The lab manager's role in assessing new technology.

Without the benefit of the lab manager's experience, as well as the ability to solicit input from all necessary parties, a lab's short-term ¿savings¿ due to new technology could amount to long-term disaster. Here are some common mistakes made by labs and how to avoid them.

Ketorolac vs meperidine for the management of pain in the emergency department.

OBJECTIVE: To compare the pain relief, sedation, and common side effect profiles of ketorolac tromethamine and meperidine for the management of acute pain in the emergency department (ED). METHODS: A prospective, double-blind, randomized clinical trial was conducted over a 12-month period using consecutive adult patients presenting to a university teaching hospital ED (annual census: 32,000), who required IM analgesia for acute pain. Adult patients with acute pain of various etiologies were randomly assigned to receive a single fixed IM dose of ketorolac (60 mg) or meperidine (100 mg). RESULTS: Ninety-three patients were enrolled in the study; 46 were randomized to meperidine and 47 to ketorolac. Using a visual analog scale, there was no difference in pain relief between the ketorolac and meperidine groups even after adjusting for baseline pain level. Ketorolac caused significantly (p < 0.005) less sedation than did meperidine at one hour. Rescue analgesia was required for seven of the 46 (15.2%) patients receiving meperidine and five of the 47 (10.6%) patients receiving ketorolac (p = NS). Seventeen of 45 (38%) patients receiving meperidine experienced side effects compared with eight of the 47 (17%) patients receiving ketorolac (p = 0.0452). CONCLUSIONS: When used to treat patients who had acute pain states, 60 mg of IM ketorolac produced analgesia similar to that produced by 100 mg of IM meperidine; however, the ketorolac produced fewer subjective side effects and less sedation than did the meperidine.

Evaluating managerial efficiency of Veterans Administration medical centers using Data Envelopment Analysis.

This study applied the methodology of Data Envelopment Analysis (DEA) to the set of VA medical centers to evaluate their relative managerial efficiencies. Each VAMC was viewed as a producer of multiple outputs and a consumer of multiple inputs. DEA uses linear programming to identify resources that were underutilized and services that were inefficiently produced. Managerial strategies based on the dual variables were constructed to indicate the manner in which inefficient VAMCs may be made efficient. The analysis showed that relative inefficiency existed in about one third of the VAMCs nationwide. Elimination of this inefficiency would save the VA over $300 million annually on personnel, equipment, drugs, and supplies, without reducing the level of services provided. A subsequent analysis of co-variance revealed that VAMCs affiliated with a university were generally less efficient than those without such an affiliation. A similar finding was obtained for larger VAMCs relative to smaller medical centers. In neither case, however, should these results be construed to imply that VAMCs should terminate their university affiliations or that VAMCs should be made smaller since factors other than relative efficiency are clearly as or more important in such decisions.

The impact of prospective reimbursement on nursing home efficiency.

Data Envelopment Analysis (DEA) was used to estimate the relative efficiencies of nursing homes in Maine for 2 years before the introduction of a prospective payment system and for 2 years afterward. A multiple regression was performed in which the DEA-estimated efficiency was the dependent variable and a number of facility characteristics and study year were the independent variables. Study findings indicate that nursing home efficiency scores fell after the introduction of prospective reimbursement; that is, generally speaking, more inputs were being used per unit of output in the period after the introduction of prospective reimbursement than in the period preceding it. This may be the result of poor management, degraded quality of inputs, improved quality of outputs, or some other unobserved trend during this same period. The study also concludes that higher occupancy rates are associated with lower efficiencies and that patients in restraints produce severe negative effects on efficiency. In addition, it appears that a sudden increase in administrative hours in the final study year played a role in that year's lower average efficiency scores, but also that all input levels generally rose while output levels remained virtually constant.

Improving managerial decision making: the case of a hospital laboratory.

Attempting to reduce costs, a hospital laboratory replaced its continuous flow analyzer, which performs 20 tests at once with a discrete analyzer able to perform a combination of the 20 tests. In order for this change to result in actual cost savings, physicians had to reduce their utilization of the laboratory. The laboratory administrators, however, assumed that the required test reduction could be realized. This assumption proved to be incorrect. Physicians continued to order a large number of tests per sample (e.g., 14). As a result of this incorrect decision laboratory costs increased by $124,200 per year. These results highlight the need to test the accuracy of managerial decision-making assumptions. The ease and low cost of conducting pilot studies to test the validity of such assumptions dictates that administrators insist that they be conducted before managerial strategies are implemented.

Cost containment and the future utilization of health manpower.

In 1980, GMENAC predicted a substantial oversupply of physicians by 1990 and a questionable role for nonphysician providers in the future. The authors contend, however, that the demand for nonphysician health care providers will intensify as competition and cost containment pressures increase. Outlined here are the future directions of manpower utilization.

Laboratory costs and utilization: guidelines for efficient use of laboratory technology.

The practice of laboratory medicine now plays a major role in the delivery of health care. Under PPS, however, the laboratory has come under close scrutiny as one place where costs can be reduced. This article examines the use of continuous-flow and discrete analyzers in the chemistry laboratory and provides guidelines for determining which analyzer is most appropriate for a given organization.

The effect of clinical education programs on hospital production.

Because of rising hospital costs and the reluctance of third-party payers to reimburse for clinical training, major questions have been raised about the costs and benefits of these programs. The effect of student programs on production has, nonetheless, been largely neglected, in part because of the difficulty of measuring the effectiveness of these programs. To address this deficiency, multiple regression analysis was used to determine the impact of physical therapy, occupational therapy, and radiologic technology students on production in a large hospital in a metropolitan area. The impact of students on departmental output in all three areas was found to be positive.

Influence of selective vs. panel chemistry tests on cost and diagnostic time.

In the present economy, much concern has been focused on the cost and medical efficacy of laboratory tests being performed. This study examined the difference in laboratory costs associated with physician's use of selective vs. panel chemistries and the frequency of inefficient use of laboratory tests. A determination of the difference in the average number of laboratory visits needed to reach diagnosis associated with the use of these two test methods was made. The study was conducted at a 270-bed community hospital in suburban New York, where the physicians are free to choose selective and/or panel chemistries. Random selection of 200 outpatient records revealed that three types of ordering patterns existed: panels, selective, and a combination of the two. Of the three, panel testing resulted in substantially lower costs and fewer return visits to the laboratory than either selective or mixed (combination of selective and panel) testing.

A pyramid model of health manpower in the 1980s.

In little more than a decade, the problems and issues relating to the supply of, and demand for, skilled health manpower in the United States have shifted dramatically. Where the key words in the late 1960s were "shortage," "crisis," and "expansion of training capacity," the major concerns on the threshold of the 1980s are "oversupply," "overtraining," and "costs." Federal policy relating to health manpower is rapidly changing from attempts to increase manpower supply to efforts to contain expansion. This article presents a graphic representation of this change, along with projections for the future. Three stages of supply/demand are graphically depicted: Stage I represents the supply-deficit situation of the past; Stage II symbolizes a state of supply/demand balance; and Stage III represents the oversupply situation which seems imminent in many health manpower categories. Some suggestions for possible actions to prevent unlimited "might makes right" solutions to oversupply problems, and assessments of the results which might be expected, are presented.

The predictive ability of the allied health professions admission test.

Multiple regression models are formulated which analyze the usefulness of AHPAT as a predictor of success in allied health programs. The models are estimated by using data from the four baccalaureate programs in the School of Allied Health Professions at the State University of New York at Stony Brook. We attempt to reconcile differences in the usefulness of AHPAT that have been noted in the literature. Estimation results indicate that AHPAT is indeed a useful predictor, but the new explanatory power of the models suggests that other factors need to be considered.