Browsing by Subject "Monitoring, Physiologic"
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Item Embracing electronic tools to improve patient outcomes(2017-08-18) Beg, MuhammadItem Improving Intra-Operative Parathyroid Hormone Result Times at the University Hospitals(2022-05) Wang, Virginia Y.; Reed, W. Gary; Nwariaku, Fiemu; Holt, Shelby A.Intra-operative parathyroid hormone (ioPTH) levels are the current gold standard for assessing completeness of resection in parathyroidectomy surgery. Due to the time-sensitive nature of these results, delays in processing ioPTH samples lead to non-value-added time (NVAT) in the operating room, which generates unnecessary financial burdens and potential safety hazards for both patients and the hospital system. Baseline analysis of data from 191 parathyroidectomy cases performed by the UT Southwestern Endocrine Surgery Group at Clements University Hospital (CUH) and the Outpatient Surgery Center (OSC) between September 2020 and April 2021 identified a statistically significant delay in the sample-to-lab interval time in cases at the OSC (mean of 27 minutes) compared to cases at CUH (mean of 8 minutes). The need for a lab courier at the OSC is likely a major contributor to this NVAT, as the OSC does not have an in-house lab. Though altering the lab infrastructure to make in-house ioPTH processing at the OSC would be the most effective way to equalize the delay, it was also infeasible within the time constraints of this project given the depth of high-level decision-making this would necessitate. I chose to focus instead on optimizing parathyroidectomy case preparation. I worked with CUH OR nursing clinical leads to modify the Epic template text of surgeon preference cards, which OR nursing staff use to prepare for cases. Analysis of pre- and post-change data from 43 parathyroidectomy cases performed in February and March of 2022 at CUH revealed post-change special cause variation in both the sample-to-lab and lab-to-result interval times. Moving forward, many other interventions are available to continue to improve team communication and knowledge sharing and protocolize contingency plans; further work also remains to be done to address logistical constraints at the OSC on an institutional level.Item Use of Respiratory Acoustic Monitor for Postoperative Monitoring in Children(2016-01-19) Williams, Timothy; Aboul-Fettouh, Nader; Ploski, Roxana; Griffin, Allison; Szmuk, PeterRecording vital signs is the standard of care for all patients on the hospital wards after surgery to detect respiratory and cardiovascular depression before serious complications ensue. Of all the vital signs, an altered respiratory rate is one of the best predictors of respiratory depression, cardiac arrest, and admission to the ICU. Despite its clinical importance, respiration rate is the last core vital sign without a reliable and continuous monitoring method that patients can easily tolerate. Besides manually counting respiration, the two standards of care for monitoring respiratory rate: thoracic impedance pneumography (Tl) and capnometry, fall short of monitoring respiratory rate in a reliable and tolerable fashion. These limitations have lead the Masimo corporation to develop a bio-acoustic respiratory rate monitor (RAM) to non-invasively convert acoustical airflow patterns detected from the surface of the neck into respiratory rate measurements using an innovative adhesive sensor with an integrated acoustic transducer. The accuracy and reliability of RAM has not been evaluated in the in-patient surgical wards of the pediatric population. We compared the reliability and accuracy of RAM and Tl monitoring in postoperative pediatric patients at risk of adverse respiratory events while also assessing the tolerance of the RAM sensor and ECG pads (Tl). We recruited thirty children from 2 to 16 years old (mean age 6.58) who had a tonsillectomy due to OSA at Children's Medical Center (Dallas, TX). Following arrival to the inpatient care unit an adhesive RAM sensor and pediatric Sp02 finger sensor were connected along with standard Tl ECG pads. Vital signs were recorded from the RAM sensors and Tl, and a manual RR was obtained every 2-hours until patient discharge. Data from these 30 patients were combined with 30 patients recruited from Cincinnati Children's Hospital (Cincinnati, OH) for statistical analysis. The three measurement methods (Manual, RAM, and Tl) were found to be significantly different {p=0.0255). RAM and manual measurements of RR were on the average not significantly different (p=0.0255) with a higher correlation coefficient (0.5851), whereas Tl and manual RR measurements of RR are significantly different (p=0.0066) with a lower correlation coefficient (0.4898). The average RR difference between RAM and manual was 0.17 ± 6.81, and the average RR difference for Manual vs Tl was 1.39 ft 10.63. Additional results suggest that RAM may prove a more accurate and tolerable method for monitoring pediatric respiratory rate and respiratory depression, cardiac arrest, and admission to the ICU than the standard of care methods currently in use in hospitals across the country.