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Baker, G. Ross et al. TheCanadian Adverse EventsStudy: the incidence ofadverse events amonghospital patients inCanada. CanadianMedical AssociationJournal. Vol 170: 11.1678-86. 2004.Bandali, Karim et al.Skill Integration in aSimulated andInterprofessionalEnvironment: AnInnovativeUndergraduate AppliedHealth Curriculum.Journal ofInterprofessional Care.Vol 22:2: 179-189.March, 2008.This study estimates the incidenceof Adverse Events (AEs) amongpatients in Canadian acute carehospitals.1 teaching, 1 large communityand 2 small community hospitalsin each of 5 provinces(British Columbia, Alberta,Ontario, Quebec and NovaScotia) were randomly selectedand reviewed a random sample ofcharts for non psychiatric, nonobstetric adult patients in eachhospital for the fiscal year 2000.Trained reviewers screened alleligible charts, and physiciansreviewed the positively screenedcharts to identify AEs anddetermine their preventability.A study proposing an innovativeapplied health undergraduatecurriculum model that usessimulation and interprofessionaleducation to facilitate students’integration of both technical and‘humanistic’ core skills. Themodel incorporates assessment ofstudent readiness for clinicaleducation and readiness forprofessional practice in acollaborative, team-based,patient-centred environment.Improving the education of healthcare professionals is a criticalcontributor to ultimatelyimproving patient care andoutcomes.for patients with indwelling catheters or lines.Standardization of specimen collection proceduresreduces errors by simplifying, optimizing andreducing the number of collection proceduresfollowed in a healthcare organization.Research into adverse events (AEs) has highlightedthe need to improve patient safety. AEs areunintended injuries or complications resulting indeath, disability or prolonged hospital stay that arisefrom health care management.At least 1 screening criterion was identified in 1527(40.8%) of 3745 charts. The physician reviewersidentified AEs in 255 of the charts. After adjustmentfor the sampling strategy, the AE rate was 7.5 per100 hospital admissions. Among the patients withAEs, events judged to be preventable occurred in36.9% and death in 20.8%. Physician reviewersestimated that 1521 additional hospital days wereassociated with AEs. Although men and womenexperienced equal rates of AEs, patients who hadAEs were significantly older than those who did not(mean age 64.9 v. 62.0 years).The overall incidence rate of AEs of 7.5% in thestudy suggested that, of the almost 2.5 million annualhospital admissions in Canada similar to the typestudied, about 185,000 are associated with an AEand close to 70,000 of these are potentiallypreventable.Limitations:Budget constraints limited the number of hospitals inthe study – generalizabiity of results is unknown; AErates were not studied in small or remote hospitals;only adult patients in acute care general hospitalswere included.In 2001, an estimated 24,000 preventable deathsassociated with medical error were cited by theCanadian Adverse Events Study. Most are due tosystem errors; however, the current model of healthcare education may be a contributing factor.A review of the current models in health scienceseducation reveals a scarcity of clinical placements,concerns over students’ preparedness for clinicaleducation and profession-specific delivery of healthcare education which fundamentally lackscollaboration and communication amongprofessions. These educational shortcomingsultimately impact the delivery and efficacy of healthcare. Construct validation of clinical readiness willcontinue through primary research at the MichenerInstitute for Applied Health Sciences. As the neweducational model is implemented, its impact will beassessed and documented using specific outcomesmeasurements. Appropriate modifications to themodel will be made to ensure improvement andfurther applicability to an undergraduate medicalcurriculum.12
De Capitani, C.Automation of Pre-Analytical Phase: aPerformance Evaluationand AlternativeScenarios. Journal of theAssociation forLaboratoryAutomation. Vol (2) :89– 93. 2002.Health Canada. AnEnvironmental Scan ofthe Human ResourceIssues Affecting MedicalLaboratory Technologistsand Medical RadiationTechnologists. SectionC: Findings on MedicalLaboratoryTechnologists. Ottawa:Health Canada. 2002.Hurst, Jerry. ArePhysicians’ OfficeLaboratory Results ofComparable Quality toThose Produced in OtherLaboratory Settings?Describes the automation of thepre-analytical phase in abiochemical laboratory thatperforms more than 3.6 milliontests per year. The paper presentshow an investment in thelaboratory can be evaluatedconsidering economic criteria,future performance and servicequality. Alternative scenarios interms of personnel, pre-analyticaldevices and management policiesare also considered.This report presents the combinedfindings of two different studies:an environmental scan performedin 1998 and an update completedin 2001.The environmental scan presentedthe Advisory Committee onHealth Human Resources(ACHHR) with information aswell as a number ofrecommendations to help itdetermine appropriate strategiesto address human resource issuesaffecting medical laboratorytechnologists and medicalradiation technologists.The 1998 study confirmed thatserious shortages could beanticipated in both groups oftechnologists and that a nationalstrategy was needed. The 2001study confirmed a worsening ofhuman resource shortages.In 1995, California adopted a billthat brought laboratory laws inline with the 1988 ClinicalLaboratory ImprovementAmendments’ standards forclinical laboratories and mandatedThis paper shows how an investment in thelaboratory can be evaluated from an economic pointof view and also considering future performance andservice quality.The laboratory is an integrated and complex system.In order to take into account complexity andintegration in the study, simulation has been used.The study highlights the personnel cost saving (morethan 40% of saving ) and the improvement in servicequality of pre-analytical phase automation, evenduring the period without the connection betweenLaboratory Information System-HospitalInformation System (LIS-HIS).As of 2001, most provinces were experiencingserious shortages in medical laboratory technology.Several concurrent and sometimes conflicting forcesinfluencing the medical laboratory workforceincluding:• Diminishing supply of technologists in responseto a decline in employment opportunities.• Anticipated retirement among the baby boomtechnologist workforce in the next 5 to 10 years• Growth in demand for laboratory testing todiagnose the health conditions commonlyassociated with aging (e. g. cancer, heartdisease).Projecting the labour market needs of the future isdifficult because of the difficulty in anticipatingtechnological advances in this field.Medical laboratory technology is strongly influencedby the developments of new technology and newscientific testing discoveries. The future health careor laboratory restructuring initiatives that will beundertaken in response to these developments areunknown. However, the trend of using techniciansfor routine or automated testing is a trend that isexpected to continue. Educating multi-skilledtechnologists who can respond effectively to changesin their roles is another emerging trend.Gathering complete data on the technologistworkforce and incomplete databases are majorlimitations. The differences across Canada in thelaboratory personnel used (e.g., aides, assistants) andthe corresponding variations in the trainingrequirements (e.g., on-the-job vs. certificate) makethe analysis difficult.Ontario reports that positions are starting to open upwith the risk of shortages as the workforce begins toretire in higher numbers. Ontario reports a greatershortage in the private laboratories as salaries arebetter in the public sector. Program officials arefinding it difficult to find sufficient funding for theirprograms, especially with the high cost ofinstruments.The unsatisfactory failure rate for POLs was nearly 3times (21.5% vs 8.1%) the rate for the non-POLs andabout 1.5 times (21.5% vs 14.0%) for POLs that usedlaboratory professionals as testing or supervisorypersonnel. The POL unsuccessful rate was more than4 times (4.4% vs 0.9%) the rate for non-POLs and13
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