursing product is quality care based on principles and standards of practice... and substantiated and enhanced through quantifying our practice." By using nursing resources wisely, we can "moderate the march on the market...for caring and access of what we are here for" (Cunningham, 1983, p. 90). In relaying her feelings during treatment for a malignant breast tumor, Kaufman (1989) supports the contention that caring and access are essential parts of a therapeutic regime. Curtin (1987, p. 7) warns that "You cannot provide health care by taking the care out of it." This project allowed nurses to create their own measurement system that identified and quantified the professional nursing tasks involved in each workload indicator. Nonprofessional activities were also identified, quantified, and delegated to appropriate levels of staff, thus increasing the control of the nurses over their own practice environment. In the words of Curtin (1987, p. 7), "Losers count time to make heads roll. Winners use their heads to make time count. This country cannot afford to place its health in the hands of losers."

Ambulatory Care Information Systems↗

PubMed1994

Increasing the completion of the durable power of attorney for health care. A randomized, controlled trial.

OBJECTIVE: Wider use of written advance directives may prevent many ethical dilemmas about life-sustaining interventions for patients who have lost decision-making capacity. We investigated whether a simple educational intervention increased patient completion of the durable power of attorney for health care. DESIGN: A randomized, controlled trial. SETTING: A health maintenance organization. SUBJECTS: All patients aged 65 years and older and discharged from a hospital between January 1991 and May 1991 (n = 1101) were randomized to either an intervention group or a control group. INTERVENTION: An educational pamphlet on the durable power of attorney for health care and a durable power of attorney for health care form were mailed to all patients in the intervention group. The control group received conventional care only. MAIN OUTCOME MEASURE: Completion of the durable power of attorney for health care form. RESULTS: There were no significant baseline differences between the intervention group and the control group. Following our intervention, 18.5% of the subjects in the experimental group completed a durable power of attorney for health care form, compared with 0.4% of the control group (P < .0001). CONCLUSIONS: A simple educational intervention significantly increased the completion of the durable power of attorney for health care. Our findings should stimulate further efforts to empower patients to make informed decisions about their health care.

Advance Directives↗

PubMed2004

What is violence against women: defining and measuring the problem.

Violence against women (VAW) is a prevalent problem with substantial physical and mental health consequences throughout the world, and sound public policy is dependent on having good measures of VAW. This article (a) describes and contrasts criminal justice and public health approaches toward defining VAW, (b) identifies major controversies concerning measurement of VAW, (c) summarizes basic principles in identifying and measuring VAW cases, and (d) recommends changes to improve measurement of VAW. In addition to reviewing recommendations from the Centers for Disease Control and Prevention Workshop on Building Data Systems for Monitoring and Responding to Violence Against Women and the World Health Organization World Report on Violence and Health, the article concludes that changes are needed in the FBI Uniform Crime Reports and National Crime Victimization Survey to improve measurement of rape and sexual assault.

Battered Women↗

PubMed1992

Conservation and laundry: using outside vendors to clean reusable linens.

Using outside laundry facilities is a viable and efficient means for hospitals to clean and sanitize soiled linens. Such services also allow hospitals to achieve cost-effective linen systems. All kinds of linen products, including gowns, sheets, blankets, pillowcases, mops, diapers, and surgical textiles, are easily processed through such purveyors. Even newer fabrics with improved barrier protection qualities can be serviced. The three elements that make up the laundry cost equation are purchasing, processing, and usage. Improvements and reductions in any one of these areas positively affect the other two. With this in mind, a hospital and an outside laundry service should work closely together to improve linen management, to control usage, and to remove waste, thus reducing hospitals' per-patient-day costs. Close interaction and teamwork will make the relationship work with dynamic results. Together, both parties will grow and meet the ever-evolving needs of the health care industry.

Bedding and Linens↗

PubMed1991

[Use of the automated system of information processing in tuberculosis control].

A notification variant has been designed on the basis of the No. 089 form "Notification of a patient with newly diagnosed active tuberculosis", which is used for information feeding into computer on persons with newly diagnosed tuberculosis and on those registered in a dispensary; it is also used as a corrective coupon. The automated system for information processing "Tuberculosis" has been developed which allows a centralized control over the early detection and dispensarization of patients, efficient assessment of the accumulated information and proper decision making. The effectiveness of the electronic devices used in dispensary work can be improved on the condition that phthisiologists are provided with personal computers.

Ambulatory Care Information Systems↗

PubMed1999

[Hospital organization of cardiopulmonary resuscitation].

That hospital cardiopulmonary resuscitation (CPR) should be supported by an organized plan rather than on the skills of individual health care personnel is a universally agreed-upon principle. Such a plan should guarantee that needed materials are available and in working order in all departments and that the team assigned to carry out CPR arrives promptly. Personnel other than the specialized team should also receive CPR training appropriate to their posts. The main features of a CPR plan are related to the five steps in the chain of survival: a) identification of a patient to be resuscitated, a matter that has important ethical ramifications; b) early recognition of cardiac arrest; c) early defibrillation; d) basic CPR, and e) advanced CPR. The CPR plan should incorporate the automatic recording of system, population, event and outcome variables. Task forces responsible for establishing and maintaining the plan and its quality control will periodically review the data with the aim of detecting errors, correcting them or introducing improvements. Various international societies and CPR committees have recently suggested a uniform way (the Utstein style) of recording and presenting data to allow comparisons either from hospital to hospital or over time within a single center.

Cardiopulmonary Resuscitation↗

PubMed1995

Coding medical concepts: a controlled experiment with a computerised coding tool.

In clinical routine there is a growing need to encode medical concepts with available standard coding systems. The coding process can be time consuming and may significantly add to daily paperwork, particularly regarding patients with multiple diagnoses and in busy clinical environments with a high turnover of patients. We have developed a generic computerised encoding tool--the PADS encoder--to ensure rapid, correct and complete coding of diagnoses in daily routine. The tool is integrated into an electronic patient record system (PADS, Patient Archiving & Documentation System) and takes full advantage of the user friendly Macintosh interface. The tool was tested in a controlled experiment by 18 clinicians who encoded a total of 666 medical concepts in each protocol (study protocol vs. control). The following positive findings were significantly associated with the use of the computerised coding tool: the number of correctly encoded medical concepts was higher (99.55% vs. 86.1%), coding errors were lower (0% vs. 10.81%), more modifier codes were encoded correctly (increase by up to 43%), less coding errors were made (decrease by up to 43%), the overall rate of correctly encoded and complete main and modifier codes was increased by 31.27% (97.29% vs. 66.02%), coding time was reduced by 50%. This paper presents data to suggest that a computerised coding tool can produce more complete data of higher quality and can save time compared with the traditional approach to encode medical concepts.

Computer Communication Networks↗

PubMed1994

Conscious sedation for imaging and interventional studies.

Some radiology patients may need medication to decrease anxiety and control pain. In this comprehensive article, the authors describe quality care for patients receiving conscious sedation, effective ways of delivering this service and detailed descriptions of the conscious sedation program at a northeastern university hospital. A valuable chart of recommended drugs, dosages, considerations and possible side effects is included.

Adult↗

PubMed2002

Communication across the divide. A trial of structured communication between general practice and emergency departments.

AIM: To evaluate the impact of structured form letters for general practitioner to emergency department (ED) communication. METHOD STUDY POPULATION: one hundred and fifty-five GPs with practices in the Liverpool local government area in metropolitan Sydney and patients referred by them to ED at Liverpool over five months from June to October 1998. DESIGN: randomised control trial of GPs as unit of randomisation; intervention GPs were encouraged to follow a structured proforma for their written communication with the ED. Control GPs were left to usual referral procedures. The ED was encouraged to fax a brief report back to GPs using the form. Impact measures: the quality of the referral letters was evaluated using a checklist that included: reason for referral; examination finding; medical history; investigations; psychosocial history; allergies; drugs given in the surgery and present medication. Surveys were sent every month to GPs to assess communication from the ED and adverse events observed by GPs. RESULTS: Most letters from GPs to the ED contained information on reasons for referral, medical history and examination findings. Reasons for referral were present in 95% of the intervention group GPs' letters compared with 99% of those of the control group. Investigations were included with 27% and present medications in 37%. Letters from GPs in the intervention group were more likely to contain a psychosocial history than those in the control group (13% compared with 1%). Most GPs reported receiving a letter from the ED although this was rarely by fax; most were brought to them by the patient. Phone calls were received by about one in five GPs each month. Most GPs found both of these to be useful. There were no differences between communication received by GPs in the intervention and control groups. CONCLUSION: This study demonstrates that improvements to communication between GPs and EDs are difficult and may require a systemic change within general practice and the hospital. Electronic systems may allow the sort of reciprocal communication required to establish and sustain improvement.

Communication↗

PubMedDate not supplied

[Description of the computer program used at the Hospital de Bellvitge for monitoring and control in the Parenteral Nutrition Unit].

The purpose of this paper is to introduce a computer program to control the Pharmacy Service Parenteral Nutrition Unit. The program's main feature is a broad menu of possibilities for the clinical monitoring of patients receiving PN. We explain its operation, potential and applications and give some practical examples of some of those applications.

Clinical Pharmacy Information Systems↗

PubMed1995

Equipment records for modular analytical systems.

The dominant technology in the BAS analytical chemistry laboratory is high-performance liquid chromatography (HPLC). Logbooks have been too cumbersome and unworkable for recording maintenance and repair of HPLC systems. Liquid chromatographs can have 10 or more components that can all move independently of one another as systems are reconfigured for different types of analyses. One solution to the problem of keeping accurate, easily retrievable records of equipment maintenance and repair is to use a card to record the information and a database to catalog the cards. The card contains all of the required information for routine or nonroutine maintenance and for remedial action and/or repair. The document is controlled by providing each card with a unique number and maintaining a duplicate in a bound book. The cards are filed by equipment ID number, producing an historical record of the maintenance and repair of a piece of equipment. The information on each card is also summarized in a database. Using the database, regular schedules of routine maintenance can be produced, the inclusion of all cards can be verified, and the records of a particular piece of equipment can be displayed.

Chromatography, High Pressure Liquid↗

PubMed1996

The use of continuous quality improvement methods to implement practice guidelines in asthma.

National asthma management guidelines have improved awareness of the rising morbidity and mortality from asthma but have not been widely implemented at a local level. This paper describes the use of continuous quality improvement techniques to facilitate the implementation of asthma management guidelines within a tertiary hospital setting. A baseline audit demonstrated satisfactory emergency assessment and treatment, but identified poor compliance with the patient education aspects of the asthma management plan. An evaluation of the literature demonstrated that programs combining asthma education and management were effective when directed towards adults with a recent severe asthma exacerbation. An asthma education and management service was developed to address these deficits. A repeat audit was conducted which identified improvements in asthma control and management skills for patients attending the education program, together with reductions in asthma re-admission rates for patients referred to the service. Ongoing quality assessments will target non-attenders to the service and the maintenance of asthma skills. An area Asthma Health Outcomes Council was formed to address the issues of asthma management throughout the area health service.

Adult↗

PubMedDate not supplied

ENDO-LAB: an integrated, portable endocrinology laboratory software system.

ENDO-LAB is an IBM PC-based system which performs calculations and record-keeping for the Vanderbilt University Medical Center Endocrinology Laboratory. It manages maintenance and quality control, and prints reports for regulatory agencies. The system was designed to minimize paperwork without changing laboratory procedures in any way. Key features of ENDO-LAB include a uniform user interface, and error detection mechanisms. The system is designed to detect data which has been incorrectly entered. In addition, where the efficacy of a test can be determined on the basis of limited data, preliminary graphs are screened as soon as possible, so that the user can terminate lengthy calculations whose outcome would be invalid or inconclusive. ENDO-LAB is an integrated system in that the same statistical and calibration programs can be applied to all of the analyses. The system is both extensible and portable; it has been successfully implemented outside Vanderbilt.

Clinical Laboratory Information Systems↗

PubMed1997

[A program of quality improvement in transfusion safety. Experience at Saint-Camille Hospital].

A program of quality improvement of blood transfusion safety was carried out in St Camille Hospital after a call for tenders had been jointly issued by the French Ministry of Health and the French Agency for Medical Evaluation (ANDEM). The blood transfusion process was analysed and a diagnosis of the situation was performed. Improvement actions were then undertaken to control the blood transfusion process. They consisted in education programs, elaboration of procedures and documents such as a transfusion record and a transfusion manual. The effectiveness of the actions was measured using indicators. Such a quality improvement approach revealed to be a good method to manage the blood transfusion process and to improve safety. However, it requires people's involvement in the project, and rigorous project management.

Blood Transfusion↗

PubMed1998

GMP in blood collection and processing.

The principles of Good Manufacturing Practice have, in the main, been universally developed for the guidance of the pharmaceutical industry rather than for transfusion services. However, these rules and guides are increasingly being adapted for use in blood centres, in the production of labile blood components and of plasma for fractionation. The guide for pharmaceutical industries produced by the commission of the European Communities is used as a model here, the nine basic requirements being those applicable to Quality Management, personnel, premises and equipment, document, production, Quality Control, contract manufacture and analysis, complaints and product recall, and self-inspection. Though having more direct application to the production laboratory preparing blood components, the majority of these requirements and principles are also directly applicable to all of the activities involved in blood collection.

Biological Products↗

PubMedDate not supplied

Sibling donor cord blood banking for children with sickle cell disease.

Although hematopoietic stem cell transplantation has curative potential for selected patients with sickle cell disease (SCD), most patients who are eligible for transplantation do not have a suitable donor. Cord blood (CB) from a sibling could provide an alternative stem cell source that, while not as well established as marrow, may offer certain advantages for selected families. These potential advantages include low risk to the infant donor, the possibility that mismatched CB units from sibling donors may be acceptable for transplantation, prompt availability of a stored CB unit for transplant, and decreased risk of clinically significant graft-versus-host disease. When families with SCD (or other transplant-treatable condition) conceive a sibling, no comprehensive research resource exists to assist the family in collecting the new infant's CB. With support from the National Heart Lung and Blood Institute, we are developing a noncommercial research-based CB Banking Program specifically for medically indicated sibling donations. In preliminary experience, we have collected CB from 52 SCD families across 19 states. Of these, 2 CB units have thus far been used for transplantation and 9 others are HLA-identical. We conclude that a CB bank focusing on sibling-donations may be feasible, but further study is required to determine whether such a bank can collect CB units of sufficient quantity and quality to support controlled trials of sibling CB transplantation. Families with a specific medical need, such as those already caring for a child with SCD, should consider collecting sibling CB as part of comprehensive care if the opportunity becomes available.

Anemia, Sickle Cell↗