American journal of medical quality : the official journal of the American College of Medical Quality
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Ideally antibiotics should be administered preoperatively within 2 hours of skin incision to ensure adequate tissue concentrations, especially when a vascular prosthesis is used. The quality of patient outcomes may be adversely affected when key processes, by degrees, fail to meet patient care objectives. This study was designed to incorporate the concepts of total quality management to determine how effectively this goal was achieved, and, after review of those measured results, what process improvements could be instituted to meet the established requirements for the administration of antibiotics. ⋯ It was surprising how often antibiotics were administered incorrectly in a busy vascular practice. By focusing on the process of care delivery, a continuous quality improvement team implemented simple changes that resulted in significant improvements. We are now conducting a study to determine what effect these process improvements had on our infection rate.
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Our study objective was to assess economic and clinical outcomes of use of a point-of-care (POC) blood analysis device for postoperative coronary artery bypass graft (CABG) patients. A decision analytic model was developed for patients with high expected use of blood analysis, high potential benefit from rapid turn around time of results, a large annual volume of patients, and substantial expense associated with surgery. Published literature and clinical experts provided incidence, outcome, and cost estimates associated with four clinical scenarios potentially influenced by POC testing (ventricular arrhythmias, cardiac arrest, severe postoperative bleeding, and iatrogenic anemia). ⋯ The positive clinical impact of using POC testing was consistently associated with a positive economic impact. POC blood gas analysis may be associated with decreased incidence of adverse clinical events or earlier detection of such events, resulting in significant cost savings. This study also supports previous findings that the costs of STAT blood analysis are more personnel-related than equipment-related.
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The use of both clinical medical and administrative databases is discussed in the context of an academic anesthesiology's transition from the tenets of quality assurance to those of continuous quality improvements. A historical framework is presented. The basic and aggregate models are introduced, and examples are used to illustrate the composite system.
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Projections for the future suggest that the United States population will grow by 10-15% by the year 2000, but the number of people over the age of 80 will increase by 66%. As a result, the increase that has already been observed in the number of elderly patients requiring major medical attention can only be expected to grow. This study reviews the admissions to the intensive care unit (ICU) over the last 5 years by age to analyze whether the ICU admissions are higher for the patients older than 60 years of age. ⋯ In our opinion we should treat acute critical illness but not terminal pathology. A problem exists in educating physicians about which patients will derive no benefit from the ICU. This will determine if we can decrease or avoid the use of the ICU and its accompanying expense, in situations where it does not significantly increase survival and the quality of life.