Annals of emergency medicine
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We assess the effect of sequential modifications in laboratory processing, including pneumatic tube transport and fully computerized order management, on laboratory turnaround time in the emergency department (ED). ⋯ Changes in laboratory specimen management, including the use of a pneumatic tube and computerized order management, resulted in a progressive decrease in laboratory turnaround time in the study ED.
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The Joint Commission (TJC) recently issued stringent regulations about quality control testing of waived laboratory tests. Many hospitals subsequently instituted detailed procedures for performing, evaluating, documenting, and tracking point-of-care testing for fecal occult blood testing. We hypothesize that implementing this policy would generate an "opportunity cost" because busy physicians would need to compensate for this additional time required by reducing the frequency of digital rectal examinations or fecal occult blood testing. ⋯ TJC-inspired point-of-care testing policy was negatively and unintentionally associated with physician examinations, most notably the performance of a digital rectal examination. Institutional regulations designed for patient safety may unintentionally influence patient care. Economists describe this paradoxic phenomenon as the Law of Unintended Consequences. The costs and benefits of such policies should be analyzed before implementation and enforcement of new medical regulations.
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Comment Letter Case Reports
Real time monitoring of crowding in emergency departments.