Widespread severe acute respiratory coronavirus virus 2 (SARS-CoV-2) laboratory surveillance program to minimize asymptomatic transmission in high-risk inpatient and congregate living settings.

We describe a widespread laboratory surveillance program for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) at an integrated medical campus that includes a tertiary-care center, a skilled nursing facility, a rehabilitation treatment center, and temporary shelter units. We identified 22 asymptomatic cases of SARS-CoV-2 and implemented infection control measures to prevent SARS-CoV-2 transmission in congregate settings.

Role of the Clinical Microbiology Laboratory in Antimicrobial Stewardship.

For adequate antimicrobial stewardship, microbiology needs to move from the laboratory to become physically and verbally amenable to the caregivers of an institution. Herein, we describe the contributions of our microbiology department to the antimicrobial stewardship program of a large teaching hospital as 10 main points ranging from the selection of patients deemed likely to benefit from a fast track approach, to their clinical samples, or the rapid reporting of results via a microbiology hotline, to rapid searches for pathogens and susceptibility testing. These points should serve as guidelines for similar programs designed to decrease the unnecessary use of antimicrobials.

Implementation of Infection Prevention and Antimicrobial Stewardship in Cardiac Electrophysiology Laboratories: Results from the SHEA Research Network.

Infection prevention in electrophysiology (EP) laboratories is poorly characterized; thus, we conducted a cross-sectional survey using the SHEA Research Network. We found limited uptake of basic interventions, such as surveillance and appropriate peri-procedural antimicrobial use. Further study is needed to identify ways to improve infection prevention in this setting.

Improving the efficiency of the cardiac catheterization laboratories through understanding the stochastic behavior of the scheduled procedures.

BACKGROUND: In this study, we sought to analyze the stochastic behavior of Catherization Laboratories (Cath Labs) procedures in our institution. Statistical models may help to improve estimated case durations to support management in the cost-effective use of expensive surgical resources. METHODS: We retrospectively analyzed all the procedures performed in the Cath Labs in 2012. The duration of procedures is strictly positive (larger than zero) and has mostly a large minimum duration. Because of the strictly positive character of the Cath Lab procedures, a fit of a lognormal model may be desirable. Having a minimum duration requires an estimate of the threshold (shift) parameter of the lognormal model. Therefore, the 3-parameter lognormal model is interesting. To avoid heterogeneous groups of observations, we tested every group-cardiologist-procedure combination for the normal, 2- and 3-parameter lognormal distribution. RESULTS: The total number of elective and emergency procedures performed was 6,393 (8,186 h). The final analysis included 6,135 procedures (7,779 h). Electrophysiology (intervention) procedures fit the 3-parameter lognormal model 86.1% (80.1%). Using Friedman test statistics, we conclude that the 3-parameter lognormal model is superior to the 2-parameter lognormal model. Furthermore, the 2-parameter lognormal is superior to the normal model. CONCLUSIONS: Cath Lab procedures are well-modelled by lognormal models. This information helps to improve and to refine Cath Lab schedules and hence their efficient use.

[Results of a counselling programme in antibiotic treatment in a secondary hospital]. / Programa de asesoramiento en tratamiento antibiótico en un hospital de segundo nivel: resultados de un año de actuación.

BACKGROUND: The inappropriate use of antimicrobial agents may contribute to the development of bacterial resistance to the principal antimicrobial drugs. There is no provision in the immediate future of marketing of new broad-spectrum antibiotics, especially with activity against Enterobacteriaceae, so programs should be implemented to optimize antimicrobial therapy. We describe the results of a year of a counselling program in antibiotic treatment in a secondary Andalusian hospital. METHODS: We describe 276 interventions of a multidisciplinary non-compulsory counselling program of antimicrobial management on the Costa del Sol Hospital in Marbella. We evaluated the adequacy of empirical treatment, possibility of antibiotic de-escalation, duration and dose used. We analyzed the evolution of the sensitivity profile of the main microorganisms as well as a cost-effective analysis. RESULTS: 90% of the recommendations were accepted. The main actions were assessment of empirical therapy and deescalation in relation with the result of cultures. The main drugs tested were imipenem, meropenem, cefepime, and linezolid. The sensitivity profile of imipenem and meropenem improved slightly over previous years. It was found a considerable savings in annual drug spending. CONCLUSIONS: The non-compulsory counselling programs are useful tools for optimization of antimicrobial therapy, can prevent an increase of antimicrobial resistance and reduce the cost of antibiotic treatment.

Evaluating the policy of setting up microscopy centres at township hospitals in Shandong China: experience from patients and providers.

BACKGROUND: Since 2004 the China Ministry of Health policy has required microscopy centres (MCs) to be set up in one third of township hospitals nationally, to improve the accessibility of sputum smear testing for TB in rural areas. The objective of this study was to assess the performance of MCs in Shandong province from both patient and provider perspectives. METHODS: A survey of 245 TB suspects was conducted in 8 counties of Shandong stratified by MC performance. Seventy-two health providers and administrators were interviewed at the township and county levels. RESULTS: General performance of MC was poor. In 2006, the high and low performance groups checked on average 190 and 24 TB suspects, respectively. The majority of TB suspects who visited a MC did not have their sputum checked, or sputum was checked but the result was not recorded. TB suspects who visited a MC tended to live closer to it and had better knowledge of the MC than those who visited the county TB dispensary (CTD) directly. Patients with severe TB symptoms tended to go directly to the CTD. No significant difference in medical expenses before the TB diagnosis or diagnostic delay was found between TB suspects who visited a MC and those who did not. Several reasons were identified. The policy tried to set up too many MCs regardless of transportation conditions. It lacked operational details. Township hospitals had limited funding, qualified staff, and technical support from the CTD. The existing referral incentive discouraged sputum checks at the MC. CONCLUSION: The national MC policy fell short of its goals in Shandong. Neither patients nor providers were interested in using MC in its current form. Policy recommendations are given.

One kidney transplant center's experience: linking process improvements and Medicare/Medicaid conditions of participation.

CONTEXT: An institutional priority toward transplantation, dedicated team dynamics, aggressive clinical growth, and optimal care practices are essential for delivering exceptional care to transplant patients. The importance of multidisciplinary integration of these priorities throughout the continuum of patient care is widely recognized in the transplant arena as well as by the Centers for Medicare and Medicaid Services (CMS). In fact, it is the collaboration within these aspects of care that is necessary for certification by CMS. OBJECTIVES: To establish institution-wide practices, systems, and mechanisms to optimize performance of transplant centers through the use of evidence-based protocols, clinical innovation, and data-driven quality improvements. To develop training programs and competency based orientation addressing the topics needed for transplant nurses, multidisciplinary caregivers, and clinical transplant coordinators who provide care to transplant patients. To comply with the CMS conditions of participation for transplant centers. METHODS: Formation of a renal transplant council and multidisciplinary care team. Flow chart of hospital course from admission to discharge, carefully examining patients' progression through the continuum of care, assessing for barriers to care and knowledge deficits of transplant practitioners. RESULTS: Development of multiple clinical process improvements resulting in the creation of an environment for continuous learning, optimal transplant care, and exceptional outcomes in transplantation as well as compliance with CMS conditions of participation for transplant centers.

Risk-adjusting hospital inpatient mortality using automated inpatient, outpatient, and laboratory databases.

OBJECTIVES: To develop a risk-adjustment methodology that maximizes the use of automated physiology and diagnosis data from the time period preceding hospitalization. DESIGN: : Retrospective cohort study using split-validation and logistic regression. SETTING: Seventeen hospitals in a large integrated health care delivery system. SUBJECTS: Patients (n = 259,699) hospitalized between January 2002 and June 2005. MAIN OUTCOME MEASURES: Inpatient and 30-day mortality. RESULTS: Inpatient mortality was 3.50%; 30-day mortality was 4.06%. We tested logistic regression models in a randomly chosen derivation dataset consisting of 50% of the records and applied their coefficients to the validation dataset. The final model included sex, age, admission type, admission diagnosis, a Laboratory-based Acute Physiology Score (LAPS), and a COmorbidity Point Score (COPS). The LAPS integrates information from 14 laboratory tests obtained in the 24 hours preceding hospitalization into a single continuous variable. Using Diagnostic Cost Groups software, we categorized patients as having up to 40 different comorbidities based on outpatient and inpatient data from the 12 months preceding hospitalization. The COPS integrates information regarding these 41 comorbidities into a single continuous variable. Our best model for inpatient mortality had a c statistic of 0.88 in the validation dataset, whereas the c statistic for 30-day mortality was 0.86; both models had excellent calibration. Physiologic data accounted for a substantial proportion of the model's predictive ability. CONCLUSION: Efforts to support improvement of hospital outcomes can take advantage of risk-adjustment methods based on automated physiology and diagnosis data that are not confounded by information obtained after hospital admission.

Effects of reorganization on laboratory quality: preliminary findings and lessons learned.

Reorganization and downsizing are common challenges for managers. This case study describes the implementation of a major restructuring of a clinical laboratory within a large, integrated medical-delivery organization. Economic trends prompted us to evaluate the effects of a major laboratory reorganization, with a significant shift from clinical laboratory scientists to lower waged, nonlicensed technical staff, on the analytic quality and other indicators of laboratory performance. Although a laboratory reorganization may be implemented slowly, this reorganization effort was completed quickly. Data were collected during both the pre- and post-reorganization period. Postimplementation performance indicators show no reductions in analytic quality. Effectively dealing with the human side of significant change appears to be the biggest challenge for managers, both in the short term and well after the reorganization. These results and qualitative information and insights might be of value to laboratory management contemplating a laboratory reorganization.

Selection and implementation for coagulation instruments/reagents in a multiple hospital/clinic network.

Selection, standardization, and implementation of instrumentation and reagents throughout a health care facility network can often be a difficult process. However, in today's ever-changing health care setting, it is often mandated. The Veteran's Integrated Systems Network 16 (VISN 16) was faced with such a task early in 1999, with the targeted area being its coagulation laboratories. The plan outlined in this paper was drafted to help facilitate the selection, standardization and implementation of coagulation systems for 17 health care facilities that make up the VISN 16 network. The VISN, encompassing 170,000 square miles, has 10 tertiary care hospitals, six of which have close relationships with affiliate universities. There are 299,733 patients enrolled in this health delivery system. The facilities range from large institutions performing both tertiary and outpatient care to small outpatient clinics. Because of the plan's detailed, comprehensive content, which included analyses of a large number of performance parameters as well as cost-efficiency, the selection process was carried out using a checklist that could be helpful to other organizations selecting equipment and reagents for coagulation studies. An implementation process was devised, resulting in coagulation standardization across the Integrated Health Network.

El laboratorio clínico integrado como área de gestión. Modelo Hospital Empresa Pública / The integrated laboratory clinic as an area of management. The hospital as a model of a public business

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Implementing information technology in the NHS: the role of narrative.

This paper analyses how groups use narratives in social processes of sensemaking and identity construction and in the pursuit and legitimation of their selfish interests. It does so through an examination of the narrativity of the experiences reported by the developers and users of an information technology (IT) system linking a haematology laboratory and a specialist haematology ward in a large acute hospital. The research contribution the paper makes is twofold. First, it illustrates the importance of group-level narratives in enacting organizational realities and especially in the social construction of IT systems. Second, it suggests that the narrative understanding of groups is a significant domain of organizational inquiry because it is through the spread and acceptance of their narratives that groups exercise their most profound influence.

Laboratory systems evolve to meet data demands.

As provider organizations consolidate and confront managed care pressures, they're looking for laboratory information systems that go beyond the basics. They want lab systems that can integrate with other computer systems, make data available at the point of care, and exchange information over the Internet or intranets. Systems integration efforts, however, are proving troublesome for some CIOs.

Phase 1: identifying critical success factors.

Health care processes and services of the "Policlinico" are analyzed with respect to their performance. Possible improvement is identified in reducing the process overall time at the process-service interface.

The clinical services manager: a curriculum for the 21st century.

The dynamism of change in the evolution of integrated health-care systems is driving change in the skills and competencies required to manage diagnostic services. Formal educational preparation and practical experience in a wider array of disciplines will be essential to the backgrounds of those who will be chosen for these new and ever more complex roles. Curricular elements relevant to this educational challenge are outlined herein. This article is intended to expand on the position of CLMA as reflected in the position paper "New Path for Health-Care Leadership: Clinical Systems Management," issued in August 1997 (1).

A principle-focused approach to lab management.

As in all healthcare fields, the clinical laboratory is under the stress of constant change. While planning for the financial implications is important, a more holistic approach to adaptation is for laboratorians to put the focus back where it belongs: on people, principles, and service.