Quality assurance and utilization review : official journal of the American College of Utilization Review Physicians
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Careful review of the literature suggests that the conceptual problem in analyzing hospitals' quality of care is the difficulty of identifying problem domains of hospital care. An appropriate measurement model using multiple indicators of hospital quality problems is developed and evaluated. ⋯ The findings show that hospital characteristics exert limited effects on adverse outcomes. Efficiency and average length of stay are the only statistically significant factors that explain the variation in adverse outcomes.
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Qual Assur Util Rev · Jan 1992
Quality assessment in the medical intensive care unit. Continued evolution of a data model.
Quality assessment and assurance activities in the intensive care unit are complex processes that begin with the definition of the scope of services delivered in the unit with further identification of the important aspects of care. There is also a need to establish indicators of quality, gather data, and finally to organize the data into useful information. ⋯ In this paper, we focus on the application of the concept of patient days of service for quantification of the utilization of resources as an element of quality. Efficient utilization of resources cannot be effected until data on actual utilization are collected and analyzed.
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Qual Assur Util Rev · Jan 1991
GuidelineThe rational ordering of blood cultures in the emergency department.
A large number of patients with febrile illness are evaluated in emergency departments. Blood cultures are often obtained on such patients without reference to established guidelines. As a result of such practice, unnecessary blood cultures are being ordered with negative financial impact on both hospitals and patients. ⋯ Follow-up on these results directly impacts on patient care as these patients are often subjected to call backs, additional work up, and admission to the hospital. This study reviews the manner in which blood cultures were ordered before and after the introduction of general guidelines for their use. It outlines a process whereby excessive ordering of blood cultures can be eliminated and suggests that this approach may be effective in limiting inappropriate use of other laboratory and diagnostic studies.
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We reviewed causes of cancelled elective surgery in a community hospital. Over a 6-month period, during which 4100 operating room procedures were completed, cancellations occurred in 13% of cases scheduled for outpatient surgery, 9% of cases scheduled for admission the same day, and 17% of cases scheduled for inpatient surgery. ⋯ Medical factors were responsible in the remaining cases, with reevaluation of the surgical condition and associated medical illnesses equally common as reasons in this category. Appreciation of the usual reasons for cancellation can improve utilization by permitting administrators and providers to anticipate those cases in which problems might arise so that additional attention can be paid to them.