Multisite Hospital Research Articles

Pneumatic Tube Delivery System for Blood Samples Reduces Turnaround Times Without Affecting Sample Quality

In this study, blood samples from ED patients that were delivered to the laboratory by a pneumatic tube delivery system and by a human courier were compared for timeliness and quality of results. We studied all consecutive measurements of serum hemoglobin and potassium ordered from 2 emergency departments of a multisite tertiary care hospital system, one with a pneumatic tube system and the other using human couriers. Turnaround time was measured from the time that the test was ordered by the physician to the time the result was reported on the hospital information system. Hemolysis was measured with use of a standardized, validated method. Times were normalized by log transformation (ln [minutes + 1]), and a comparison of sites was conducted using analysis of variance. Hemolysis rates of the 2 delivery systems were compared by chi2. There was no significant difference in hemolysis rate between the 2 methods of delivery (7/121 [5.79%] with a pneumatic tube system and 20/200 [10%] with a human courier). When delivered with a pneumatic tube system, the mean turnaround times (with ranges) for both hemoglobin (33 minutes [4-230]) and potassium (64 [34-208]) were shorter than those delivered by a human courier (43 minutes [3-150] and 72 [28-213], respectively). The use of a pneumatic tube delivery system for transporting blood samples from the emergency department to the laboratory can significantly reduce the turnaround times of results without a reduction in sample quality.

Impact of PACS Deployment Strategy on Dictation Turnaround Time of Chest Radiographs

The aim of the study is to measure the impact of a picture archive and communication system (PACS) on dictation turnaround time of chest radiographs in a multisite hospital and relate variations across sites to local factors and implementation strategy. The multisite hospital is composed of three sites. Dictation turnaround time was calculated by using data obtained from the radiology information system for examinations performed during three 90-day periods (immediately before PACS implementation, immediately after PACS implementation, and 1 year after implementation). Productivity, expressed as number of examinations dictated per full-time-equivalent radiologist, also was calculated. For each 3-month period, average interval delay was calculated. Values for average interval delay obtained during the different pre- and post-PACS periods were compared by using analysis of variance. This was done for each hospital. In the immediate post-PACS period at site 1, dictation turnaround time decreased 5% (P < .05), whereas productivity decreased 16.5%. The implementation strategy was revised for the next two sites, and dictation turnaround time decreased 21% (P < .001) in both sites in the immediate post-PACS period. Productivity increased 2% and 3% in these sites. One year after implementation, decreases in turnaround ranged from 28% to 55% (P < .001) in the three sites. Our experience suggests that PACSs cannot be isolated from their contexts; therefore, implementation strategy matters in the realization of projected benefits. In addition, regardless of differences in film-based environments before PACS, all three sites benefited from conversion to filmless operation, with the greatest benefits seen in the site that was least efficient before implementation.

Guideline adherence in medication management of psychotic disorders: an observational multisite hospital study

To evaluate guideline adherence in in-patient medication care of psychotic disorders. A total of 508 persons with psychotic disorders were included in a naturalistic multisite hospital study. Subjects were assessed weekly on mental state, social functioning, socioeconomic factors and medication prescriptions. In total, 17% of individuals were prescribed antipsychotic dosages above the recommended value. Among those with persistent psychotic symptoms, 73% received insufficient antipsychotic drug management. About 58% of patients with depressive symptoms were not treated according to guidelines, and 53% of patients did not receive adequate management of side-effects from antipsychotic medications. Subjects with more than six previous psychiatric hospitalizations (OR 1.80, CI: 1.05-3.08) and those with a prominent thought disorder (OR 2.28, CI: 1.23-4.23) had a higher likelihood of not being treated according to guidelines. Individuals with chronic and thought-disordered psychosis may be at a higher risk of receiving medication care not supported by guidelines.

Low birth weight in Mexico: new evidence from a multi-site postpartum hospital survey.

To identify factors related to cases of low birth weight among a sample of Mexican women. The present analysis utilizes data from a post partum survey of 565 women implemented in eight different social security hospitals in western Mexico during 2001. Women giving birth to low weight infants (2.5 kgs) were oversampled and make up half of the sample. A series of logistic regression equations are presented that estimate the risk of low birth weight. Study findings indicate that, although behavioral factors appear to be highly significant in predicting the odds of low birth weight, socioeconomic and sociodemographic factors were found to be important in determining utilization of prenatal care. The key role of behavioral characteristics in determining low birth weight risk and the role of socioeconomic and sociodemographic factors in determining prenatal care usage highlights the need to improve prenatal care utilization by disadvantaged populations.

PMA2: DEVELOPMENT OF COST-EFFECTIVE WEB-BASED OUTCOMES RESEARCH STUDIES AND DISEASE MANAGEMENT PROGRAMS

Innovations in information technology are rapidly changing the health care market. With more and more clinical trials being conducted and managed on the web, the Internet provides an opportunity for conducting effective multi-center outcomes research studies and developing disease management programs. OBJECTIVES: This research describes the development of a web-driven application for ongoing collection, analysis, and reporting of outcomes research data. In addition, the web application was developed to gain experience in provision of benchmarking reports to health care providers conducting disease management programs. METHODS: Given current privacy regulations a multi-level security system with error checking was developed to assure integrity of data entering the system. Through integration of several programming languages (Visual Basic Script, Java Script, and HTML) into web-based active server pages, a method for immediate data collection, summary, and on-demand reporting was successfully developed. The system was deployed remotely via an Internet Service Provider. A prospective multi-site (10) hospital based infectious disease study of fungal risk and treatment patterns; and a retrospective lipid/cardiology clinic based study of patient care was conducted using the above technology. RESULTS: For expenditures of less than $1,000, secure web applications were developed that provided electronic data capture of all study variables. The customizability of the program allowed for developing applications for differing disease states thereby reducing set-up costs and improving efficiency. Simultaneous multi-site training and minimal data entry errors further reduced costs. The applications also provided real-time reports that enhanced patient-care and reported practice patterns that highlighted national and regional variations. CONCLUSIONS: The success of these studies has demonstrated the utility of the internet in providing health care practitioners with a cost-effective tool for efficiently conducting multi-center outcomes research and disease management. Considering the increasing popularity and access to the Internet, this research has significant implications for outcomes research and disease management.