scholarly journals Inadequate pelvic radiographs: implications of not getting it right the first time

2017 ◽  
Vol 99 (7) ◽  
pp. 534-539 ◽  
Author(s):  
S Parker ◽  
NS Nagra ◽  
K Kulkarni ◽  
J Pegrum ◽  
S Barry ◽  
...  
Keyword(s):  
Patient Safety ◽  
Working Hours ◽  
Economic Implications ◽  
Out Of Hours ◽  
European Guidelines ◽  
Pelvic Radiographs ◽  
Pelvic Radiograph ◽  
Significant Difference ◽  
Picture Archiving And Communication ◽  
Repeat Imaging

Introduction Pelvic radiography is a frequent investigation. European guidelines aim to ensure appropriate use and adequate quality. When initial images are inadequate, repeat radiographs are often required, which may have significant patient safety and economic implications. Objectives The study aimed to assess the adequacy of pelvic imaging across three orthopaedic centres, to identify causes for inadequate imaging and to establish the cost of inadequate imaging from financial and patient safety perspectives. Methods Pelvic radiographs were identified on Picture Archiving and Communication System software at three UK hospitals. Radiographs were assessed against European guidelines and indications for repeat imaging were analysed. Results A total of 1,531 sequential pelvic radiographs were reviewed. The mean age of patients was 60 years (range 5 months to 101 years). Of this total, 51.9% of images were suboptimal, with no significant difference across the three hospitals (P > 0.05). Hospital 3 repeated radiographs in 6.3% of cases, compare with 18.1% and 19.7% at hospitals 1 and 2, respectively (P > 0.05). Hospital 3 identified pathology missed on the initial radiograph in 1% of cases, compared with 5.4% and 5.5% at hospitals 1 and 2, respectively (P > 0.05). Out-of-hours imaging is associated with a higher rate of suboptimal quality (69.1%) compared with normal working hours (51.3%; P = 0.006). Adequacy rates vary with age (χ 2 = 43.62, P < 0.001). Risk of having a suboptimal radiograph increases above the age of 60-years (χ 2 = 4.45, P < 0.05). The annual cost of repeat radiographs was £56,200 per hospital. Discussion and conclusion High rates of pelvic radiograph inadequacy can lead to missed pathology and the requirement for repeat imaging, which has significant patient safety and financial implications. Risk factors for inadequate radiographs include older patients and those having out-of-hours imaging.

scholarly journals Evaluation of surgical nurses’ attitudes concerning patient safety

2015 ◽  
Vol 12 (1) ◽  
pp. 1537 ◽  
Author(s):  
Ali Sahin ◽  
Fatma Ayhan ◽  
Serife Kursun
Keyword(s):  
Patient Safety ◽  
Operating Room ◽  
Health Workers ◽  
Working Hours ◽  
Operating Rooms ◽  
Worker Safety ◽  
Safety Attitudes ◽  
Surgical Nurses ◽  
Significant Difference ◽  
The Mean

<p>The present study was designed as a descriptive study to evaluate the attitudes of surgical nurses concerning patient safety. The study included 123 nurses, who have been working in the operating rooms of<strong> </strong>the hospitals in Karaman, Konya for at least one year and were voluntary to participate in the study<strong>.</strong> Data collection tools included a questionnaire to inquire demographic characteristics of surgical nurses, and “Safety Attitudes Questionnaire (SAQ) -Operating Room Version” to evaluate their attitudes concerning patient safety. The mean scores obtained from<strong> </strong>SAQ sub-dimensions were between 42.12<strong> </strong>±16.82 and 69.07±24.44, whereas the mean score of SAQ total was 59.11 ±13.29. Statistically significant difference was determined between the mean SAQ total score and age, weekly working hours, duration of working in the operating room, resting status, receiving in service training, and training about patient safety. The present study will enhance patient safety in operating rooms by providing an improvement in communication among health workers and in team collaboration, regulating working hours, and scheduling training programs to establish an opinion about worker safety and patient safety.</p>

scholarly journals Medical Students’ Insights Towards Patient Safety

2021 ◽  
Vol 21 (2) ◽  
pp. e253-259
Author(s):  
Saeed Alshahrani ◽  
Ahmad Alswaidan ◽  
Ala Alkharaan ◽  
Abdulrahman Alfawzan ◽  
Aysha Alshahrani ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Patient Safety ◽  
Medical Students ◽  
Age Groups ◽  
Working Hours ◽  
Undergraduate Medical Students ◽  
Cross Sectional ◽  
Significant Difference ◽  
Students Attitudes ◽  
Team Functioning

Objectives: This study aimed to explore Saudi Arabian medical students’ perceptions of patient safety. Methods: A cross-sectional descriptive study was conducted in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, in September 2019. The Attitudes to Patient Safety Questionnaire (APSQ III) was used to explore undergraduate medical students’ attitudes towards and knowledge of PS. The main outcomes measured were the APSQ III’s nine domains. Data were analysed using Statistical Package for the Social Sciences and students’ attitudes were communicated as mean scores ± standard deviations. Results: A total of 301 participants were included in this study (response rate: 85.75%). Six domains reflected a positive attitude while three domains showed a neutral attitude. The domain of ‘team functioning’ had the highest mean score (5.8) followed by ‘working hours as a cause of error’ (5.6) and ‘error inevitability’ (5.4). There was a significant difference between gender in the domain ‘patient involvement in reducing error’ (P = 0.012) and ‘importance of patient safety (PS) in the curriculum’ (P = 0.001). In addition, the ‘importance of PS in the curriculum’ domain was significantly different across different age groups (P = 0.039). Conclusion: Medical students were highly interested in PS and recommended implementing a comprehensive undergraduate PS programme to fulfil their educational needs. Keywords: Undergraduate Medical Education; Patient Safety; Medical Errors; Attitude; Medical Students; Medical Ethics; Patient Care; Saudi Arabia.

scholarly journals 481 Improving the Quality of Pelvic Radiographs - Making A Difference One Picture at A Time

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Saleem ◽  
S Parikh ◽  
T Parratt
Keyword(s):  
Patient Safety ◽  
Retrospective Analysis ◽  
General Hospital ◽  
Clinical Outcomes ◽  
International Guidelines ◽  
Pelvic Radiographs ◽  
Making A Difference ◽  
Compromise Patient Safety ◽  
Repeat Imaging

Abstract Inadequate pelvic radiographs can lead to missed pathology, necessitate repeat imaging, and subsequently compromise patient safety. The audit conducted aimed to assess and improve the quality of pelvic radiographs at our Trust against local and international guidelines. Retrospective analysis of pelvic radiographs over a one-month period using PACS at Colchester General Hospital was conducted. All pelvic radiographs were assessed according to International Guidelines (EUR 16250EN). Postoperative radiographs were measured against local guidelines. The results were then presented in the departmental meeting and a re-audit was performed in June 2020. A total of 190 pelvic radiographs were collected in September 2019. From the 23 postoperative radiographs, 9 did not include distal end of prosthesis. During the re-audit in June 2020 the same number of pelvic images were collected. Data showed that only 2 out of 29 postoperative images did not include the distal end of the prosthesis. The audit demonstrated need for improvement at our Trust. This was carried out through a presentation in the departmental meeting, highlighting areas that needed improvement. The re-audited results from June 2020 have shown an improvement in the quality of pelvic radiographs and have had direct implications in clinical outcomes.

The effectiveness of scenario-based learning to develop patient safety behavior in first year nursing students

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Derya Uzelli Yilmaz ◽  
Esra Akin Palandoken ◽  
Burcu Ceylan ◽  
Ayşe Akbiyik
Keyword(s):  
Patient Safety ◽  
Nursing Students ◽  
Intramuscular Injection ◽  
Skills Training ◽  
First Year ◽  
Safety Skills ◽  
Safety Behavior ◽  
Significant Difference ◽  
Academic Year ◽  
Nursing Course

AbstractThe aim of this study was to examine the effect of scenario-based learning (SBL) compared to traditional demonstration method on the development of patient safety behavior in first year nursing students. During the 2016–2017 academic year, the Fundamentals of Nursing course curriculum contained the teaching of demonstration method (n=168). In the academic year 2017–2018 was performed with SBL method in the same context (n=183). Objective Structured Clinical Examination (OSCE) that assesses the same three skills was implemented in both academic terms to provide standardization so that students could evaluated in terms of patient safety competency. It was found that students’ performance of some of the steps assessed were not consistently between the demonstration and SBL methods across the three skills. There was a statistically significant difference between demonstration method and SBL method for students’ performing the skill steps related to patient safety in intramuscular injection (p<0.05) Our results suggest that the integration of SBL into the nursing skills training may be used as a method of teaching in order to the development of patient safety skills.

EXPRESS: Off-hour effect on time metrics and clinical outcomes in endovascular treatment for large vessel occlusion, a systematic review and meta-analysis

2021 ◽  
pp. 174749302110125
Author(s):  
Mingming Zha ◽  
Qingwen Yang ◽  
Shuo Liu ◽  
Min Wu ◽  
Kangmo Huang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Working Hours ◽  
Good Prognosis ◽  
Large Vessel ◽  
Cochrane Library ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Significant Difference

Background There is an ongoing debate on the off-hour effect on endovascular treatment (EVT) for acute large vessel occlusion (LVO). Aims This meta-analysis aimed to compare time metrics and clinical outcomes of acute LVO patients who presented/were treated during off-hour with those during working hours. Summary of review Structured searches on the PubMed, Embase, Web of Science, and Cochrane Library databases were conducted through February 23rd, 2021. The primary outcomes were onset to door, door to imaging, door to puncture, puncture to recanalization, procedural time, successful recanalization, symptomatic intracerebral hemorrhage (SICH), mortality in hospital, good prognosis (90-day modified Rankin Scale [mRS] score 0-2), and 90-day mortality. The secondary outcomes were imaging to puncture, onset to puncture, onset to recanalization, door to recanalization time, mRS 0-2 at discharge, and consecutive 90-day mRS score. The odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) of the outcomes were calculated using random-effect models. Heterogenicity and publication bias were analyzed. Subgroup and sensitivity analyses were conducted as appropriate. Nineteen studies published between 2014 and 2021 with a total of 14185 patients were eligible for quantitative synthesis. Patients in the off-hour group were significantly younger than those in the on-hour group and with comparable stroke severity and intravenous thrombolysis rate. The off-hour group had longer onset to door (WMD [95%CI], 12.83 [1.84-23.82] min), door to puncture (WMD [95%CI], 11.45 [5.93-16.97] min), imaging to puncture (WMD [95%CI], 10.39 [4.61-16.17] min), onset to puncture (WMD [95%CI], 25.30 [13.11-37.50] min), onset to recanalization (WMD [95%CI], 25.16 [10.28-40.04] min), and door to recanalization (WMD [95%CI], 18.02 [10.01-26.03] min) time. Significantly lower successful recanalization rate (OR [95%CI], 0.85 [0.76-0.95]; P=0.004; I2=0%) was detected in the off-hour group. No significant difference was noted regarding SICH and prognosis. But a trend towards lower OR of good prognosis was witnessed in the off-hour group (OR [95%CI], 0.92 [0.84-1.01]; P=0.084; I2=0%). Conclusions Patients who presented/were treated during off-hour were associated with excessive delays before the initiation of EVT, lower successful reperfusion rate, and a trend towards worse prognosis when compared with working hours. Optimizing the workflows of EVT during off-hour is needed.

scholarly journals Early pyrexia after endovascular aneurysm repair: are cultures needed?

2011 ◽  
Vol 93 (2) ◽  
pp. 111-113 ◽  
Author(s):  
L Corfield ◽  
J Chan ◽  
T Chance ◽  
N Wilson
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Blood Cultures ◽  
Stent Insertion ◽  
Out Of Hours ◽  
Microbiological Investigation ◽  
Significant Difference ◽  
Aneurysm Repair ◽  
Infective Complications ◽  
Post Implantation

INTRODUCTION The post-implantation syndrome after endovascular aneurysm repair (EVAR) is increasingly recognised. However, when non-vascular trainees are responsible for the care of these patients out of hours, many are investigated if pyrexial. This study assesses the role of microbiological investigations in pyrexia after endovascular aneurysm repair. PATIENTS AND METHODS The notes of 75 EVAR patients were reviewed retrospectively. The incidence of postoperative pyrexia and infective complications were calculated and the result of any cultures obtained. RESULTS Overall, 58 (77.3%) patients were pyrexial with 48 h of stent insertion. Twenty-four had blood cultures and 12 had urine cultures taken within 48 h of surgery. All of these cultures were negative. However, of those with a pyrexia after 48 h, one of nine blood cultures and two of 11 urine cultures grew organisms. Five pyrexial patients and one apyrexial patient developed a wound infection (a non-significant difference, P = 1.00). CONCLUSIONS Pyrexia within 48 h of EVAR is common. Microbiological investigation in the first 48 h in these patients is unrewarding. After 48 h, cultures are more likely to show growth. Although each patient must be assessed clinically for signs of sepsis, blood and urine cultures within 48 h of EVAR are generally unnecessary.

scholarly journals Usefulness of Pelvic Radiographs in the Initial Trauma Evaluation with Concurrent CT: Is Additional Radiation Exposure Necessary?

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Anne K. Misiura ◽  
Autumn D. Nanassy ◽  
Jacqueline Urbine
Keyword(s):  
Trauma Center ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Additional Information ◽  
Pelvic Radiographs ◽  
Pelvic Radiograph ◽  
Digital Radiograph ◽  
Urban Level ◽  
Level I ◽  
Pediatric Trauma Center

Trauma patients in a Level I Pediatric Trauma Center may undergo CT of the abdomen and pelvis with concurrent radiograph during initial evaluation in an attempt to diagnose injury. To determine if plain digital radiograph of the pelvis adds additional information in the initial trauma evaluation when CT of the abdomen and pelvis is also performed, trauma patients who presented to an urban Level I Pediatric Trauma Center between 1 January 2010 and 7 February 2017 in whom pelvic radiograph and CT of the abdomen and pelvis were performed within 24 hours of each other were analyzed. A total of 172 trauma patients had pelvic radiograph and CT exams performed within 24 hours of each other. There were 12 cases in which the radiograph missed pelvic fractures seen on CT and 2 cases in which the radiograph suspected a fracture that was not present on subsequent CT. Furthermore, fractures in the pelvis were missed on pelvic radiographs in 12 of 35 cases identified on CT. Sensitivity of pelvic radiograph in detecting fractures seen on CT was 65.7% with a 95% confidence interval of 47.79-80.87%. Results suggest that there is no added diagnostic information gained from a pelvic radiograph when concurrent CT is also obtained, a practice which exposes the pediatric trauma patient to unnecessary radiation.

Attendance rates during working-hours versus out-of-hours otolaryngology clinics

2008 ◽  
Vol 90 (9) ◽  
pp. 316-319 ◽  
Author(s):  
AJ Donne ◽  
D Siau ◽  
R Swindell ◽  
JJ Homer
Keyword(s):  
General Public ◽  
Working Hours ◽  
Social Attitudes ◽  
Attendance Rates ◽  
Out Of Hours

In the foreword to Choice matters: Increasing choice improves patients' experiences, the minister of state for delivery and quality states that patients want and expect convenient services tailored to accommodate their increasingly busy lives. The British Social Attitudes Survey 22nd Report indicated that patients with semi-routine and routine occupations were more interested in choice compared to patients with managerial and professional occupations. However, almost 60% of the latter group were still interested. Clearly a major proportion of the general public are keen to be empowered with greater choice.

scholarly journals Usefulness of Grayscale Values of Hypoechoic Lesions Matched with Target Lesions Observed on Magnetic Resonance Imaging for the Prediction of Clinically Significant Prostate Cancer

2021 ◽  
Author(s):  
Dong Gyun Kim ◽  
Jeong Woo Yoo ◽  
Kyo Chul Koo ◽  
Byung Ha Chung ◽  
Kwang Suk Lee
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Area Under The Curve ◽  
Imaging Data ◽  
Resonance Imaging ◽  
Scoring Method ◽  
Significant Difference ◽  
Picture Archiving And Communication ◽  
Clinically Significant

Abstract INTRODUCTION: To analyze grayscale values for hypoechoic lesions matched with target lesions evaluated using prebiopsy magnetic resonance imaging (MRI). METHODS We collected data on 420 target lesions in patients who underwent MRI/transrectal ultrasound fusion biopsies. Images of hypoechoic lesions that matched the target lesions on MRI were stored in a picture archiving and communication system, and their grayscale values were estimated using the red/green/blue scoring method through an embedded function. We analyzed imaging data using grayscale values. RESULTS Of the 420 lesions, 261 (62.1%) were prostate cancer lesions. Grayscale ranges (42.6–91.8) were significant predictors of clinically significant prostate cancer (csPC) in multivariable logistic regression analyses. Area under the curve for detecting csPC using grayscale values along with conventional variables was 0.839, which was significantly higher than that for detecting csPC using only conventional variables (0.828; p = 0.036). Subgroup analysis revealed a significant difference for PI-RADS 3 lesions between grayscale values for benign and cancerous lesions (p = 0.008). Grayscale values were the only significant predictive factor (p = 0.005) for csPC. CONCLUSIONS Distribution of grayscale values according to PI-RAD 3 scores was useful, and the grayscale range (42.6–91.8) was an important factor for csPC diagnosis.

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