scholarly journals Adverse events in radiation oncology: A case series from wake up safe, the pediatric anesthesia quality improvement initiative

2019 ◽  
Vol 29 (3) ◽  
pp. 265-270 ◽  
Author(s):  
Robert E. Christensen ◽  
Rebecca C. Nause-Osthoff ◽  
Jeffrey C. Waldman ◽  
Daniel E. Spratt ◽  
Jason W. D. Hearn
Keyword(s):  
Quality Improvement ◽  
Adverse Events ◽  
Radiation Oncology ◽  
Pediatric Anesthesia ◽  
Case Series ◽  
Quality Improvement Initiative

scholarly journals Complications Associated With Removal of Airway Devices Under Deep Anesthesia In Children: An Analysis of The Wake Up Safe Database

2021 ◽  
Author(s):  
Lisa Vitale ◽  
Briana Rodriguez ◽  
Anne Baetzel ◽  
Robert Christensen ◽  
Bishr Haydar
Keyword(s):  
Adverse Events ◽  
Pediatric Anesthesia ◽  
National Database ◽  
Quality Improvement Initiative ◽  
Serious Adverse Events ◽  
Screening Criteria ◽  
Prolonged Intubation ◽  
Respiratory Events ◽  
In Series ◽  
Airway Devices

Abstract Background: Previous studies examining removal of endotracheal tubes and supraglottic devices under deep anesthesia were underpowered to identify rare complications. This study sought to report all adverse events associated with this practice found in a large national database of pediatric anesthesia adverse events.Methods: An extract of an adverse events database created by the Wake Up Safe database, a multi-institutional pediatric anesthesia quality improvement initiative, was performed for this study. It was screened to identify anesthetics with variables indicating removal of airway devices under deep anesthesia. Three anesthesiologists screened the data to identify events where this practice possibly contributed to the event. Event data was extracted and collated. Results: 102 events met screening criteria and 66 met inclusion criteria. Two cardiac etiology events were identified, one of which resulted in the patient’s demise. The remaining 97% of events were respiratory in nature (64 events), including airway obstruction, laryngospasm, bronchospasm and aspiration. Some respiratory events consisted of multiple distinct events in series. Nineteen respiratory events resulted in cardiac arrest (29.7%) of which 15 (78.9%) were deemed preventable by local anesthesiologists performing independent review. Respiratory events resulted in intensive care unit admission (37.5%), prolonged intubation and temporary neurologic injury but no permanent harm. Provider and patient factors were root causes in most events. Upon investigation, areas for improvement identified included improving patient selection, ensuring monitoring, availability of intravenous access, and access to emergency drugs and equipment until emergence.Conclusions: Serious adverse events have been associated with this practice, but no respiratory events were associated with long-term harm.

Peer review in radiotherapy (RT): A national quality improvement initiative.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 221-221 ◽  
Author(s):  
Michael Donald Brundage ◽  
Brenda H Bass ◽  
Sophie Foxcroft ◽  
Ross Halperin ◽  
Thomas McGowan ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Peer Review ◽  
Quality Indicators ◽  
Radiation Oncology ◽  
Preliminary Evidence ◽  
Steering Committee ◽  
Perceived Barriers ◽  
Quality Improvement Initiative ◽  
Implementation Framework ◽  
National Quality

221 Background: Peer review (PR) in Radiation Oncology has been shown to be effective in improving quality of treatment by detecting and correcting deficiencies in proposed treatment plans prior to treatment. PR is also effective in: guiding departmental treatment planning policies and processes; reducing variation in practice; providing a venue for multi-disciplinary communication, and increasing staff and trainee awareness of evolving treatment processes. The importance of PR is reflected in the inclusion of 3 PR-specific quality indicators in the Canadian Partnership for Quality Radiotherapy QA Guidelines for Radiation Oncology programs. Given this endorsement, we aim to enhance PR implementation across all Canadian cancer centres using a knowledge-translation and implementation framework. Methods: This project will facilitate increased uptake of PR in Canadian RT programs by implementing the top-down model used with success in Ontario. This model has several key components, including: a) engaging the leadership of provincial cancer agencies to promote PR at every Provincial cancer centre; b) providing modest financial support for the acquisition of the required hardware and/or staff time for coordinating PR activities; c) systematic collection of each centre’s baseline PR activities, perceived barriers and potential facilitators of PR at each centre; d) creation of a continuous quality improvement cycle by monitoring PR quality indicators over time; e) systematic knowledge and information sharing regarding effective PR processes. Results: Funding for this initiative was obtained from the Canadian Partnership against Cancer (CPAC) in April 2014. A steering committee consisting of stakeholders from across Canada has been struck and provincial launches, based on the tenets used in Ontario, have commenced in 7 of 13 provinces with others expressing interest. A national survey to obtain baseline data relating to PR activities, perceived barriers, and facilitators is underway and will be reported. Conclusions: Preliminary evidence suggests a “snowball effect” of increasing PR uptake across Canada. The implementation model could be applied in other jurisdictions interested in increasing PR in radiation oncology.

scholarly journals Remote Contouring and Virtual Review during the COVID-19 Pandemic (RECOVR-COVID19): Results of a Quality Improvement Initiative for Virtual Resident Training in Radiation Oncology

2021 ◽  
Vol 28 (4) ◽  
pp. 2961-2968
Author(s):  
Andrew J. Arifin ◽  
Rohann J. M. Correa ◽  
Christopher D. Goodman ◽  
Joanna Laba ◽  
Robert E. Dinniwell ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Radiation Oncology ◽  
Learning Opportunities ◽  
Resident Training ◽  
Quality Improvement Initiative ◽  
Immediate Feedback ◽  
Educational Value ◽  
Competency Based Medical Education ◽  
Competency Based ◽  
Post Hoc

The need to minimize in-person interactions during the COVID-19 pandemic has led to fewer clinical learning opportunities for trainees. With ongoing utilization of virtual platforms for resident education, efforts to maximize their value are essential. Herein we describe a resident-led quality improvement initiative to optimize remote contouring and virtual contour review. From April to June 2020, radiation oncology (RO) residents at our institution were assigned modified duties. We implemented a program to source and assign cases to residents for remote contouring and to promote and optimize virtual contour review. Resident-perceived educational value was prospectively collected and analyzed. All nine RO residents at our institution (PGY1–5) participated, and 97 cases were contoured during the evaluation period. Introduction of the Remote Contouring and Virtual Review (RECOVR) program coincided with a significant increase in mean cases contoured per week, from 5.5 to 17.3 (p = 0.015), and an increased proportion of cases receiving virtual review, from 14.8% to 58.6% (p < 0.001). Residents reported that the value of immediate feedback during virtual review was similar to that of in-person review (4.6 ± 0.1 vs. 4.5 ± 0.2, p = 0.803) and significantly higher than feedback received post hoc (e.g., email; 3.6 ± 0.2, p < 0.001). The implementation of a remote process for contour review led to significant increases in contouring, and virtual contour review was rated as highly as in-person interactions. Our findings provide a data-driven rationale and framework for integrating remote contouring and virtual review into competency-based medical education.

Adverse Events Associated with Bone Marrow Biopsy In A Resident Training Program; First Do No Harm

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4775-4775
Author(s):  
James T. Paul ◽  
Emily K. Rimmer ◽  
Carmen Morales ◽  
Graham Bay ◽  
Kiraninder Lamba ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Bone Marrow ◽  
Patient Safety ◽  
Quality Improvement ◽  
Adverse Events ◽  
Case Series ◽  
Resident Training ◽  
Health Science ◽  
Sample Quality ◽  
Ensure Patient Safety

Abstract Abstract 4775 BACKGROUND: Bone marrow aspirates and biopsies are commonly performed to evaluate a variety of hematological abnormalities. Generally, it is regarded as a safe procedure; however, the complication rate is uncertain. Much of the data surrounding bone marrow complications derives from retrospective, voluntary reported data from the UK and is estimated to occur in 0.08 – 0.12% of procedures. Data also suggests that the quality of bone marrow specimens may vary with operator expertise. OBJECTIVES: In this report we present a case series of adverse events following bone marrow examinations performed by internal medical residents. In response to these procedural outcomes, we will outline a comprehensive quality improvement and quality assurance initiative designed to improve resident training, ensure patient safety, and enhance sample quality. CASE SERIES: Four cases of attempted bone marrow aspirate and biopsy on the Clinical Teaching Units (CTU) at the Health Science Centre from June 2010 to April 2011 were identified. All four procedures were performed by internal medicine residents at varying levels of training and were unsuccessful despite multiple attempts. In two of the cases the GIM attending was also unsuccessful in obtaining sample. Two cases of major bleeding occurred necessitating multiple units of red blood cells to be transfused and one patient required admission to the intensive care unit. In another case the patient was unable to ambulate for 3 days due to severe leg pain at the site of attempted biopsy. Improper landmarking for the procedure was common in all cases and confirmed with 3D computed axial tomographic rendering in 2 patients. INTERVENTION: In response to these patient adverse patient outcomes and with patient safety in mind, we decided that, until a more detailed plan could be developed, all bone marrow biopsies performed on the CTU will be supervised by an attending hematologist. With involvement from stakeholders in internal medicine, hematology and hematopathology, we developed a multifaceted quality improvement and assurance initiative. We designed an educational curriculum starting with an academic half day that would consist of an instructional video followed by a practical session in the Clinical Learning and Simulation Facility. This will allow residents to strengthen communication skills by obtaining informed consent and build important procedural skills through the use of simulators. Learning will be reinforced through resident rotations on the Hematology service that will include participation in a weekly bone marrow clinic. This clinic would allow residents an opportunity to perform a number of successive bone marrows in a controlled environment under the supervision of an attending hematologist. To evaluate resident performance and adverse events, a data collection instrument will be developed to monitor the success of these interventions for bone marrows completed on the CTUs. A credentialing process to ensure competency of resident training is being considered. ANCTICIPATED RESULTS: With the implementation of a multifaceted and comprehensive strategy we expect to improve resident training, ensure patient safety, and enhance sample quality resulting in less need for repeat procedures. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Smoking Cessation at a Safety-Net Hospital: A Radiation Oncology Resident-Led Quality Improvement Initiative

2020 ◽  
Vol 5 (5) ◽  
pp. 1061-1065
Author(s):  
Stephen J. Ramey ◽  
Benjamin Silver ◽  
Dayssy A. Diaz ◽  
Akul Munjal ◽  
Shahil Mehta ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Quality Improvement ◽  
Radiation Oncology ◽  
Safety Net ◽  
Quality Improvement Initiative ◽  
Safety Net Hospital

Outcomes from wake up safe, the pediatric anesthesia quality improvement initiative

2020 ◽  
Vol 30 (12) ◽  
pp. 1348-1354
Author(s):  
Manon Haché ◽  
Lena S. Sun ◽  
Ghadah Gadi ◽  
Jennifer Busse ◽  
Angela C. Lee ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pediatric Anesthesia ◽  
Quality Improvement Initiative

scholarly journals Remote Contouring and Virtual Review During the COVID-19 Pandemic (RECOVR-COVID19): Results of a Quality Improvement Initiative for Virtual Resident Training in Radiation Oncology

2021 ◽  
Vol 111 (1) ◽  
pp. e6
Author(s):  
Andrew J. Arifin ◽  
Rohann J.M. Correa ◽  
Christopher D. Goodman ◽  
Joanna Laba ◽  
Robert E. Dinniwell ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Radiation Oncology ◽  
Resident Training ◽  
Quality Improvement Initiative

scholarly journals Canadian paramedic experience with intramuscular ketamine for extreme agitation: A quality improvement initiative

2020 ◽  
Vol 17 ◽  
Author(s):  
Jennie Helmer ◽  
Joe Acker ◽  
Jon Deakin ◽  
Tania Johnston
Keyword(s):  
Quality Improvement ◽  
Adverse Effects ◽  
Adverse Events ◽  
Airway Management ◽  
Effective Control ◽  
Quality Improvement Initiative ◽  
Patient Response ◽  
Excited Delirium ◽  
Management Interventions ◽  
Combining Data

BackgroundThere are no published reports in Canada examining paramedic use of ketamine for highly agitated patients or excited delirium syndrome. We employed a Plan, Do, Study, Act (PDSA) quality improvement approach to evaluate the safety and effectiveness of advanced care paramedic administered intramuscular (IM) ketamine for patients with extreme agitation in the out-of-hospital setting.MethodsData were prospectively collected from July 2018 to January 2019 when advanced care paramedics with specific training administered IM ketamine as an alternative to midazolam. Paramedics used a clinical audit form to document the ketamine dose, patient response on the Richmond Agitation Sedation Scale (RASS) at time intervals, adverse effects, and any airway management interventions they performed. ResultsThirty-three patients received either 4 mg/kg or 5 mg/kg of ketamine. Combining data for both doses, the median change in RASS score at 5 minutes post-ketamine was 3 (range 0 to 8) and statistically significant for each dose. There were seven cases (21%) with reported adverse effects including SpO2 <90% (3/7), hypersalivation (3/7), trismus or teeth grinding (2/7), muscular rigidity (1/7) and laryngospasm (1/7). Statistical analysis confirmed that the incidence of adverse events was not dose dependent. Basic airway management was performed in one-third of all cases.ConclusionWe piloted the implementation of ketamine for sedation in our paramedic system by employing a PDSA cycle. Ketamine 5 mg/kg IM provided effective control of acutely agitated patients with adequate sedation at 5 minutes post-delivery. Any adverse events that occurred as a result of IM ketamine were readily managed with basic airway management interventions.

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