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At least 19 recordsLinked to original sources

Improvement in transfusion safety using a new blood unit and patient identification system as part of safe transfusion practice.

A new patient and blood unit identification system designed to confirm the identity of crossmatched blood products and that of the intended recipient was evaluated. Six hundred seventy-two red cell concentrates were transfused to 312 patients. Participating hospital personnel and patients were interviewed regarding the use and benefit of this unique system, which incorporates a "lock-box" approach to the identification process. The product and procedure were accepted unanimously and enthusiastically, and three potential mistransfusions were avoided by use of the system during the limited period of observation. This type of approach to the identification process affords greater security than conventional practices and minimally burdens staff.

Blood Transfusion

Hospital activity analysis: a source of information about serial hospital admissions.

This paper describes a method for linking serial hospital admissions for the same patient on the basis of existing Hospital Activity Analysis data. Details are given of a linkage procedure suitable for use with a computer, which takes account of possible errors in the recording of items of personal information. Applications of the procedure to give the clinician better access to information about previous hospital admissions and as a basis for monitoring the effectiveness of particular hospital-based procedures are described.

Computers

The John Doe syndrome: diagnosis and outcome of patients unidentified at the time of emergency department admission.

Patients unidentified at the time of admission to urban emergency departments are a group about whom little is known. To determine the medical diagnoses and outcomes of these "John" and "Mary Does", we reviewed emergency department charts for these patients admitted from January 1 to December 31, 1988. During this period there were 344 initially unidentifiable patients, for 0.44% of all visits. Age was 36.9 +/- 15.6 years (mean +/- SD); 71% were male. All patients had one or more of the following diagnoses, with mortality highest for cardiopulmonary arrest (n = 42, mortality = 100%), followed by major trauma (163, 68%), drug overdose (27, 41%), miscellaneous medical conditions (11, 18%), neuropsychiatric disorders (59, 12%), acute alcohol intoxication (62, 0%), and seizures (13, 0%). Overall mortality was 47%. Identification was made prior to hospital discharge in 92% of cases. In this group, the most common sources of information were the patient (38%), family (19%), or documents eventually found on the person or in belongings (4%). Survivors were much more likely to be identified than those who died (99% versus 84%, P less than .0001). These observations describe a John Doe syndrome in patients whose identity is obscured by critical illness, the effects of drugs or alcohol, or neuropsychiatric disease. Economic privation is a major underlying risk factor.

Diagnosis

Putting bar codes to work for improved patient care.

Healthcare bar code applications have developed more slowly than industrial or supermarket bar codes, but they are beginning to gain acceptance. Clinical laboratories that use bar code systems have already improved productivity and, more importantly, patient care through reduction of human clerical errors in identifying laboratory samples. Soon, integration of proven technology should expand the benefits of automatic ID to a broader range of healthcare applications.

Blood Banking

[Computerization--a broad view].

This article describes the computer system as installed at three of the South African Medical Services (SAMS) hospitals. The system was developed as an improvement to the existing computerised inpatient system. Nursing personnel were involved from the design stage where a work group was formed to provide nursing input to the system. The patient identification subsystem is an integral part of the system. The patients' personal details as well as his blood group, address and medical-aid details are stored by this system. The hospital administration subsystem includes planned admission bookings, hospital and ward admission as well as discharges both on recuperative leave and final discharge. A ward information screen supplies information as to ward occupancy as well as patient information such as condition, nursing level of care, intravenous infusions and diet. Sub functions from this screen allow the update of the above information, capturing of details of births or deaths, collection or return of valuables and the printing of labels. A reminder function is present for patient appointments. Various management reports are available including summaries of occupancy, patients in other hospitals, admissions, discharges, births and deaths. Printouts are available of patients in various groups, lists of planned admissions for various dates, ward layouts, activity lists, diet lists and patient reminder lists.

Bed Occupancy

Prognostic factors in patients with hepatocellular carcinoma receiving systemic chemotherapy. Identification of two groups of patients with prospects for prolonged survival.

Among 37 patients with hepatocellular carcinoma given systemic chemotherapy, 12 (32 percent) lived 14 to 37 months from initiation of treatment whereas the remainder died within five months. Individual factors associated with improved survival included fully ambulatory performance status, lack of jaundice, response to chemotherapy, the fibrolamellar carcinoma pathologic variant, absence of cirrhosis, and normal serum alpha-fetoprotein levels. Patients living longer than 12 months fell into two groups. Seven patients with fibrolamellar carcinoma lacked evidence of hepatitis B serum markers or cirrhosis and had normal alpha-fetoprotein levels and surprisingly frequent extrahepatic metastases. All but one were Caucasians aged 25 years or less. The other five "long-term" survivors were all fully ambulatory without jaundice, and the majority were older non-Caucasians with tumor confined to the liver at the time of diagnosis and with hepatitis B markers, elevated alpha-fetoprotein levels, or cirrhosis. All patients without fibrolamellar carcinoma who were less than fully ambulatory or who had jaundice died quickly. Patients with fibrolamellar carcinoma have homogeneous clinical features, and their disease follows a relatively indolent course. In other patients with hepatocellular carcinoma, assessment of ambulatory status and serum bilirubin determination can identify those with some prospect of prolonged survival.

Adolescent

Design and implementation of computer-readable patient data cards--applications in Europe.

Computers have been widely accepted today as essential tools for handling and processing an ever-increasing flood of information. At the same time people, including patients and medical staff, are becoming more mobile and face the problem of interacting with the different computerized systems. We are also experiencing the acceptance of the small rectangular plastic cards as the instrument for vast numbers of transactions throughout the world. These factors have highlighted the possible attractions of machine-readable patient data cards that can be carried by the patients themselves. The patient data card is expected to provide quick reference information to any physician or health worker consulted by the carrier. This information should avoid duplication of diagnostic, therapeutic and prescription measures and help give a conveniently structured summary of the patient's medical history. Advances in technology have made it possible to move from the familiar credit card which can store only a limited amount of information, to new, similarly shaped cards with much greater capabilities. The basic technologies for patient data cards are examined. An analysis is then attempted of the possible information contents of such a card that could be used at a national and European level, and of the field trials in Europe so far. Questions of security and standardization are also addressed. A number of conclusions and recommendations are also made which are based on the experience gained from a relevant implementation attempted, and participation in a recent study undertaken by the EEC in the area.

Computer Security