Hospital admissions of adolescents in sergipe, from 2002 to 2012 / Internações hospitalares de adolescentes em sergipe, de 2002 a 2012

ABSTRACT Objective: To describe hospital admissions of adolescents living in Sergipe, Northeast Brazil, from 2002 to 2012. Methods: Descriptive study, based on data collected from the Hospital Information System of the Unified Health System. Hospital admissions were divided into four groups of causes: by pregnancy, childbirth and puerperium; by external causes; by primary care conditions; and other causes. Numbers, percentages and coefficients were used in the analysis and compared by year, sex, age (from 10 to 14 and from 15 to 19 years), and the average annual cost of hospitalizations for each group of causes. Results: In the period studied, there were 149,850 hospital admissions of adolescents, 58.4% for pregnancy, childbirth and puerperium, 9.3% for primary care conditions, 8.3% for external causes and 24.0% for other causes. All coefficients decreased from 2002 to 2012 by 39.7%. Primary care conditions had the most significant reduction (143.1%), followed by external causes (60.1%). As for age groups, the coefficients for external causes in the age group of 15 to -19 years, and for pregnancy, childbirth and puerperium, in the age range of 10 to 14 years, are noteworthy because they remained stable in the period. There was an increase in the average cost of all admissions (234.7%), especially for external causes. Conclusions: Health actions to reduce hospital admission due to conditions sensitive to primary care should be given more attention, as well as those related to external causes and pregnancy, among adolescents living in Sergipe, Northeastern Brazil.

RESUMO Objetivo: Descrever as internações hospitalares de adolescentes residentes em Sergipe, de 2002 a 2012. Métodos: Estudo descritivo, a partir de dados do Sistema de Informação Hospitalar do Sistema Único de Saúde, no qual as internações foram divididas em quatro grupos de causas: primeiro, por gravidez, parto e puerpério; segundo, por causas externas; terceiro, por condições sensíveis à atenção primária; e quarto, demais internações. Para a análise, foram utilizados os números, percentuais e coeficientes, por ano, sexo, idade (de 10 a 14; e de 15 a 19 anos) e custo médio anual das internações segundo os grupos de causas. Resultados: No período, ocorreram 149.850 hospitalizações de adolescentes, sendo 58,4% por gravidez, parto e puerpério; 9,3% por condições sensíveis à atenção primária; 8,3% por causas externas; e 24,0% foram as demais internações. Houve redução de 39,7% em todos os coeficientes entre 2002 e 2012, sendo que as por condições sensíveis à atenção primária apresentaram maior redução (143,1%), seguidas das causas externas (60,1%). Em relação às faixas etárias, chama a atenção os coeficientes por causas externas na idade de 15 a 19 anos e a gravidez, parto e o puerpério, dos 10 a 14 anos, por apresentarem estabilidade no período. Houve aumento do custo médio de todas as internações, de 234,7%, destacando-se o das causas externas. Conclusões: Impõe-se a necessidade de se incrementar ações de saúde para diminuir as hospitalizações por condições sensíveis à atenção primária, à incidência das causas externas e à gravidez entre os adolescentes sergipanos.

Assessing the quality of medical death certification: a case study of concordance between national statistics and results from a medical record review in a regional hospital in the Philippines.

BACKGROUND: Medical certificates of cause of death (MCCOD) issued by hospital physicians are a key input to vital registration systems. Deaths certified by hospital physicians have been implicitly considered to be of high quality, but recent evidence suggests otherwise. We conducted a medical record review (MRR) of hospital MCCOD in the Philippines and compared the cause of death concordance with certificates coded by the Philippines Statistics Authority (PSA). METHODS: MCCOD for adult deaths in Bohol Regional Hospital (BRH) in 2007-2008 and 2011 were collected and reviewed by a team of study physicians. Corresponding MCCOD coded by the PSA were linked by a hospital identifier. The study physicians wrote a new MCCOD using the patient medical record, noted the quality of the medical record to produce a cause of death, and indicated whether it was necessary to change the underlying cause of death (UCOD). Chance-corrected concordance, cause-specific mortality fraction (CSMF) accuracy, and chance-corrected CSMF were used to examine the concordance between the MRR and PSA. RESULTS: A total of 1052 adult deaths were linked between the MRR and PSA. Median chance-corrected concordance was 0.73, CSMF accuracy was 0.85, and chance-corrected CSMF accuracy was 0.58. 74.8% of medical records were deemed to be of high enough quality to assign a cause of death, yet study physicians indicated that it was necessary to change the UCOD in 41% of deaths, 82% of which required addition of a new UCOD. CONCLUSIONS: Medical records were generally of sufficient quality to assign a cause of death and concordance between the PSA and MRR was reasonably high, suggesting that routine mortality statistics data are reasonably accurate for describing population level causes of death in Bohol. While overall agreement between the PSA and MRR in major cause groups was sufficient for public health purposes, improvements in death certification practices are recommended to help physicians differentiate between treatable (immediate) COD and COD that are important for public health surveillance.

[Measurement of Quality with Routine Data]. / Qualitätsmessung aus Routinedaten.

There is a growing interest in quality measurement in the healthcare sector. Hospitals in Germany are obligated to participate in measures for external quality assurance and they must establish an internal quality management system. In addition to the legal requirements, measurement of quality is also possible with routine data. Suitable sources are the ICD system or unstandardized information from treatment documentation. The selection of suitable quality indicators is necessary to interpret the data. Complications or achievement of surgical objectives can be suitable quality indicators. Analysis of procedures or the assessment of waiting time are also possible indicators. Our first data concerning waiting time show that with increasing use of an electronic patient guidance system, the waiting time decreased in our outpatient department. Assessment of quality indicators from routine data enables a continuous measurement of quality over a long period. Measures to increase quality can easily be checked. Routine data also provide the possibility to participate in a public reporting of quality indicators.

Improving outcomes using German Inpatient Quality Indicators in conjunction with peer review procedures.

Some hospital comparisons seem to generate confusion because different methods of outcome comparisons lead to different results in hospital rankings. This article questions the concept of overall comparisons of hospitals, which are multiproduct enterprises and may have specialties that provide good results in some areas despite having worse outcomes in others. Therefore, the authors argue for a disease specific view of outcome measurement. The concept of the German Inpatient Quality Indicators is explained. These indicators cover volume, mortality, and other information by a disease specific approach, which includes information for potential patients as well as specific feedback to the physicians responsible for the respective specialty. This article focuses on the feedback to the hospitals and explains how these indicators can be used for improvement in conjunction with a peer review process. The indicators provide information to the hospitals regarding their relative position because German reference values are available for all indicators. Thus, the indicators can serve as a trigger instrument for identifying possible quality problems. Based on these indications, peer review can be used to analyze the treatment processes and to eventually verify weaknesses and define actions for improvement. The first studies indicate that the use of this approach within hospital quality management can largely improve hospital outcomes in hospitals with subpar results compared to the German average.

Determine the therapeutic role of radiotherapy in administrative data: a data mining approach.

BACKGROUND: Clinical data gathered for administrative purposes often lack sufficient information to separate the records of radiotherapy given for palliation from those given for cure. An absence, incompleteness, or inaccuracy of such information could hinder or bias the study of the utilization and outcome of radiotherapy. This study has three specific purposes: 1) develop a method to determine the therapeutic role of radiotherapy (TRR); 2) assess the accuracy of the method; 3) report the quality of the information on treatment "intent" recorded in the clinical data in Ontario, Canada. A general purpose is to use this study as a prototype to demonstrate and test a method to assess the quality of administrative data. METHODS: This is a population based retrospective study. A random sample was drawn from the treatment records with "intent" assigned in treating hospitals. A decision tree is grown using treatment parameters as predictors and "intent" as outcome variable to classify the treatments into curative or palliative. The tree classifier was applied to the entire dataset, and the classification results were compared with those identified by "intent". A manual audit was conducted to assess the accuracy of the classification. RESULTS: The following parameters predicted the TRR, from the strongest to the weakest: radiation dose per fraction, treated body-region, disease site, and time of treatment. When applied to the records of treatments given between 1990 and 2008 in Ontario, Canada, the classification rules correctly classified 96.1% of the records. The quality of the "intent" variable was as follows: 77.5% correctly classified, 3.7% misclassified, and 18.8% did not have an "intent" assigned. CONCLUSIONS: The classification rules derived in this study can be used to determine the TRR when such information is unavailable, incomplete, or inaccurate in administrative data. The study demonstrates that data mining approach can be used to effectively assess and improve the quality of large administrative datasets.

[Documents and transfusion acts: heterogeneous practices]. / Documents et acte transfusionnel: hétérogénéité des pratiques.

Blood transfusion is currently a delegated medical act in patient care services. Blood transfusion safety depends on the strict respect of processes from the prescription of blood products and required patient immuno-hematology exams to the administration of blood products and follow-up of the patient. We conducted a survey among haemovigilance correspondents to establish the documents needed to practice blood transfusion. Blood products delivery depends on the hospitals local organizations and blood products traceability relies on hospitals levels of computerization. We notice heterogeneous practices. Consequently, an updating of the December 15th 2003 circular relative to the transfusion act seems necessary and could thus lead to blood transfusions homogenous practices.

[Protocol for peripheral parenteral nutrition management ready to use in surgical patients]. / Protocolo para el manejo de nutrición parenteral periférica lista para usar en paciente quirúrgico.

INTRODUCTION: Patients undergoing elective surgery, require a comprehensive clinical treatment that tends to maintain or prevent deterioration of nutritional status and promote clinical outcomes, and in turn improve the safety of parenteral nutrition therapy through optimization of technology, as a option aimed at minimizing risk and lower operating costs in institutions providing health services. AIM: To review the literature in order to study the requirements and recommendations of peripheral parenteral nutritional support and / or complementary ready to use in people undergoing surgery. METHODS: Data synthesis after reviewing the relevant literature, to allow the protocol design. The search was conducted in the following databases: PubMed, Medline, Embase and ScienceDirect. CONCLUSIONS: Peripheral parenteral nutrition is a ready to use alternative nutritional support that improves the contribution Protein-Energy and demonstrate improvements in patient safety, decrease costs and increase patient satisfaction.

Introducción: Los pacientes sometidos a cirugía electiva, requieren de un tratamiento clínico integral que propenda por mantener o evitar el deterioro del estado nutricional y favorecer los resultados clínicos, y a su vez mejorar la seguridad de la terapia nutricional parenteral mediante la optimización de la tecnología, como una opción enfocada a la minimización de riesgo y la disminución de los costos operativos en las instituciones de prestación de servicios de salud. Objetivo: Realizar una revisión de la literatura con el fin de estudiar las indicaciones y recomendaciones del soporte nutricional parenteral periférico y/o complementario listo para usar en personas sometidas a una intervención quirúrgica. Métodos: Síntesis de datos tras la revisión de la bibliografía pertinente, que permitiera el diseño del protocolo. Se realizó la búsqueda en las siguientes bases de datos: PubMed, Medline, ScienceDirect y Embase. Conclusiones: La nutrición parenteral periférica lista para usar es una alternativa de soporte nutricional, que permite mejorar el aporte Proteico-Energético así como demostrar mejoras en la seguridad del paciente, disminución de los costos y aumentar la satisfacción del paciente.

Avaliação da qualidade dos registros dos curativos em prontuários realizados pela enfermagem / Assessing the quality of records in the dressing charts, performed by nursing

To evaluate the quality of the records of healing performed by nursing records. Method: Descriptive study with retrospective documentary analysis. This study was conduded in adult Intensive Care Unit of the Hospital of Samuel Libanius. Results: 65 (65%) of annotations not present in this type of tissue lesion, 85 (85%) had no type of exudate, 100 (100%) indicated no measurement of the wound and in 80 (80%), the appearance of margin and center of the lesion were not recorded, 100 (100%) of the notes were with abbreviation, 59 (59%) had no clarity of notes and 80(80%) had grammatical errors and language of 80 (80%) contained incorrect errata and technical terminologies, 75 (75%) of nursing prescriptions were not checked and in 54 (54%) of the notes the lefter was not legible. Conclusion: In this study the authors concluded that the quality of the ratings of nursing care are limited and inadequate...

Avaliar a qualidade dos registros dos curativos realizados pela enfermagem em prontuários. Método: Estudo descritivo, com análise documental retrospectiva. Este estudo foi realizado na Unidade de Terapia Intensiva adulto do Hospital das Clínicas Samuel Libânio. Resultados: Sessentae cinco (65%) das anotações não descreviam qual o tipo de tecido presente na lesão, 85 (85%) não apresentavam tipo de exsudato, 100(100%) não indicavam mensuração da ferida, e em 80 (80%) o aspecto da margem e centro da lesão não foram registrados. Todas as (100%) anotações estavam com abreviatura, 59 (59%) das anotações não apresentavam clareza, 80 (80%) apresentavam erros gramaticais da linguagem e 80 (80%) continham terminologias técnicas erratas e incorretas. Setenta e cinco (75%) das prescrições de enfermagem não estavam checadas,e em 54 (54%) das anotações a letra não estava legível. Conclusão: Por meio deste estudo, os autores concluíram que a qualidade das anotações da assistência de enfermagem são limitadas e inadequadas...

[Variations in the epidemiolgy of adverse events: methodology of the Harvard Medical Practice Design]. / Varianz in der Epidemiologie unerwünschter Ereignisse: Methodik des Harvard Medical Practice Design.

The Harvard Medical Practice (HMP) Design is based on a multi-staged retrospective review of inpatient records and is used to assess the frequency of (preventable) adverse events ([P]AE) in large study populations. Up to now HMP studies have been conducted in 9 countries. Results differ largely from 2.9% to 3.7% of patients with AE in the USA up to 16.6% in Australia. In our analysis we systematically compare the methodology of 9 HMP studies published in the English language and discuss possible impacts on reported frequencies. Modifications in HMP studies can be individualised from each stage of planning, conducting, and reporting results. In doing so 2 studies from the USA with lowest rates of AE can be characterised by their context of liability and the absence of screening for nosocomial infections. Studies with a high proportion of AE are marked by an intense training of reviewers. Further conclusions are hindered by divergences in defining periods of observation, by presenting frequencies as cumulative prevalences, and differences in the reporting of study results. As a consequence future HMP studies should go for complete, consistent and transparent coverage. Further research should concentrate on advancing methods for collecting data on (P)AE.

The accuracy of complications documented in a prospective complication registry.

BACKGROUND: The objectives of this study were to evaluate the accuracy of a prospective complication registry for documenting complications and identify possible factors for non-registering. METHODS: Five hundred randomly selected patients admitted at the Department of Surgery of St. Elisabeth Hospital Tilburg, The Netherlands, in the year 2005, were evaluated for incidence and type of complications by an examination of their medical records and compared with a prospective complication registry. The system was independently reviewed by two persons for missing complications. Patient files with missing complications in the registry were screened for factors possibly responsible for non-registering. RESULTS: Two hundred thirteen complications were detected, 58 (27%) missing in the registry. There were 50 different types of complications documented. The number of events missing per category were: drug-related (50%, n = 4), organ dysfunction (44%, n = 14), infection-related (25%, n = 19), surgery/intervention-related (23%, n = 14), and hospital-provider errors (19%, n = 7). Not all clinically important complications were adequately documented (e.g., anastomotic leakage). The kappa score was 0.695, making the interrater reliability substantial. CONCLUSION: The accuracy of registering complications is fairly acceptable compared to the ranges mentioned in literature. It is disappointing that clinically important events are missing in the registry. The inaccuracy could be explained by a great diversity of documented events, due to a broad definition, suggesting ignorance of the responsible team of which events to register.

The modern staged repair of classic bladder exstrophy: a detailed postoperative management strategy for primary bladder closure.

PURPOSE: Successful primary bladder closure of classic bladder exstrophy sets the stage for development of adequate bladder capacity and eventual voided continence. The postoperative pathway following primary bladder closure at the authors' institution is quantitatively and qualitatively detailed. MATERIALS AND METHODS: Sixty-five consecutive newborns (47 male) undergoing primary closure of classic bladder exstrophy were identified and data were extracted relating to immediate postoperative care. Overall success rate was utilized to validate the pathway. RESULTS: Mean age at time of primary closure was 4.6 days and mean hospital stay was 35.8 days. Osteotomy was performed in 19 patients (mean age 8.8 days), and was not required in 39 infants (mean age 2.9 days). All patients were immobilized for 4 weeks. Tunneled epidural analgesia was employed in 61/65 patients. All patients had ureteral catheters and a suprapubic tube, along with a comprehensive antibiotic regimen. Postoperative total parenteral nutrition was commonly administered, and enteral feedings started around day 4.6. Our success rate of primary closure was 95.4%. CONCLUSIONS: A detailed and regimented plan for bladder drainage, immobilization, pain control, nutrition, antimicrobial prophylaxis, and adequate healing time is a cornerstone for the postoperative management of the primary closure of bladder exstrophy.

The importance of a database in the management of healthcare services.

OBJECTIVE: To present the epidemiological profile of cancer patients belonging to a database of a Hospital Cancer Registry and to report on the importance of this database in managing healthcare services at an Oncology and Hematology Center. METHODS: A retrospective survey conducted with 1617 records of patients diagnosed with cancer at the institution between 2004 and 2009. The types of cancer analyzed were of the colon and rectum, breast, prostate and lung. The variables used in the study were age, gender, stage of disease upon diagnosis and treatment. Researchers used an application called SisHCR for data collection, and Excel® for data analysis. To ensure data safety and reliability, passwords were required for accessing files, spreadsheets were backed up on a weekly basis, and patients' CPF numbers were used to avoid data duplication. RESULTS: Of the 1617 records analyzed, 36.42% belonged to the topographic group of the breast, and approximately 40% of patients with colorectal cancer were 70 years of age or older. Stage II was prevalent, representing 44% of the sample, and the treatment most used was surgery (57% of cases). CONCLUSION: The study suggested that the Hospital Cancer Registry database is an instrument capable of generating important information about cancer, and that through this information, epidemiological studies can be carried out and the processes of management and care can be improved.

O papel dos profissionais de saúde na qualidade da informação de ótitos perinatais e nascidos vivos no município de São Paulo / SIM and SINASC social representation of nurses and administrative professional sectors that work in hospitals SUS and non-SUS in the city of Sao Paulo

Introdução: A mortalidade perinatal é um importante indicador de saúde materno- infantil, por esse motivo vem ocorrendo uma evolução nos estudos dessas informações. Muitos estudos avaliam a qualidade dos dados do Sistema de Informações de Nascidos Vivos (SINASC) e Sistemas de Informações de Mortalidade (SIM) com métodos quantitativos (validade/completitude), porém são escassas as investigações qualitativas. Objetivo: Avaliar a representação social dos enfermeiros e profissionais de setores administrativos sobre o preenchimento das Declarações de Nascido Vivo (DNs) e se ou como auxiliam no preenchimento das Declarações de Óbito (DOs) fetais e neonatais. Métodos: Foram realizadas 24 entrevistas com enfermeiros e profissionais de setores administrativos em 16 hospitais, com e sem vínculo com o SUS, no município de São Paulo, em 2009. As análises foram realizadas utilizando a metodologia qualitativa com a técnica do Discurso do Sujeito Coletivo. Resultados: Os profissionais e enfermeiros se reconhecem como parte integrante do processo de produção da informação. Os discursos indicam que a atividade está incorporada na rotina do trabalho; há comprometimento na busca de soluções quando se deparam com dificuldades de preenchimento; há valorização de se sentirem acompanhados por uma instância superior do sistema; sentem que o treinamento é um espaço de encontro para retorno e compreensão das finalidades e usos das informações que produzem. Esta consciência aumenta o comprometimento e assegura informações mais fidedignas. Conclusões: Tanto nos hospitais SUS como não-SUS não se verificou um padrão relativo ao profissional responsável pelo preenchimento das DNs, apesar da definição legal de que o médico é o responsável pelas informações da DO muitas vezes outros profissionais preenchem parte das informações. As entrevistas revelaram que os profissionais conhecem e reconhecem a utilidade das informações registradas nas DNs com base nos treinamentos fornecidos pela equipe do Sistema de Informação de Nascidos Vivos (SINASC). Os profissionais e enfermeiros se reconhecem como parte integrante do processo de produção da informação e sentem que o treinamento é um espaço de encontro para retorno e compreensão das finalidades e usos das informações que produzem. Essa consciência aumenta o comprometimento e assegura informações mais fidedignas.

[Benchmarking in psychiatric acute care--a demonstration project in a hospitals network]. / Benchmarking in der psychiatrischen Akutbehandlung - Ein Modellprojekt im Klinikverbund.

The aim of this project was to improve treatment processes and results in acutely ill inpatients within a network of nine psychiatric state hospitals of the Landschaftsverband Rheinland by introducing a benchmarking process. The project was based upon pre-existing measures of quality management. Patient groups were selected that were characterised by a severe clinical development or a high demand for mental health care services (alcohol abuse, depression of the elderly, schizophrenia). Room for improvement concerning specific hospitals and the overall hospital network were identified. The project was conducted with two patient cohorts before and after a quality-related intervention. Interventions were implemented for specific hospitals and the overall hospital network. Overall treatment documentations of 1,696 patients (1(st) cohort n=1,856, 2(nd) cohort n=1,696) were completed. Although there was no constant quantifiable statistically significant improvement of quality within the three patient groups (and certainly not with respect to the overall network), there was successful improvement of essential treatment processes for certain hospitals and the overall network under benchmarking. This was especially relevant where treatment recommendations were concerned. Future projects should focus on the conformance with treatment guidelines by defining both structural and process measures as a starting point and evaluation criterion.

The pregnant motor vehicle accident casualty: adherence to basic workup and admission guidelines.

OBJECTIVE: To investigate the workup/treatment provided to pregnant motor vehicle accident (MVA) casualties in a mature trauma system. Adherence to recommendations was used to measure quality of care. BACKGROUND: MVAs affect approximately 3% of pregnant women. Trauma casualty outcome improves after implementation of guidelines. METHODS: A 5-year audit of clinical practice in 2 university hospitals with a trauma call system where the general surgeon is the primary care physician. Trauma guidelines (general/specific to treatment of pregnant MVA casualties) were used to examine adherence. Pregnant casualties aged >18 years, injured in a private vehicle were identified via computerized hospital databases. Data relevant to the study were extracted from ED/admission files. RESULTS: Among the 236 casualties included there were no maternal deaths. Six casualties (2.5%) had significant injuries and 3 (1.2%) required surgery (all within 24-hours of admission). Contrary to established procedure, maternal vital signs were often not documented. In contrast, fetal viability was usually documented; most casualties underwent ultrasound fetal evaluation (233 of 236, 98.7%) and those with viable pregnancies underwent fetal heart rate monitoring (162 of 169, 96%). A sixth of the MVA casualties (16%) were examined only by an obstetrician. All casualties were admitted but only 15 (6.4%) were admitted in accordance with guidelines. Readmission rates (1.3%) were similar to those observed in nonpregnant casualties. CONCLUSIONS: Pregnant MVA casualties are underexamined and overadmitted. Concerns regarding potential obstetrical complications distract medical attention away from basic trauma guidelines. Education programs should emphasize prioritizing the mother and adhering to the basic rules of trauma care despite the presence of the fetus.

Pain management documentation: analyzing one hospital's computerized clinical records.

Pain management documentation, consisting of assessment, interventions, and reassessment, can help provide an important means of communication among practitioners to individualize care. Standard-setting organizations use pain management documentation as a key indicator of quality. Adoption of the electronic medical record alters the presentation of pain management documentation data for clinical and quality evaluation use. The purpose of this study was to describe pain management documentation output from the electronic medical record to gain an understanding of its presentation and evaluate the quantity and quality of the output. After institutional review board approval, data were abstracted from 51 electronic records of postsurgical patients in a 100-bed community hospital. Time-variant pain assessments, interventions, and reassessments were organized into pain management episodes to provide clinically interpretable data for evaluation. Data sources were identified. Data generated 1499 episodes for analysis. Analysis of variance results implied that pain management documentation changes with pain severity. Despite legibility and date and time stamping, inconsistencies and omitted and duplicated documentation were identified. Inconsistent data origination posed difficulty for interpreting clinically relevant associations. Improvements are required to streamline fields and consolidate entries to allow for output in alignment with care.

[Computerization of hospital blood banks in France]. / Informatisation des dépôts de produits sanguins labiles en France.

In France, most blood products are delivered by the Établissement français du sang, directly to the recipients, and hospital blood banks deliver a minor part, but are independent from it. However that may be, hospital blood banks are hazardous activities regarding recipients, blood products, blood supply for the hospital and regional blood supply. Because of the high risk level, a computerized information system is compulsory for all hospital blood banks, except for those only devoted to vital emergency transfusion. On the field, integration of computerization in the different processes is very heterogeneous. So it has been decided to publish guidelines for computerizing hospital blood banks information systems and production management. They have been built according to risk assessment and are intended to minimize those risks. The principle is that all acquisition and processing of data about recipients or blood products and tracking, must be fully computerized and that the result of all manual processes must be checked by computer before proceeding to the next step. The guidelines list the different processes and, for each of them, the functions the software must play. All together, they form the basic level all hospital blood banks should reach. Optional functions are listed. Moreover, the guidelines are also aimed at being a common tool for regional health authorities who supervise hospital blood banks.

Operative reports: form and function.

HYPOTHESIS: Little is known about how closely operative reports reflect what was actually performed during an operation, nor has the construction of operative reports been adequately studied with the aims of clarifying the objectives of those reports and improving their efficacy. We hypothesized that if more attention is paid to the objectives of operative reports, their content will more predictably contain the most relevant information, which might channel thinking in beneficial directions during performance of the operation. DESIGN: Multivariate analysis of 250 laparoscopic cholecystectomy operative reports (125 uncomplicated and 125 with bile duct injury). SETTING: Academic research. PARTICIPANTS: University (105 cases) and community (145 cases) hospitals. MAIN OUTCOME MEASURES: Variations in content and design of operative reports. Cognitive task analysis of laparoscopic cholecystectomy was conducted, and a model operative report was generated and compared with the actual operative reports. RESULTS: Descriptions of key elements in adequate dissection of the Calot triangle were present in 24.8% and 0.0% of operative reports from uncomplicated and bile duct injury cases, respectively. Thorough dissection of the Calot triangle, identification of the cystic duct-infundibulum junction, and lateral retraction of the infundibulum correlated with uncomplicated cases, while irregular cues (eg, perceived anatomic or other deviations) correlated with bile duct injury cases. CONCLUSIONS: Current practice generates operative reports that vary widely in content and too often omit important elements. This research suggests that the construction of operative reports should be constrained such that the reports routinely include the fundamental goals of the operation and what was performed to meet them. Cognitive task analysis is based on the ways the mind controls the performance of tasks; it is an excellent method for determining the extra content needed in operative reports. The resulting designs should also serve as mental guidelines to facilitate learning and to enhance the safety of the operation.