ABSTRACT
Health care practitioners at all levels within an organization have a professional responsibility to deliver quality patient care. The overall systems operation, as well as customer outcomes, can be enhanced by using redesign and process improvement strategies. This article highlights the implementation of these change strategies as a part of process improvement efforts in the Outpatient Surgery Care Unit (OSCU). OSCU work process redesign was one in a series of 8 redesign efforts in the department of Surgical Services. A summary of the redesign process and its corresponding educational program is provided. Tools used to enhance efficiency and cost savings are also included.
Subject(s)
Hospital Restructuring/organization & administration , Outcome and Process Assessment, Health Care/organization & administration , Outpatient Clinics, Hospital/organization & administration , Surgicenters/organization & administration , Total Quality Management/organization & administration , Work Simplification , Cost Savings , Education, Nursing, Continuing/organization & administration , Efficiency, Organizational , Health Services Research , Humans , Inservice Training/organization & administration , Michigan , Models, Organizational , Nursing Process , Nursing Staff, Hospital/education , Postanesthesia Nursing/education , Postanesthesia Nursing/organization & administration , Program Development , Program Evaluation , Trauma CentersABSTRACT
An inception cohort of 107 patients was reviewed to establish the natural history of asymptomatic urolithiasis. With an over-all mean followup of 31.6 months, 73 patients (68.2%) remained asymptomatic and were censored at the time of the last clinical visit. A symptomatic event developed in 34 patients (31.8%). Spontaneous passage occurred in 16 patients (15.0%), endoureteral removal was done in 6 (5.6%), percutaneous nephrostolithotomy was done in 3 (2.8%) and 9 (8.4%) were referred for therapeutic lithotripsy. Cumulative 5-year probability of a symptomatic event developing was 48.5%. A linear association was identified between the development of a symptomatic event and the number of previous stones as well as the number of asymptomatic stones at identification. A significant burden of illness is associated with an expectant strategy as an approach to asymptomatic urolithiasis. Of the patients who had a symptomatic event 47% had spontaneous stone passage, while 26.5% required urological intervention and 26.5% were referred for therapeutic lithotripsy. Prophylactic extracorporeal shock wave lithotripsy, although often advocated, has associated risks and is not always a benign procedure. A randomized controlled trial is required to evaluate properly the role of prophylactic lithotripsy versus an expectant strategy.
