The value of risk-reducing information.

Abstract This manuscript integrates the utility-increasing advantages of risk reductions into well-known value-of-information justifications for executive information systems (EIS). Accordingly, even some EISs which never pay for themselves financially can be advantageous if they sufficiently reduce the uncertainty of net income for risk averse hospitals. The manuscript demonstrates the potential importance of risk reductions in the context of a hypothetical hospital administrator charged with selecting among alternative managed care contracts, each with uncertain outcomes. An administrator representing a hospital with diminishing marginal utility from income, a standard interpretation of risk-aversion, may find that an otherwise unprofitable EIS reduces income variations (risk) sufficiently to justify its purchase

Analyzing HMO membership patterns: A microcomputer application.

This illustration has attempted to sensitize HMO managers to the need for their direct participation in data analyses. The manager can indeed accomplish such studies using a microcomputer and readily available software. As an active participant in these analyses, the manager lends realism to their results, and sharpens personal analytical skills to meet the increasing administrative challenges of the maturing prepaid health care delivery market

CSF Lactate Levels in High Risk Neonates with and without Asphyxia

Determination of CSF lactate levels were performed in 150 nonasphyxiated and 46 asphyxiated high risk neonates. Statistical analysis of log lactate levels of nonasphyxiated infants showed significant relationship to gestational and postnatal ages (P &amp;lt;.0001 and &amp;lt;.0002, respectively). CSF lactate elevation was seen in 16/29 infants studied within eight hours of asphyxia in contrast to 0/17 infants studied after eight hours (P &amp;lt;.001). Higher incidence of CSF lactate elevation was seen in term infants (7/8), infants with fetal distress (13/17), and very low Apgar scores (11/18). Seven of eight infants with markedly elevated lactate levels had both fetal distress and very low Apgar scores. CSF lactate determination in the immediate postasphyxial period appears to be an objective way of assessing the severity of cerebral hypoxia.</jats:p

Optimum investments in project evaluations: When are cost-effectiveness analyses cost-effective?

Abstract This manuscript extends the classical models of the value of information to ask whether a hospital\u27s net financial return is ever maximized by a cost- effectiveness analysis of retrospective data when watchful waiting and a full randomized clinical trial are alternative methodologies. The manuscript demonstrates that (1) some small-scale retrospective analyses may negatively affect net income and (2) under some conditions, larger-scale retrospective analyses may maximize net income. The manuscript also suggests that risk aversion increases the value of information and therefore the optimum expenditure on a project evaluation

Do Transient Working Conditions Trigger Medical Errors?

Objective: Organizational factors affecting working conditions for health care workers have received significant attention as latent causes of medical errors. Little is known, however, about the risks associated with transient or changing working conditions. The purpose of this study was to identify specific transient, modifiable working conditions in the hospital environment that serve as triggers for medical errors. Methods: A case-crossover design was used to study proximate causes of medical errors. Nursing personnel directly involved in a medical error were interviewed within 2 weeks of the error. Specific attributes of working conditions were assessed at the time immediately preceding the error and at times when no error occurred. Variables examined include subjects’ perceptions of work pace, patient census, patient acuity, teamwork, and distractions. Preliminary results are based on 112 interviews completed to date. Results: Subjects were more likely to describe their work environment as more hectic and reported increased distractions and feelings of fatigue during the 30 minutes prior to the error occurring as compared with the entire error shift. Subjects were more likely to report missing important patient information, having higher-acuity patients, and experiencing unplanned events on shifts when errors occurred, as compared with shifts when no errors occurred. Conclusions: These preliminary results suggest that working conditions immediately preceding the medical error and on the error shift differed from times when no error occurred, suggesting that transient working conditions may contribute to medical errors. Changes to the work environment such as improving the transmission of important patient information may help reduce the occurrence of medical errors

An Analysis of Nurses ’ Cognitive Work: A New Perspective for Understanding Medical Errors

Health care researchers agree that the acute care hospital environment is filled with numerous distractions. Within this environment, professional nurses make clinical judgments about their patients, whose conditions may change minute by minute. As a result, nurses constantly organize and reorganize the priorities and tasks of care to accommodate patients ’ fluctuating status. To date, little attention has been given to how interruptions in the workplace influence nurses ’ ability to anticipate and carry out the actions directed by their clinical judgment. This paper describes an ongoing research study aimed at exploring the effect of interruptions on the cognitive work of nursing. A methodology combining human factors techniques and qualitative observation of nurses in practice has produced a cognitive pathway. The pathway is a unique visual graphic that offers a perspective of the nature of nurses ’ work and the relationship interruptions and cognitive load may have on omissions and errors in care. The approach to analyzing the cognitive work of nurses has important implications for understanding the origins of medical errors

Cytomegalovirus and HLA-A, B, and DR locus interactions: Impact on renal transplant graft survival.

Abstract Graft failure rates for renal transplantations performed between 1989 and 1994 and recorded in the US Renal Data System database were retrospectively evaluated for interactions between cytomegalovirus and HLA- A, B, and DR loci. Twelve significant interactions were observed. There were significantly greater risks of graft failure for the total effect of cytomegalovirus and donor or matched HLA-DR9, recipient or matched HLA-B-51, and matched HLA-B13. We conclude that further study of renal transplants with these combinations of cytomegalovirus and HLA loci is needed to determine whether the observed interactions should be taken into consideration when matching donors with recipients