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Developing a data retrieval and statistics program.

We created our own data base management program for microbiology, using Applesoft Basic language. Although it is slower than commercial software, it is an inexpensive way to maintain current statistics on departmental activity, including organisms cultured and susceptibility patterns.

Our microbiology department serves a 500-bed medical center. Statistics, compiled manually, had been dropping lower and lower on the list of prioritiers after prospective payment led to layoffs and attrition. When up-to-date, monthly susceptibility summaries could no longer be provided to clinicians and the infection control committee, we turned to our Apple II Plus. Till then, The microcomputer had been used exclusively for automatic recording of data from our blood culturing instrument.

The data base management program was actually constructed by author Kay McConnell with input on microbiology's needs from her co-authors. McConnell had learned Applesoft Basic at home on her own Apple II Plus.

Data entered on each specimen include patient name, lab or specimen accession number, room, age, billing number, admission date, requisition date, specimen type, organisms cultured, and susceptibility patterns.

From all the individual test records, we generate complete monthly list of microbiology testing, sorted by patient name, room number (for infection control purposes), specimen type, and type of organism. In addition, we generate overall statistics on identifications and susceptibilities by specimen type and by organism.

The information is stored on a floppy disk, with printouts for backup. The Apple II Plus has dual disk drives and 48K RAM, and we use an Epson FX-100 printer.

Here are different aspects of the program:

* Code files. These three files are directories covering the numerical codes for organisms (101, E. Coli) and the alphabetical codes for specimens (BRON, bronchial) and antibiotics (GM, gentamicin). While any number of specimen and organism codes can be specified, the antibiotic file is limited to a maximum of 25 for space reasons, since all the drug codes have to be shown in each report on susceptibilities.

If we want to modify the antibiotic file, we must wait until the beginning of a new year. Computer generation of monthly and yearly susceptibility statistics depends on the codes and their order.

* Data entry. The data entry format on the computer screen (Figure 1) corresponds to the sequence in which informatin appears on our requisition form. The specimen code is entered alongside SPEC. Antibiotic codes are read vertically. The first code is just the letter P for penicillin; the second is AK for amikacin; the third, AM for ampicillin; and so on. Beneath each of these, on the organism code line, is an S for susceptible, R for resistant, or a period if the drug has not been tested. When several consecutive drugs are not tested, periods are easier to count than blank spaces.

Up to four organisms per specimen can be entered at one time. If any more organisms are cultured from the same specimen, a second record must be created. This was one of the points we paused over when developing the program. How many organisms would each culture yield? Rarely more than four, but frequently more than three, a review of past reports revealed.

At the top left of the data entry screen is an exit option, allowing a return to the main menu. At the bottom of the screen, the user has a chance to enter the displayed data into the main patient file, revise the data, or delete it all. Also at the bottom is the latest total of patient records for the month.

Data entry is performed whenever any employee has a spare 10 or 15 minutes. It is the only employee time devoted to organism and susceptibility statistics now. The Apple and the Epson do the rest.

* Search and edit. The main file can be searched by either patient name or specimen accession number. Data for an individual test record are displayed on the screen, and the following options are given: continue search, edit data, delete data, or return (to the main menue). Continued search by name calls up all the specimens cultured that month on the same patient. Continued search by specimen number allows us to see any added organisms cultured on a specimen, beyond the maximum of four in th first record displayed on the screen.

Searches are usually conducted with some editing purpose in mind. For example, when we find out the identity of a patient originally admitted as John Doe, we go into the files and change the name. Occasionally, a physician will ask for all the culture data on a patient. Retrieval takes less than a minute.

We also have an Apple program called FID that enables us to copy computer files and programs for backup.

* Calculations and printouts. Among the availabe screen displays and hard copies are: a CRT listing and printout of the names and computer-record numbers of all patients in a monthly file, for use as an index; a CRT listing of statistics on a single organism, needed when a physician asks for drug susceptibilities; and printouts of all data in the main file, sorted by patient name, by floor, by organism, or by specimen. These last printouts serve as hardcopy backup to the disk.

In additin, we have monthly and annual printouts of statistics by organism and by specimen. The former shows the number of times each organism was cultured and the percentage of organisms tested that were susceptible to each drug (Figure II). The data are used by microbiologists, clinicians, and the infection control committee to compare susceptibilities among new and old drugs and to monitor increasing antibiotic resistance by organisms.

The printout of specimen statistics lists each specimen type, how many were cultured during the month or year, and the percentage of those cultured that grew any of the coded organisms. Infection control is particularly interested in this information.

There are drawbacks to our data base management software. For one thing, a wide carriage printer is needed for some of the printouts. For another, the program is slow compared with commercial software, as we have mentioned. With 338 entries in the main patient file, 119 entries in the organism file, 22 entries in the antibiotic file, and 21 entries in the specimen file, it would take: 29 seconds to search by name through the entire patient file; 2 minutes, 40 seconds to load from the disk to the computer and sort by patient, and 14 minutes to print out; 2 minutes, 17 seconds to load and sort by floor, and 13 minutes to print out; 60 minutes to sort and print out by organism; 10 minutes to sort and print out by specimen; 66 minutes to calculate and print out monthly statistics by organism; and 38 minutes to calculate and print out monthly statistics by specimen.

Now for the advantages. Since we already had the Apple II Plus and since the program was written by a laboratory employee on her own time, the only supply costs we have run up are for 14 floppy disks per year and printer paper.

Even though the software is relatively slow, it is still much faster than our previous system of manual sorting and calculations. We have cut 50 per cent off the time technologists and volunteer hospital workers used to spend in compiling our statistics. Since all data are now kept on floppy disks and a small collection of printouts, we have also reduced the space needed to store our data.

We can continually monitor microbiology data and get up-to-the-minute interim reports on our overall activity.

With programming knowledge and ability to handle random access files in Applesoft Basic, the program can constantly be updated and improved. Modifications can be accomplished within days--sometimes within minutes--therefore providing us with a program tailored to our needs.
COPYRIGHT 1985 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1985 Gale, Cengage Learning. All rights reserved.

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Title Annotation:for medical laboratories
Author:McConnell, Kay; Esterle, Lois; Luscre, Anthony
Publication:Medical Laboratory Observer
Date:Mar 1, 1985
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