PURPOSE – The purpose of this article is to discuss lean as a learning system in a hospital ward. DESIGN/METHODOLOGY/APPROACH – Discusses lean as a learning system in a hospital ward. FINDINGS – The Toyota veterans are fond of saying, lean is about “making people before making parts” or, in the wards’ context,...

Some of the frequently asked questions are: Should we use BE (base excess) or SID (strong ion difference) as a measure of a metabolic acid-base disturbance?  Is there any difference between BB (buffer base) and SID? Should we use SBE (standard base excess), i.e. BE referring to the expanded extracellular fluid or...

CONTEXT: Sensitive D-dimer assays have been developed to exclude the diagnosis of deep vein thrombosis (DVT) and have exhibited great success when used in conjunction with a diagnostic algorithm, including pretest probability scoring and a compression ultrasound (CUS). Improving specificity of D-dimer assays would...

Clinical laboratory measurement of serum/plasma creatinine concentration has been used to assess patient kidney function for well over 50 years. With incorporation of creatinine analyses to blood gas and other point-of-care platforms the test is now available outside the laboratory, at the bedside and in the clinic.  ...

PURPOSE – The purpose of this paper is to show how over the last 18 months Bolton Hospitals NHS Trust have been exploring whether or not lean methodologies, often known as the Toyota Production System, can indeed be applied to healthcare. DESIGN/METHODOLOGY/APPROACH – This paper is a viewpoint. FINDINGS – One’s...

Tight glycemic control (TGC) in the intensive care unit is essential to comprehensive clinical management.  However, TGC that is too aggressive in the wrong patient populations (particularly non-diabetics) can result in hypoglycemia, which brings with it a set of sequelae that can increase morbidity and mortality....

One of the principal utilities of arterial blood gas (ABG) analysis is to help assess blood oxygenation status. The two ABG parameters used for this assessment are pO₂(a) (partial pressure of oxygen in arterial blood) and sO₂(a) (% of total hemoglobin that is saturated with oxygen). In health pO₂(a) is maintained...

Sepsis and septic shock lead to local and systemic activation of different response systems, including coagulation and fibrinolysis.  Despite numerous attempts the high mortality rate of these patients has remained stable over the last 20 years. In this overview the pathophysiological insights and possible...

Troponin values above the 99th percentile and increasing/falling values found by serial testing in addition to signs and symptoms of myocardial ischemia means AMI. Low troponin values, near or below the 99th percentile, can be used for prognosis. Highest hazard ratios were found when using the 90th percentile,...

Pleural effusion, defined as excess fluid in the pleural space, can complicate the course of a large and pathologically diverse range of pulmonary and non-pulmonary diseases. Laboratory analysis of pleural fluid provides much useful information for the clinician whose diagnostic challenge is the patient presenting...