Intensive Care Lab Assessing Process Capability Example 6.5 Cp = Cp = Upper specification - Lower specification 30 - 20 6(1.35) 6 = 1.23 Process Capability Ratio Does not meet 4 (1.33 Cp) target Before Process Modification Upper specification = 30.0 minutes Lower specification = 20.0 minutes Average service = 26.2 minutes  = 1.35 minutes Cpk = 0.94 Cp = 1.23 After Process Modification Upper specification = 30.0 minutes Lower specification = 20.0 minutes Average service = 26.1 minutes  = 1.2 minutes Cpk = 1.08 Cp = 1.39 © 2007 Pearson Education
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Reading List 1. 2. 3. 4. 5. 6. 7. 8. 9 10 11. 12 13 Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M;Early Goal-Directed Therapy Collaborative Group. Nugyen HB, Rivers EP, Havstad S, Knoblich B, Ressler JA, Muzzin AM, Tomlanovich MC:Critical care in the emergency department:Aphysiologic assissment and outcome evaluation.Acad Emerg Med. 2000 Dec;7(12):1354-61. Shoemaker WC, Wo CC, Yu S, Farjam F, Thangathurai D:Invasive and noinvasive haemodynamic monitoring of acutely ill sepsis and septic shock patients in the emergency department. Eur J Emerg Med. 2000 Sep;7(3):169-75. Truog RD, Cist AF, Brackett SE, Burns JP, Curley MA, Danis M, DeVita MA, Rosenbaum SH, Rothenberg DM, Sprung CL, Webb SA, Wlody GS, Hurford WE. Recommendations for end-of-life in the intensive care unit:The Ethics Committee of the Society of Critical Care Medicine. Crit Care Med. 2001 Dec;29(12):2332-48. Sprung CL, Geber D, Eidelman LA, Baras M, Pizov R, Nimrod A, Oppenheim A, Epstein L, Cotev S. Evaluation of triage decisions for intensive care admission.Crit Care Med. 1999 June;27(6):1073-9. Metcalfe MA, Sloggett A, McPherson K. Mortality among appropriately referred patients refused admission to intensive care units. Lancet. 1997 July 5;350(9070):7-11. Morales IJ, Peters SG, Afessa B. Hospital mortality rate and length of stay in patients admitted at night to the intensive care unit. Crit Care Med. 2003 Marcgl31(3)L858-63, Diringer MN, Edwards DF. Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage. Crit Care Med. 2001 Mar;29(3):635-40. Afessa B. Triage of patients with acute gastroinestional bleeding for intensive care unit admission based on risk factors for poor outcome. J Clin Gastroenterol. 2000 Apr;30(3):281-5. .Morales IJ, Peters SG, Afessa B. Hospital mortality rate and length of stay in patients admitted a night to the intensive car unit. Crit Care Med. 2003 Mar;31(3):858-63. Rosenberg AL, Hofer TP, Strachan C, Watts CM, Hayward RA. Accepting critically ill transfer patients:adverse effect on a referral cneter’s outcome and benchmark measures. Ann Intern Med. 2003 June3;138(11):882-90. Higgins TL, McGee WT, Steingrub JS, Rapoport J, Lemeshow S, Teres. Early indicators of prolonged intensive care unit stay:impact of illness severity, physician staffing, and pre-intensive care unit length of stay. Crit Care Med. 2003 Jan;31(1):45-51. Rocker G, Cook D, Sjokvist P, Weaver B, Finfer S, McDonald E, Marsh J, Kirby A, Levy M, Dodek P, Heyland D, Guyatt G; Level of Care Study Investigators;Canadian Critical Care Trials Group. Crit Care Med. 2004 May;32(5):114954. Nasraway SA, Button GJ, Rand WM, Hudson-Jinks T, Gustafson M. Surviors of catastrophic illness:outcome after direct transfer from intensive care to extended care facilities. Crit Care Med. 2000Jan;28(1):19-25.
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Intensive Care Lab Assessing Process Capability Example 6.5 Cpk = Minimum of Cpk = Cpk = Upper specification = 30 minutes Lower specification = 20 minutes Average service = 26.2 minutes  = 1.35 minutes x= – Lower specification Minimum of 3 26.2 – 20.0 3(1.35) Minimum of © 2007 Pearson Education , 1.53, 0.94 Upper specification – x= 3 , 30.0 – 26.2 3(1.35) = 0.94 Process Capability Index
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Intensive Care Lab Example 6.5 The intensive care unit lab process has an average turnaround time of 26.2 minutes and a standard deviation of 1.35 minutes. The nominal value for this service is 25 minutes with an upper specification limit of 30 minutes and a lower specification limit of 20 minutes. The administrator of the lab wants to have four-sigma performance for her lab. Is the lab process capable of this level of performance? Upper specification = 30 minutes Lower specification = 20 minutes Average service = 26.2 minutes  = 1.35 minutes © 2007 Pearson Education
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Process Capability Index, Cpk Process Capability Index, Cpk, is an index that measures the potential for a process to generate defective outputs relative to either upper or lower specifications. Cpk = Minimum of x= – Lower specification 3 , Upper specification – x= 3 We take the minimum of the two ratios because it gives the worst-case situation. © 2007 Pearson Education
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Sulfate Reduction Norman Landfill Cozzarelli temp oC pH USGS Reston, VA (avail) Well MLSNPD -6 MLS38-6 DO Ca2+ (ppm) (mg/L) chemet. field lab 0.04 166.00 0.11 514.00 Mg2+ (mg/L) field 16.6 ND field 7.01 6.78 Si Fe 2+ Mn2+ Sr2+ Ba2+ SiO2 (mg/L) (mg/L) (mg/L) (mg/L) (mg/L) (mg/L) lab 8.70 16.80 lab 0.13 19.30 lab 1.94 0.90 lab 1.06 9.87 lab 0.14 7.12 lab 52.60 232.00 lab 18.60 35.90 Na+ (mg/L) lab 91.80 606.00 NO3(mg/L) IC lab 0.05 3.48 K+ (mg/L) lab 2.50 14.40 NH4+ Cl(mg/L) IC lab 181.0 1026.6 SO4 2(mg/L) IC lab 113.60 0.10 Br- Alk (HCO3) mg/L lab 626 2,642 - (mg/L) IC lab 0.79 7.54 DOC (ppm) (mg/L) Chemet. field lab 2.1 2.9 15.0 158.7 Barium concentration appears insignificant unless barium is lost to cation exchange or mineral precipitation.
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