Post-intervention Data Collection Research Articles

Lowering the language barrier in an acute psychiatric setting.

The aim of this paper is to investigate the effectiveness of a training and policy strategy to improve communication opportunities in an acute inpatient unit for patients of non-English-speaking background (NESB) with low English proficiency. A pre- and post-intervention design involved: (i) a survey of the multilingual skills of 80 clinical staff; (ii) recording of patients' ethnic background and proficiency; (iii) pre- and post-intervention data collection of the main outcome measure (communications with patients in a language other than English [LOTE]); and (iv) staff training, and active encouragement, in interpreter use. English proficiency was assessed using the population census proficiency question. Of 257 admissions, 33% were of NESB and 19% preferred to speak a LOTE. The staff survey yielded a 49% return rate and showed that, of 11 LOTEs spoken by patients, seven were also spoken by 17 of the staff. Twenty-nine percent of staff were not clinically proficient in these languages. Compared to the NESB population, a higher proportion of NESB patients rated low on proficiency. Following the intervention, interpreter bookings and booking duration increased significantly. A standard training package and a policy promoting interpreter use improved communication opportunities in an acute setting where language needs are typically poorly met. Failure to ensure effective communicate raises risks of misdiagnosis and inappropriate treatment. By measuring patients' proficiency directly, the present study identified a higher level of need for interpreter services than estimated by past reports.

Cost-effective medicine: The financial impact that practice guidelines have on outpatient hospital charges in the emergency department

The objective of this study was to determine whether specific cost-effective guidelines based on a patient's chief complaint can significantly reduce outpatient hospital charges in the ED. A prospective randomized single-blinded clinical trial was conducted in an urban community hospital ED with a 14,000 annual census. The first phase of the study involved preintervention data collection. The second phase focused on development, physician approval, and implementation of 23 specific cost-effective guidelines, as well as general recommendations for diagnostic tests. The third phase involved postintervention data collection. Results showed that the total outpatient hospital charge decreased by 28% per patient. The laboratory hospital charge decreased by 46% per patient. The radiology hospital charge decreased by 20% per patient. The hospital supply charge and pharmacy charge decreased by 31 % per patient and 11% per patient, respectively. In conclusion, cost-effective medicine practiced with specific guidelines, based on a patient's chief complaint, significantly reduces unnecessary diagnostic tests and medical treatments ordered by emergency physicians.

Therapeutic Drug Monitoring

A pilot study done at our institution and previous studies in the literature indicate that therapeutic drug monitoring (TDM) is frequently performed without a proper indication. In addition, samples are often improperly collected or interpreted by physicians. The purpose of this study was to determine if a pharmacy-based educational intervention could positively influence the performance of TDM in a teaching institution. A cost-savings analysis on the reduction of drug levels not indicated or improperly sampled was also performed. The study consisted of a preliminary data collection period, an educational intervention, and a postintervention data collection period. The pre- and posteducational intervention periods consisted of a 1-month concurrent review of aminoglycosides, digoxin, and theophylline serum levels. The educational intervention consisted of in-service programs and newsletter. There were 188 and 211 serum drug levels analyzed during the pre- and postintervention periods, respectively. Overall, the educational intervention significantly increased the number of drug levels obtained for rational indications, correctly sampled and appropriately interpreted by physicians (p less than 0.001, chi 2 analysis). Cost savings associated with this program was +2,788 in patient charges (+559 in hospital costs) per month. This study demonstrated that TDM may be significantly improved through education.