Retrospective Analysis of Intra-Departmental Requests for Consultation To Hematology Department

2021 ◽  
Vol 15 (11) ◽  
pp. 3141-3142
Author(s):  
Irfan Khan ◽  
Muhammad Muneeb ◽  
Shahzeb Ahmed ◽  
Muhammad Haseeb ◽  
Muhammad Bin Usman ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Retrospective Study ◽  
Retrospective Analysis ◽  
Bone Marrow Biopsy ◽  
Initial Assessment ◽  
Referral Letter ◽  
Referral Process ◽  
Medicine Department ◽  
Referral Letters

Aim: To investigate how much information a specialist hematologist receives at the time of initial assessment of referred patients through a referral letter. Study design: Retrospective study Place and duration of study: Haematology department BVH, October 2020 to February 2021 (5 months) Methods & Results: Among the 96 referral letters received, Majority 45 (47%) was referred from medicine department. Most common reason for referring the patient was evaluation of Pancytopenia n=19 (19.8%), Request for bone marrow biopsy n=14 (14.6%), being the second most common. The reason for referral was not properly stated in n=9 (9.4%) of patients in our study. Majority of referred patients were above 46 years of age n=22 (22.9%). CBC was mentioned only in n=35 (36.5%). Conclusion: Our study concludes that quality of referral letter was well below the acceptable standards. A well-documented protocol for referral letter is the need of hour to improve the quality of a referral process. Keywords: referral letter, pancytopenia, bone marrow, hematology clinics

A New Rotary Powered Device for Bone Marrow Aspiration and Biopsy Yields Superior Specimens with Less Pain: Results of a Randomized Clinical Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1529-1529 ◽  
Author(s):  
Ronan Swords ◽  
Javier Anguita ◽  
Russell A. Higgins ◽  
Andrea Yunes ◽  
Michael Naski ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Research Funding ◽  
Bone Marrow Aspiration ◽  
Morbidity And Mortality ◽  
Procedure Time ◽  
Medullary Bone ◽  
Biopsy Device ◽  
The Mean

Abstract Abstract 1529 Introduction: The importance of bone marrow aspiration and biopsy in the evaluation of hematopoietic and non-hematopoietic disorders is well established. However, this technique is associated with morbidity and mortality risks.1 Recently, a battery-powered bone marrow biopsy system was developed to allow operators to safely, quickly and efficiently access the marrow space. We previously evaluated this device in swine models and in patients needing routine hematology outpatient evaluation.2 In the current study we compared the powered device to the traditional manual technique by relatively assessing pain scores, procedure times, biopsy capture rates, quality of material retrieved, safety and operator satisfaction. Methods: Two large academic medical centers participated in this trial (San Antonio, TX and Madrid, Spain). The study protocol was approved by each center's institutional review board. Adult patients requiring bone marrow biopsies were considered for the study. Following informed consent, patients were randomized to have procedures using a manual biopsy device (T-handle Jamshidi bone marrow biopsy and aspiration set, Cardinal Health, Dublin, OH) or the Powered device (OnControl 11 gauge/102mm Bone Marrow Biopsy System, Vidacare Corporation, Shavano Park, TX). After infiltration of the skin and medullary bone with local anesthesia, a visual analog scale (VAS) pain score was recorded immediately following skin puncture and once again at the end of the procedure for each patient. Procedure time was measured from skin puncture to core specimen ejection from the needle. Pathologic assessment of 30 randomized samples was carried out. Operator satisfaction with devices was measured on a scale of 0–10, with 10 as the highest rating. Statistics were calculated using t-test and chi-square, with an alpha-level of 0.05. Results: Five operators from 2 sites enrolled 50 patients (Powered, n=25; Manual, n=25). Of those patients, 58% were male and 42% were female; and had a mean age of 56.0±18.0 years. The mean height was 167.5 ± 10.5cm and the mean weight was 78.7 ± 22.7kg. Forty percent were lymphoma patients—the largest diagnostic group. Between patient groups, there were no significant differences in the means for these variables. See Table below for quantitative results, including pathology analysis. For the pathology qualitative analysis, there was no difference between groups for hemorrhage, clot/particle spicules, or smear spicules. Conclusions: Results of this trial suggest that the use of a Powered bone marrow biopsy device significantly reduces needle insertion pain. While not reflected in the results, overall pain may be better tolerated due to the important difference in procedure time. Moreover, the superior size and overall quality of core specimens retrieved by the Powered device provides more material for pathologic evaluation, thereby increasing diagnostic yield and reducing the need for repeat procedures. Cohesiveness of the medullary bone sampled was comparable for both techniques; however, the Powered system was less likely to recover non-hematopoietic tissue (e.g. cortical bone and soft tissue). Artifact was slightly more common with the Powered device (aspiration, hemorrhage and crush) but this did not impact on the diagnostic quality of the sample. No differences in safety data were noted for either technique and operator satisfaction favored the Powered device. 1. Bain BJ. Bone marrow biopsy morbidity and mortality. British Journal of Haematology 2003;121:949-51. 2. Swords RT, Kelly KR, Cohen SC et al. Rotary powered device for bone marrow aspiration and biopsy yields excellent specimens quickly and efficiently. J Clin Pathol 2010;63:562-5. Disclosures: Swords: Vidacare Corporation: Research Funding. Anguita:Vidacare Corporation: Research Funding. Kelly:Vidacare Corporation: Research Funding. Philbeck:Vidacare Corporation: Employment. Miller:Vidacare Corporation: Employment, Equity Ownership. Brenner:Vidacare Corporation: Research Funding.

Impact of Operator Techniques On Quality of Bone Marrow Assessment

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2055-2055
Author(s):  
Oreofe O Odejide ◽  
Daniel J. DeAngelo ◽  
Angel M. Cronin ◽  
Zachary A. Bernazzoli ◽  
Joseph O. Jacobson ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Operator Technique ◽  
Core Length ◽  
Lower Likelihood ◽  
Lateral Decubitus ◽  
Multivariable Models ◽  
Pathology Reports ◽  
The Impact

Abstract Abstract 2055 Background: Although bone marrow aspiration and biopsy have been utilized in the diagnosis and staging of hematologic malignancies for almost a century, little is known about the potential impact of operator techniques on the quality of specimens obtained. We aimed to characterize the impact of operator techniques used for bone marrow biopsies, and to determine if any of these techniques are associated with specimen quality. Methods: From April to July 2012, we recorded operator data corresponding to all consecutive bone marrow biopsy procedures resulting in a specimen performed as part of routine care at the Dana-Farber Cancer Institute (Boston, MA). These data included type of needle used, whether or not the operator redirected the needle between aspirate and biopsy, patient position (prone or lateral decubitus), use of a drill, use of a measuring stylet, and volume of aspirate obtained in the first pull. We then reviewed the resulting pathology reports, focusing on specific indicators of quality such as presence of a diagnosis, spicularity, and core length. For the purposes of this study, we allowed credit for a diagnostic specimen if the pathology reports mentioned normal trilineage hematopoiesis or a pathologic process on either the aspirate or core biopsy. Univariate associations between operator techniques and bone marrow biopsy quality were determined using chi-square and Fisher's exact tests; multivariable logistic regression taking patient characteristics (age, gender and body mass index) and individual operator into account were also fit to characterize operator techniques that were independently predictive of quality. Finally, we assessed the association between spicularity and core length with diagnosticity. Results: 413 procedures performed by a total of 23 operators were analyzed. 91.5% of the bone marrow evaluations were diagnostic, 66.6% were spicular, and 52.8% had a core length greater than 1cm. The univariate analysis of operator techniques is detailed below: In multivariable models, no operator technique was significantly associated with obtaining diagnostic specimens; however, lateral decubitus position was associated with lower likelihood of obtaining spicular specimens (odds ratio (OR) 0.15 [95% confidence interval (CI) 0.04, 0.59], p=0.007), and redirecting was associated with lower likelihood of core length >1cm (OR 0.41 [95% CI 0.20, 0.82], p=0.01). Spicular specimens had significantly higher rates of diagnosticity compared to aspicular specimens (96.3% vs. 71%, p <0.001). Finally, among the thirty-five patients who had non-diagnostic biopsies, nine underwent repeat biopsy within thirty days of initial procedure. Conclusion: In our large cohort of observed bone marrow procedures, we found a high diagnostic rate of 91.5%. Moreover, although there were several univariate associations, in multivariable models, specific operator techniques did not predict higher likelihood of obtaining a diagnostic specimen. Although redirecting was associated with shorter cores, core length was not significantly associated with diagnosticity. Overall, our data suggest that several different operator techniques ultimately result in bone marrow specimens of similar quality. Disclosures: No relevant conflicts of interest to declare.

An Appraisal of the Quality of Referral Letters from General Dental Practitioners to a Temporomandibular Disorder Clinic

2003 ◽  
Vol os10 (4) ◽  
pp. 105-108 ◽  
Author(s):  
Annette E O'Donovan ◽  
Paul M Ager ◽  
Stephen J Davies ◽  
Philip W Smith
Keyword(s):  
Retrospective Analysis ◽  
Temporomandibular Disorders ◽  
Temporomandibular Disorder ◽  
Insufficient Information ◽  
Quality Scale ◽  
Dental Practitioners ◽  
Dental Hospital ◽  
Pro Forma ◽  
Referral Letters

Aim To assess the usefulness of referral letters from general dental practitioners (GDPs) to a clinic seeing referrals related to temporomandibular disorders. Design A retrospective analysis of all referral letters received by the TMD clinic at Manchester Dental Hospital over a ten-week period. Methods The new patient referral letters to the TMD clinic were examined against suggested criteria of 16 points of information considered to be useful by clinicians working in the clinic. The letters were then assessed using a quality scale based on the level of useful information given in the letter, and using this scale, classified into groups of ‘very helpful’, ‘some help’ or ‘a little helpful’. Results Out of the 100 letters analysed, the majority (94) proved to be a ‘little helpful’ for the TMD clinician; that is to say, the letter included only 0–4 points (out of 16) regarded as important information for the specialist. The maximum number of points of information contained in a letter was nine. No letters were categorised as ‘very helpful’ for the clinician, and only 6% of the referral letters were considered to provide some help (5–12 points). Conclusions During the period of the study, in general, referral letters to the TMD clinic concerned contained insufficient information. The introduction of a referral pro forma, produced by the TMD clinic, and guidelines might improve the quality of referrals.

scholarly journals EP.TH.81Contribution of Information on GP Referral Letters to Patient Management in a Rapid-diagnosis Breast Clinic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Eleonora Gkigkelou ◽  
Katharine Kirkpatrick ◽  
Duraisamy Ravichandran
Keyword(s):  
Family History ◽  
Patient Management ◽  
Median Number ◽  
Irrelevant Information ◽  
Rapid Diagnosis ◽  
Initial Assessment ◽  
Patient Questionnaire ◽  
Referral Letter ◽  
Breast Clinic ◽  
Referral Letters

Abstract Aims GP referral letters to rapid-diagnosis breast clinics are often poorly scanned copies of standard 2 week-wait proforma that are difficult to read, lengthy, and contain a large amount of irrelevant information. We studied the contribution of information in referral letters in patient management and compared this with information provided by patients themselves. Methods Patients completed a standard questionnaire (one side of A4) on arrival at clinic. This included all information relevant to a breast clinic such as family history and comorbidities. A consultant surgeon then saw the patients with the questionnaire and performed clinical assessment and imaging as necessary, without referring to GP letters. The letters were read before patients left clinic. Any additional useful information was noted. Results 202 consecutive new patients, median age 44 (16-93) seen in 23 clinics by 2 consultants were studied. The median number of pages in referral letter was 5 (1-14). Patient questionnaire took less than 30 seconds to read. The presenting complaints were real or perceived lump (n = 105), pain (n = 44), both (n = 14) and others (n = 39). 21 patients had cancer. Additional useful information in the referral letter was noted in 20 patients (10%). However, in no case this affected the patient management adversely. Conclusions GP letters are lengthy but contribute relatively little to the initial assessment and management of patients in a busy rapid diagnosis breast clinic. A patient-completed targeted questionnaire is quicker and can potentially replace a GP referral letter in most patients.

scholarly journals Staining of bone marrow aspiration slides: novel immediate staining Vs EDTA–stored samples

2018 ◽  
Vol 6 (6) ◽  
Author(s):  
Asfa Zawar ◽  
Shahzad Ali Jiskani ◽  
Maryam Zulfiqar ◽  
Aliena Sohail ◽  
Asma Mustafa ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Bone Marrow Aspirate ◽  
Controlled Trial ◽  
Bone Marrow Aspiration ◽  
P Value ◽  
Trephine Biopsy ◽  
Medical Sciences ◽  
Hematoxylin And Eosin

Background: Bone Marrow Biopsy is used as an intervention to diagnose certain hematological and systemic diseases as an adjunct to routine laboratory investigations. The procedure includes getting an aspirate and a trephine biopsy. Slides/Smears are prepared from the aspirate and touch imprints along with Hematoxylin and Eosin (H and E) stained sections are prepared from the trephine. Traditionally the slides from the aspirate have been prepared directly (without anticoagulants) and examined along with the trephine biopsy sections to reach a diagnosis. EDTA (Ethylene Diammine Tetra Acetate) preserved specimen can also be used to make slides of the aspirate. Objective: To compare two methods of bone marrow aspirate preparation. Design of study: Randomized controlled trial. Place of study: Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad Materials and methods: Patients coming to the Department of Pathology for bone marrow biopsy had their samples taken. Half of each sample was used to make direct smears and the other half was preserved in EDTA i.e. the purple top vials. Slides were made at the end of the procedure by the preserved sample and then the two were stained by the same person and procedure (Wright stain) and examined for any differences in quality. SPSS version 21.2 was used to analyze the data. Results: A total of 132 was taken.77 (58.3%) were males and 55(41.7%) were females. 50(37.9%) were adults and 82(62.1%) were children. P–value was found to be 0.81392 which was non-significant proving the fact that the 2 techniques are comparable. Conclusion: EDTA preserved bone marrow aspirate can be used to prepare slides at the end of the whole procedure without compromising the quality of the smears and result interpretation.

scholarly journals Referrals to a Pediatric Emergency Department of a Tertiary Care Teaching Hospital Before and After Introduction of a Referral Education Module - a Quality Improvement Study

2020 ◽  
Author(s):  
Gopalakrishnan Ezhumalai ◽  
Muralidharan Jayashree ◽  
Karthi Nallasamy ◽  
Arun Bansal ◽  
Bhavneet Bharti
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Critically Ill Children ◽  
Referral Letter ◽  
Care Providers ◽  
Post Intervention ◽  
Intervention Phase ◽  
Before And After ◽  
Referral Letters

Abstract Background: Provision of timely care to critically ill children is essential for good outcome. Referral from smaller peripheral hospitals to higher centers for intensive care is common. However, lack of an organized referral and feedback system compromises optimal care. We studied the quality of referral letters coming to our Emergency Department (ED) with respect to their demography, association with severity of illness and mortality before and after referral education. Methods: Our study was completed in three phases in the Pediatric ED; Pre-intervention, Intervention and Post intervention phases. Quality of referral letter was matched with a quality checklist proforma and graded as ‘good’, ‘fair’ and ‘poor’ if it scored >7, 5 –7 and < 5 points respectively. A peer reviewed referral education module was prepared using case studies, expert opinions, and lacunae observed in the first phase and administered to health care providers (HCP’s) of referring hospitals. Quality of referral letter was compared between pre and post intervention phases. Results: Most referrals belonged to the neighboring states of Punjab (48.2%) and Haryana (22.4%). Major referring hospitals were from public sector (80.9%), of which the teaching hospitals topped the list (53.6%). Government run ambulance services (85.5%) was commonest mode of transport used and need for a PICU bed and/or mechanical ventilation (50.4%) was the commonest reason for referral. The post intervention phase saw a significant decline in the proportion of poor (93.2 vs.78.2%; p=0.001) and a significant increase in the proportion of fair (6.1 vs 18%; p=0.001) and good referral letters (0.7 vs 18%; p=0.001). The proportion of children with physiological decompensation at triage had reduced significantly in the post intervention phase [513 out of 1403 (36.5%) vs. 310 out of 957 (32.3%); p= 0.001]. Conclusion: Referral education had significantly improved the quality of referral letters. Proportion of children with physiological decompensation at triage had decreased significantly after referral module. This change suggests sensitization of the peripheral hospitals towards a better referral process. Continued multifaceted approach will be required for sustained and increased benefits

scholarly journals EP.TU.673Optimising the referral process to the Surgical Emergency Clinic through mutual education of primary and secondary care teams: an audit cycle

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Tiffany Cheung ◽  
Faiza Muneer ◽  
Michael Freeborn ◽  
Katie Cross
Keyword(s):  
Retrospective Analysis ◽  
Secondary Care ◽  
Referral Process ◽  
Patient Access ◽  
Specialist Care ◽  
Surgical Emergency ◽  
Referral Form ◽  
Audit Cycle

Abstract Aims The Surgical Emergency Clinic (SEC) in our Hospital facilitates access to General Surgical consultant-led emergency assessment. Anecdotally, referrals are often (likely inadvertently) inappropriate and / or incomplete, which may delay assessment by the correct specialist. We audited the quality of GP referrals to the SEC against four standards: Methods Retrospective analysis of 50 GP referrals to the SEC between November - December 2017, after recording data pertinent to the above standards in a spreadsheet. Results were presented at a local GP development day, a re-designed referral form incorporating GP feedback received was uploaded onto the Trust’s intranet and an email inbox created for e-referrals. 50 further referrals between September - November 2018 were analysed. Results Full completion of the referral form increased from 0% (initial audit) to 29% (re-audit), and appropriateness of referrals from 62% to 90%. The proportion of patients having had specified blood and urine tests in advance improved overall also. Conclusions Our experience demonstrates that primary and secondary care teams actively communicating and working closely together can improve the referral process for both parties, and most importantly enhance patient access to timely, appropriate specialist care.

A Multicenter Randomized Clinical Trial Comparing a Powered Bone Marrow Biopsy System and Manual Bone Marrow Biopsy Procedures.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3840-3840
Author(s):  
James R. Berenson ◽  
Ori Yellin ◽  
Deanna Bojanower ◽  
Croopnick Jonathan ◽  
David Aboulafia ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Bone Marrow ◽  
Randomized Clinical Trial ◽  
Bone Marrow Biopsy ◽  
Research Funding ◽  
Procedure Time ◽  
Analog Scale ◽  
Pain Scores ◽  
Biopsy Core

Abstract Abstract 3840 Background: Bone marrow (BM) examination is instrumental in evaluating hematologic and oncologic disorders and monitoring the response to treatment in these patients. A powered BM sampling device was recently introduced and a multicenter randomized clinical trial was designed to determine if the new device has advantages over traditional manually-inserted needles in terms of decreased pain, decreased procedure time, higher biopsy core capture rate, ease of use, improved sample yield, and higher operator satisfaction scores. Methods: The protocol was approved by the Western Institutional Review Board and the study was conducted in community-based cancer centers across the United States. Adult patients requiring BM aspirate and biopsy procedures were considered eligible for the study. After obtaining informed consent, patients were randomized to undergo a procedure using either a Manual device (e.g. Jamshidi) or a Powered device (OnControl 11 gauge/102mm Bone Marrow Biopsy System, Vidacare Corporation, Shavano Park, TX). Using the visual analog scale (VAS), pain scores were captured immediately following the procedure. Follow-up assessments for pain and complications were completed 1 and 7 days following the biopsy procedure. Procedure time was measured from needle-to-skin contact to core specimen ejection from the needle. Core specimens were submitted to a pathology reference laboratory for grading. Pathology assessment included measurement and overall quality of the specimen. Following an interim analysis, for subsequent patients enrolled in the study, an additional visual analog scale (VAS) pain score was recorded immediately following biopsy needle penetration of the iliac crest bone cortex. Statistics were calculated using t-test and chi-square, with an alpha-level of 0.05. Results: Thirteen operators from 10 sites participated in the study, and enrolled 102 patients (Powered, n=52; Manual, n=50). Of those patients, 56% were male. Their mean age was 66.3 ± 14.1 years with a mean height of 169.0 ± 10.2 cm and a mean weight of 76.3 ± 16.7kg. Forty-eight percent had lymphoproliferative disorders. There were no significant differences in the means for these variables between patients enrolled in the two arms of the study. This was the first BM biopsy for 69% and 56% of Powered and Manual patients, respectively. Measurement of needle insertion pain was done on a subset of patients and the VAS pain scores were not different between the arms (3.1 ± 3.1 for Powered [n=14] and 3.2 ± 2.9 for Manual [n=14]). Mean VAS scores for overall procedural pain were also not significantly different between the arms (4.8 ± 2.8 for Powered and 3.5 ± 2.3 for Manual [p=0.623]). However, one day after the procedure, more patients (67%) who underwent the Powered procedure were pain-free than those patients in the Manual group (33%; p=0.003). One week following the procedure, there was no difference in the proportion of patients who were pain-free (82.3% for Powered patients; 77.3% for Manual patients. Notably, mean procedure time was less than half among patients who underwent the Powered (96.0 seconds ± 80.9) compared with the Manual procedure [201.7 seconds ± 147.9; p<0.001]). Biopsy core acquisition success rate was similar between the arms (90.4% for Powered and 98% for Manual [p=0.205]). The mean length of biopsy core specimens was similar between the arms (Powered 13.3 ± 5.5 mm [n=9] compared to Manual 11.0 ± 5.5 mm [n=10]). There were two non-serious complications for the Powered (4%) and no complications for the Manual procedure (p=.0161). Conclusions: The results of this first multicenter randomized control trial evaluating the OnControl Bone Marrow Biopsy System are promising. They suggest use of the Powered BM biopsy device markedly shortens the procedure time and reduces intermediate-term pain—important considerations for the quality of life for patients undergoing this procedure. Further studies with more BM biopsy and aspirate specimens are needed to confirm this beneficial effect. Disclosures: Berenson: Vidacare Corporation: Research Funding. Yellin:Vidacare Corporation: Research Funding. Bojanower:Vidacare Corporation: Research Funding. Jonathan:Vidacare Corporation: Research Funding. Aboulafia:Vidacare Corporation: Honoraria. Upadhyaya:Vidacare Corporation: Research Funding. Blumenstein:Vidacare Corporation: Consultancy.

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