Quality Analysis

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The ambulatory health service at a university is experiencing an increased number of student complaints
concerning the services it offers in its walk-in urgent care clinic. Using the data in Table 14-5 on page 296 of
the textbook, select a complaint for analysis. Your analysis must include a fish-bone chart, other appropriate
charts (run and / or control), and any other techniques you deem necessary to analyze the data appropriately.
Write a two to three (2-3) page paper in which you:
Construct a fish-bone chart using Word or MS Paint.
Construct a run and / or control chart using Excel.
Recommend to the ambulatory health service on how it can improve the services it offers in its walk-in urgent
care clinic, based on your analysis. Provide a rationale for your recommendation.

 

Sample Solution

• Ormeloxifene a non steroidal selective estrogen receptors modulator and has been used for past 20years as an oral contraceptive. It is good option for menorrhagia leading to 77-85% reduction in menstrual blood loss and causes amenorrhea in 17-42% patients.[1]

• Ormeloxifene is a benzopyram SERM, which blocks the cytosol receptors by its competitive binding over estradiol. It is primarily a potent estrogen antagonist and demonstrates a suppressive or a stimulatory effect on gonadotropin release. It normalizes the bleeding from uterine cavity by regularizing the expression of estrogen receptors on the endometrium and hence used in dysfunctional uterine bleeding.[4] It is cheap, effective and has good patient compliance.

• One minimally invasive procedure for control of menorrhagia is levonorgesterol intrauterine device. The Levonorgestrol ICUD has a reservoir containing 52mg levonorgestrol mixed with polydimethylsiloxane, which controls the rate of hormone release. Menstrual blood loss in women with heavy menstrual bleeding can be reduced by 75-95% due to progestin induced decidualization of the endometrium. Levonorgestrol IUCD is an attractive option for ovulatory women with heavy menstrual bleeding.

• Hysterectomy should be the last resort in management of dysfunctional uterine bleeding, because of the morbidity, mortality associated with the surgical procedure, economic burden, need for rest.

MATERIALS AND METHODS: A comparative study was conducted in 80 patients ( 40 into ormeloxifene group and 40 into levonorgestrel group) of reproductive age group attending the outpatient department or admitted in-patients in department of obstetrics and gynecology at Sri Siddharth

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