Remote ultrasound diagnostics disrupting traditional military frontline healthcare delivery

2021 ◽  
pp. bmjmilitary-2021-001821
Author(s):  
Georgina Blenkinsop ◽  
R A Heller ◽  
N J Carter ◽  
A Burkett ◽  
M Ballard ◽  
...  
Keyword(s):  
Patient Care ◽  
Healthcare Delivery ◽  
Improve Patient Care ◽  
Guidance System ◽  
Diagnostic Quality ◽  
Aeromedical Evacuation ◽  
Care Experience ◽  
Ultrasound Diagnostics ◽  
Diagnostic Capability ◽  
Improve Patient

Accurate and reliable diagnostic capability is essential in deployed healthcare to aid decision-making and mitigate risk. This is important for both the patient and the deployed healthcare system, especially when considering the prioritisation of scarce aeromedical evacuation assets and frontline resources. Novel ultrasound tele-guidance technology presents a valuable diagnostic solution for remotely deployed military clinicians. This report discusses the first use of a consultant radiologist guiding a clinician, untrained in ultrasound, to perform an ultrasound scan via a live tele-guidance feed in the deployed environment using the Butterfly iQ+ tele-guidance system. Distance scanning provided a diagnostic quality report when compared with locally performed imaging to improve patient care and maintain operational output. This example demonstrates feasibility of remote point-of-care imaging systems in provision of location-agnostic high-quality diagnostic capability. Future opportunities to develop care pathways using bedside tele-diagnostics will democratise access, drive efficiency and improve patient care experience and outcomes.

scholarly journals How do emergency departments and emergency leaders catalyze positive change through quality improvement collaborations?

CJEM ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 542-549 ◽  
Author(s):  
Lucas B. Chartier ◽  
Shawn E. Mondoux ◽  
Antonia S. Stang ◽  
Adam M. Dukelow ◽  
Shawn K. Dowling ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Care ◽  
Expert Panel ◽  
Healthcare Delivery ◽  
Improve Patient Care ◽  
Local Data ◽  
Team Members ◽  
Incentive Structures ◽  
Improve Patient ◽  
Canadian Healthcare

ABSTRACTObjectivesQuality Improvement and Patient Safety (QIPS) plays an important role in addressing shortcomings in optimal healthcare delivery. However, there is little published guidance available for emergency department (ED) teams with respect to developing their own QIPS programs. We sought to create recommendations for established and aspiring ED leaders to use as a pathway to better patient care through programmatic QIPS activities, starting internally and working towards interdepartmental collaboration.MethodsAn expert panel comprised of ten ED clinicians with QIPS and leadership expertise was established. A scoping review was conducted to identify published literature on establishing QIPS programs and frameworks in healthcare. Stakeholder consultations were conducted among Canadian healthcare leaders, and recommendations were drafted by the expert panel based on all the accumulated information. These were reviewed and refined at the 2018 CAEP Academic Symposium in Calgary using in-person and technologically-supported feedback.ResultsRecommendations include: creating a sense of urgency for improvement; engaging relevant stakeholders and leaders; creating a formal local QIPS Committee; securing funding and resources; obtaining local data to guide the work; supporting QIPS training for team members; encouraging interprofessional, cross-departmental, and patient collaborations; using an established QIPS framework to guide the work; developing reward mechanisms and incentive structures; and considering to start small by focusing on a project rather than a program.ConclusionA list of 10 recommendations is presented as guiding principles for the establishment and sustainable deployment of QIPS activities in EDs throughout Canada and abroad. ED leaders are encouraged to implement our recommendations in an effort to improve patient care.

Abstract 11119: Real-Time Nanopore Sequencing for Bacterial Pneumonia After Out-of-Hospital Cardiac Arrest, a Pilot Proof-of-Concept Study

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Alexandra Weissman ◽  
Mariam Bramah Lawani ◽  
Thomas Rohan ◽  
Clifton W CALLAWAY
Keyword(s):  
Patient Care ◽  
Pathogen Detection ◽  
Bacterial Pathogen ◽  
Improve Patient Care ◽  
Antibiotic Administration ◽  
Nanopore Sequencing ◽  
Proof Of Concept ◽  
Chi Square ◽  
Significant Difference ◽  
Improve Patient

Introduction: Pneumonia is common after OHCA but is difficult to diagnose in the first 72 hours following ROSC, this results in early untargeted antibiotic administration based on non-specific imaging and laboratory findings. Antibiotic resistance is rising, is influenced by untargeted antibiotic administration, and can increase patient morbidity and mortality as well as healthcare costs. Precision methods of bacterial pathogen detection in OHCA patients are needed to improve patient care. This proof-of-concept pilot study aimed to assess feasibility of bacterial pathogen sequencing and comparability of sequencing results to clinical culture after OHCA. Methods: Blood and bronchoalveolar lavage (BAL) were obtained from residual clinical specimens collected within 12 hours of ROSC. Bacterial DNA was extracted using the Qiagen PowerLyzer PowerSoil DNA kit, sequenced using the MinION nanopore sequencer, and analyzed with Oxford Nanopore Technologies’ EPI2ME bioinformatics software. Sequencing results were compared to culture results using McNemar’s chi-square statistic. Study-defined pneumonia was based on presence of at least two characteristics within 72 hours of ROSC: fever (temperature ≥38°C); persistent leukocytosis >15,000 or leukopenia <3,500 for 48 hours; persistent chest radiography infiltrates for 48 hours per clinical radiology read; bacterial pathogen cultured. Results: We enrolled 38 consecutive OHCA subjects: mean age 61.8 years (18.0); 16 (42%) female; 25 (66%) White, 7 (18%) Black, 6 (16%) “Other” race; 7 subjects (18%) survived and 31 (82%) died; 16 (42%) subjects had pneumonia. Sequencing results were available in 12 hours while culture results were available in 48-72 hours after collection. There was a non-significant difference in the proportion of the same pathogens identified for each method per McNemar’s chi-square: p = 0.38, difference of 0.095 (-0.095, 0.286). Conclusions: Nanopore sequencing detects pathogenic bacteria comparable to clinical microbiologic culture and in less time. This technology can produce a paradigm shift in early bacterial pathogen detection in OHCA survivors, which can improve patient care. The technology is applicable to other patient populations and for viral and fungal pathogens.

Fetal Occipital Encephalocele: A Case Report

2021 ◽  
pp. 875647932110668
Author(s):  
Amanda Hogan ◽  
Natalie Ullmer
Keyword(s):  
Case Report ◽  
Patient Care ◽  
Treatment Planning ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Three Dimensional ◽  
Improve Patient Care ◽  
Two Dimensional ◽  
Occipital Encephalocele ◽  
Improve Patient

Encephaloceles are considered neural tube defects, but their exact cause is unknown. The outcome is dismal, and essential management and counseling are needed for patients. Two-dimensional and three-dimensional sonography can be used to detect encephaloceles as early as 11 weeks, assist in treatment planning, and improve patient care. This case report presents an occipital encephalocele diagnosed by sonography and followed until delivery.

scholarly journals Using patient-reported outcome measurement to improve patient care

2017 ◽  
Vol 29 (6) ◽  
pp. 874-879 ◽  
Author(s):  
John Øvretveit ◽  
Lisa Zubkoff ◽  
Eugene C Nelson ◽  
Susan Frampton ◽  
Janne Lehmann Knudsen ◽  
...  
Keyword(s):  
Patient Care ◽  
Outcome Measurement ◽  
Improve Patient Care ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Improve Patient
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