scholarly journals P040: Retrospective assessment of discrepancies in preliminary radiological reports in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S78-S79
Author(s):  
N. Saha ◽  
S. Chakraborty
Keyword(s):  
Specific Pattern ◽  
Patient Harm ◽  
Emergency Physicians ◽  
Retrospective Assessment ◽  
Academic Hospitals ◽  
Incorrect Diagnosis ◽  
Weak Points ◽  
Staff Radiologist ◽  
Major Discrepancy ◽  
Radiology Residents

Background: Preliminary reports and subsequent immediate management decisions of radiological scans are often performed by emergency physicians and on-call radiology residents. Many academic hospitals have resident-only coverage for after-hour shifts. Generally, these preliminary reports are eventually reviewed by a staff radiologist, during which discrepancies may be identified. Depending on the severity of the discrepancy and the time taken to notify the treating physician, there is potential for significant impact on the patient's care. Aim Statement: In an attempt to identify and minimize errors in radiological readings, and to improve the communication of discrepancies, our project aims to retrospectively audit all radiological discrepancies that have occurred at The Ottawa Hospital's emergency departments from April 2018 to May 2019. Measures & Designs: A systematic review of all cases with noted radiological discrepancies was obtained from the Picture Archive and Communication System software and EPIC platform. Analysis of these cases will allow us to define when errors occur, what is the type and severity of the error, how long it took to relay the discrepancy to a treating physician, and what was the subsequent management impact. Evaluation/Results: We discovered 712 cases with radiological reading discrepancies, 168 major, 527 minor, and 17 incidentals. Interestingly, a significant portion of major (severely affecting care/life-threatning) discrepancies were reported from radiology residents, especially on CT images, although emergency physicians had the most discrepancies (mostly minor). Radiology residents were seen to have more discrepant reports during after-hour services while emergency physicians did not show any specific pattern of discrepant reporting. The average time to report a major discrepancy to a treating physician is 8.8 hours, where the maximum time taken was 104 hours and the minimum was 0.2 hours. 56% of reports with major discrepancies made no mention of who was notified. Discussion/Impact: By identifying weak points in radiological reporting, our results will allow us to provide suggestions at an administration and teaching level to minimize discrepancies. It is critical to create a workflow where mistakes are mitigated, and communication is efficient and standardized to prevent patient harm from delayed or incorrect diagnosis.

Interobserver agreement between radiologists and radiology residents and emergency physicians in the detection of PE using CTPA

2014 ◽  
Vol 38 (4) ◽  
pp. 445-447 ◽  
Author(s):  
Bruno Hochhegger ◽  
Giordano R.T. Alves ◽  
Marcus Chaves ◽  
Ana Luiza Moreira ◽  
Renato Kist ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Emergency Physicians ◽  
Radiology Residents

scholarly journals Increasing Neuroradiology Exam Volumes On-Call Do Not Result in Increased Major Discrepancies in Primary Reads Performed by Residents

2014 ◽  
Vol 8 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Jared T Verdoorn ◽  
Christopher H Hunt ◽  
Marianne T Luetmer ◽  
Christopher P Wood ◽  
Laurence J Eckel ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Educational Environment ◽  
Staff Radiologist ◽  
Major Discrepancy ◽  
Discrepancy Rate ◽  
The Mean ◽  
Phone Contact ◽  
Affect Patient Care ◽  
Common Perception ◽  
Ct Studies

Background and Purpose: A common perception is that increased on-call workload leads to increased resident mistakes. To test this, we evaluated whether increased imaging volume has led to increased errors by residents. Materials and Methods: A retrospective review was made of all overnight neuroradiology CT exams with a primary resident read from 2006-2010. All studies were over-read by staff neuroradiologists next morning. As the volume is higher on Friday through Sunday nights, weekend studies were examined separately. Discrepancies were classified as either minor or major. “Major” discrepancy was defined as a discrepancy that the staff radiologist felt was significant enough to potentially affect patient care, necessitating a corrected report and phone contact with the ordering physician and documentation. The total number of major discrepancies was recorded by quarter. In addition, the total number of neuroradiology CT studies read overnight on-call was noted. Results: The mean number of cases per night during the weekday increased from 3.0 in 2006 to 5.2 in 2010 (p<0.001). During the weekend, the mean number of cases per night increased from 5.4 in 2006 to 7.6 in 2010 (p<0.001). Despite this increase, the major discrepancy rate decreased from 2.7% in 2006 to 2.3% in 2010 (p=0.34). Conclusion: Despite an increase in neuroradiology exam volumes, there continues to be a low major discrepancy rate for primary resident interpretations. While continued surveillance of on-call volumes is crucial to the educational environment, concern of increased major errors should not be used as sole justification to limit autonomy.

scholarly journals P087: Cellulitis and erysipelas management at an academic emergency department: current practice vs the literature

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S107-S108
Author(s):  
J. Martin ◽  
C.R. Wilson ◽  
T. Chaplin
Keyword(s):  
Emergency Departments ◽  
Retrospective Chart Review ◽  
Current Evidence ◽  
Emergency Physicians ◽  
Patient Demographics ◽  
Academic Hospitals ◽  
Kingston General Hospital ◽  
Management Plans ◽  
Resistance Patterns ◽  
Antibiotic Resistance Patterns

Introduction: Cellulitis and erysipelas are common presentations for the general practitioner. Antibiotic therapy targeting beta-hemolytic streptococci and Staphylococcus aureus is the mainstay of treatment for children and adults with these infections. Although evidence-based Canadian guidelines for appropriate management exist, inconsistent practices persist. Our objective was to determine the level of adherence to current evidence by emergency physicians at two academic hospitals in Kingston, Ontario. Methods: We conducted a retrospective chart review of 200 randomly selected electronic medical records. Records belonged to patients with a discharge diagnosis of cellulitis or erysipelas who were seen in the emergency departments of Kingston General Hospital or Hotel Dieu Hospital between January 1 and June 30, 2015. We manually collected data describing patient demographics, medical history, and medical management. Results: There were 707 total visits to the emergency departments in the study period for cellulitis or erysipelas. In our random sample, for those diagnosed with cellulitis, 44% received oral cephalexin alone, which was the most common form of therapy for uncomplicated infection. Of all the patients who received any antibiotics, 36% received at least one dose of parenteral antibiotics, despite only 6.7% showing systemic signs of illness. Emergency physicians chose ceftriaxone for 88% of the patients who received parenteral antibiotics. Conclusion: There was wide variation in antibiotic selection and route of administration for patients with cellulitis or erysipelas. Ceftriaxone was chosen for most patients receiving parenteral antibiotics, but it may not have been the most effective antibiotic in some cases. Overuse of antibiotics is common, and we believe medication choice should be justified based on disease severity, spectrum of activity, and regional antibiotic resistance patterns, among other factors. In conclusion, we found that emergency physicians could more closely align management plans with current guidelines to improve management of uncomplicated infection and reduce unnecessary administration of parenteral antibiotics.

Diagnostic Concordance Between Categorical and Dimensional Instruments to Assess Personality Disorder in Chronic Fatigue Syndrome

2017 ◽  
Vol 33 (3) ◽  
pp. 158-165
Author(s):  
Natalia Calvo ◽  
Naia Sáez-Francàs ◽  
Sergi Valero ◽  
Jesús Castro-Marrero ◽  
José Alegre Martín ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Chronic Fatigue Syndrome ◽  
Personality Assessment ◽  
Chronic Fatigue ◽  
Specific Pattern ◽  
Harm Avoidance ◽  
Assessment Instrument ◽  
Compulsive Disorder ◽  
Fatigue Syndrome ◽  
Self Transcendence

Abstract. The study examines the relationship between a categorical and a dimensional personality assessment instrument in patients with Chronic Fatigue Syndrome (CFS). A total of 162 CFS patients were included in the study (91.4% women; mean age 47.5 years). All subjects completed the Spanish versions of the Personality Diagnostic Questionnaire-4+ (PDQ-4+) and the Temperament and Character Inventory-Revised (TCI-R). Results: 78 (48.1%) of the patients presented a Personality Disorder (PD), the most frequent being Cluster C, specifically Obsessive-compulsive disorder, followed by Avoidant disorder. PDs showed a specific pattern of correlation with temperament scales. All PD clusters correlated positively with Harm Avoidance and Self-Transcendence, and negatively with Reward Dependence, Self-Directedness, and Cooperativeness. In a logistic regression analysis, Self-Directedness and Cooperativeness predicted PD presence. The findings are consistent with previous studies in non-CFS samples and suggest that the combination of the Temperament and Character dimensions (low Self-Directedness and Cooperativeness and high Harm Avoidance and Self-Transcendence) correlates with PD severity, and that Self-Directedness and Cooperativeness are associated with PD presence in CFS patients. The integration of these two perspectives expands the current comprehension of personality pathology in CFS patients.

Essays on Hume, Smith and the Scottish Enlightenment

2018 ◽  
Author(s):  
Christopher J. Berry
Keyword(s):  
Intellectual History ◽  
David Hume ◽  
Adam Smith ◽  
Detailed Examination ◽  
Scottish Enlightenment ◽  
Subsequent Work ◽  
Retrospective Assessment ◽  
The 1960S

A collection of essays by a leading scholar. The work selected spans several decades, which together with three new unpublished pieces, cumulatively constitute a distinct interpretation of the Scottish Enlightenment as a whole while incorporating detailed examination of the work of David Hume and Adam Smith. There is, in addition, a substantial introduction which, alongside Berry’s personal intellectual history, provides a commentary on the development of the study of the Scottish Enlightenment from the 1960s. Each of the previously published chapters includes a postscript where Berry comments on subsequent work and his own retrospective assessment. The recurrent themes are the ideas of sociability and socialisation, the Humean science of man and Smith’s analysis of the relation between commerce and morality.

Al-Rasm al-ʿUthmānī: Towards Correct Pronunciation and the Preclusion of Ambiguity

2011 ◽  
Vol 13 (2) ◽  
pp. 201-171
Author(s):  
Nāṣir Al-Dīn Abū Khaḍīr
Keyword(s):  
Specific Pattern ◽  
Writing Style ◽  
The Third ◽  
The Past ◽  
Different Ages ◽  
Correct Pronunciation ◽  
The One ◽  
The Mind

The ʿUthmānic way of writing (al-rasm al-ʿUthmānī) is a science that specialises in the writing of Qur'anic words in accordance with a specific ‘pattern’. It follows the writing style of the Companions at the time of the third caliph, ʿUthmān b. ʿAffān, and was attributed to ʿUthmān on the basis that he was the one who ordered the collection and copying of the Qur'an into the actual muṣḥaf. This article aims to expound on the two fundamental functions of al-rasm al-ʿUthmānī: that of paying regard to the ‘correct’ pronunciation of the words in the muṣḥaf, and the pursuit of the preclusion of ambiguity which may arise in the mind of the reader and his auditor. There is a further practical aim for this study: to show the connection between modern orthography and the ʿUthmānic rasm in order that we, nowadays, are thereby able to overcome the problems faced by calligraphers and writers of the past in their different ages and cultures.

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