Analysis of critical report notification from musculoskeletal radiology in a tertiary academic medical institution with a regional trauma center

Purpose We aimed to analyze the prevalence, causes, and clinical settings of 4-year critical radiologic reports (CRRs) notified from the musculoskeletal section of the radiology department. Then, we investigated the communication outcomes. Methods This study was approved by our institutional review board. We retrospectively included 175 musculoskeletal CRRs from our database between January 2017 and December 2020. The CRRs were analyzed by two musculoskeletal radiologists, who categorized the CRRs by clinical setting (emergency department(ED) patient, outpatient, and inpatient), body part, type of image modality, reason for CRR, incidental lesion, and clinical outcome. The clinical outcome was retrieved from the electronic medical records. Results The 175 musculoskeletal CRRs accounted for 5.4% of the CRRs (n = 3217) available in the study period. Most CRRs (94.9%, 166/175) corresponded to the musculoskeletal system, while the remaining ones (5.1%, 9/175) corresponded to the non-musculoskeletal system. In addition, the spine, extremities, and thoracic cage accounted for 52.6%, 40.6%, and 1.7% of the musculoskeletal CRRs, respectively. Moreover, most patients presented to the ED (50.3%, 88/175), followed by inpatients (30.9%, 54/175), and outpatients (18.9%, 33/175). The CRR reasons included missed fracture (54.3%), suspected malignancy (16%), clinical emergency (10.3%), unexpected infection/inflammation (11.4%), and others (8%). Furthermore, 11 (6.3%) incidental lesions were not related to the primary imaging purpose. Referring clinicians actively acknowledged 80% of the CRRs. The loss to follow-up action was the highest in the ED patients (35.2%, 31/88; p < 0.001), being significantly higher than that in outpatients (6.1%, 2/33) and inpatients (3.7%, 2/54). Conclusion Missed fractures were the most common cause of musculoskeletal CRRs. ED showed prevalence in musculoskeletal CRRs and reflected the highest loss to follow-up action. ED physicians should pay more attention to CRRs to enhance patient care.

A Web-based, Provider-driven Mobile App to Enhance Patient Care Coordination between Dialysis Facilities and Hospitals: Development and Pilot Implementation Study (Preprint)

BACKGROUND To fill the communication and care coordination gap between hospitals and dialysis facilities, we piloted a web-based, provider-driven mobile app (“DialysisConnect”). Here, we describe its development and pilot implementation. OBJECTIVE . METHODS DialysisConnect was developed iteratively, with focus group and user testing feedback, and made available to 106 potential users at one hospital [hospitalists, advanced practice providers (APPs), care coordinator] and four affiliated dialysis facilities (nephrologists, APPs, nurses/nurse managers) prior to the start of the pilot (11/1/20-5/31/21). Mid- and end-of-pilot online surveys of potential users were performed. Descriptive statistics were used to describe system usage patterns, ratings on multiple satisfaction items (1=not at all; 3=to a great extent), and provider-selected motivators and barriers to using DialysisConnect. RESULTS The pilot version of DialysisConnect included automatically uploaded clinical information from dialysis facilities, forms for entering critical admission and discharge information, and a direct communications channel. While physicians comprised most of the potential users of DialysisConnect, APPs and dialysis nurses were the most active users. Activity was unevenly distributed: e.g., one hospital-based APP recorded most of the admissions (n=225, 89%) and discharges (n=226, 93%) among patients treated at the pilot dialysis facilities. End-of-pilot ratings of DialysisConnect were generally higher for users vs. non-users: e.g., “I can see the potential value of DialysisConnect for my work with dialysis patients” [mean (SD): 2.8 (0.4) vs 2.3 (0.6), P=0.02]. Providers most commonly selected reduced time and energy spent gathering information as a motivator (42.3%) and lack of time to use the system as a barrier (30.8%). CONCLUSIONS In this pilot, we found that APPs and nurses were most likely to engage with the system. Survey participants generally viewed the system favorably, while identifying substantial barriers to its use. These results inform how best to motivate providers to use this and similar systems and inform future pragmatic research in care coordination in this and other populations.

Non-Invasive Myocardial Infarction Ischemic Area Estimation Through Four-Dimensional Ultrasound

Background/Objective: Following myocardial infarction, infarct size and cardiac function are significant predictors of long-term prognosis. Most echocardiography studies rely on two-dimensional analysis for estimation of left ventricular function and electrical activity analysis for estimation of infarct area. Other imaging modalities, such as cardiac magnetic resonance imaging, are limited by time, cost, availability, patient tolerance, and incompatible implantable devices. Using an experimental mouse model of myocardial infarction, we hypothesize that four-dimensional ultrasound offers a possible alternative for easy, quick, and reliable estimation of infarct size. Methods: A cohort of 10 mice underwent four-dimensional cardiac imaging at baseline using a small animal high frequency ultrasound. A thoracotomy was subsequently performed, and a suture placed to ligate the left coronary artery approximately midway down the left ventricle. Sequential four-dimensional ultrasound was performed at six time points over 28 days, following which the mice were euthanized. The hearts were then removed and sent for embedding and sectioning into seven uniform segments stained using both H&E and Masson’ s Trichrome. Results: Thus far, we have segmented the imaging and collected end diastolic volume, peak systolic volume, stroke volume, ejection fraction, transmural thickness, and circumferential strain. Additionally, four-dimensional models of the left ventricles have been rendered. Histological embedding, sectioning, and staining is still in progress, and therefore validation against the gold standard is still in process. Conclusion and Impact: Treatment and monitoring of myocardial infarction patients is reliant upon accurate assessment of patient status and prognosis. This study provides initial evidence for the validity of four-dimensional ultrasound as a tool for estimation of myocardial infarction size, providing an alternative to current two-dimensional methods that are less accurate and a more accessible alternative to highly specialized and costly equipment. Improved and accessible imaging methods have the potential to enhance patient care, ultimately improving overall health outcomes.

An Exploration of Language and Nursing Practice to Improve Communication in the Context of Ear Syringing

<p>Action research is a critical reflective process that involves spirals of cycles if of planning, acting, reflecting/evaluating and replanning the next cycle. This action research inquiry explores communication and nursing practice in an effort to improve practice and enhance patient care. Implications of this study indicate that action research is a method that works, and it is a satisfying way of challenging and changing nursing practice. Using ear syringing as a procedure, in the general practice setting and at two separate surgeries, another Practice Nurse and I co-researched this study during working hours. 12 people consented to participate in the research that involved the audiotaping of each ear syringing interaction. Following each transcription of the recording, my co-researcher and I read our own and then each other's transcripts, and listened to the recordings. We then met to discuss and reflect on our findings and to plan the next cycle. Throughout the process, my co researcher and I found a number of areas of practice we could change or enhance. Changes included the use of technical language such as "contraindications" and "auditory meatus", the side effects of syringing, improvements in communicating situations where ear syringing is not recommended and the options available, and post procedure information. These changes became a significant challenge and areas for improvement when both my co-researcher and I forgot the changes, thus repeating previous errors and omissions. This factor highlighted the need to practise any changes prior to interactions, and to have a cue card on hand to facilitate recollection and to cement improvements into practice. Although time constraints limited this inquiry to three cycles, at the final meeting we agreed to continue the reflective process we had begun to explore our practice.</p>

An Exploration of Language and Nursing Practice to Improve Communication in the Context of Ear Syringing

<p>Action research is a critical reflective process that involves spirals of cycles if of planning, acting, reflecting/evaluating and replanning the next cycle. This action research inquiry explores communication and nursing practice in an effort to improve practice and enhance patient care. Implications of this study indicate that action research is a method that works, and it is a satisfying way of challenging and changing nursing practice. Using ear syringing as a procedure, in the general practice setting and at two separate surgeries, another Practice Nurse and I co-researched this study during working hours. 12 people consented to participate in the research that involved the audiotaping of each ear syringing interaction. Following each transcription of the recording, my co-researcher and I read our own and then each other's transcripts, and listened to the recordings. We then met to discuss and reflect on our findings and to plan the next cycle. Throughout the process, my co researcher and I found a number of areas of practice we could change or enhance. Changes included the use of technical language such as "contraindications" and "auditory meatus", the side effects of syringing, improvements in communicating situations where ear syringing is not recommended and the options available, and post procedure information. These changes became a significant challenge and areas for improvement when both my co-researcher and I forgot the changes, thus repeating previous errors and omissions. This factor highlighted the need to practise any changes prior to interactions, and to have a cue card on hand to facilitate recollection and to cement improvements into practice. Although time constraints limited this inquiry to three cycles, at the final meeting we agreed to continue the reflective process we had begun to explore our practice.</p>

Improving patient care in neurosurgery through postoperative telephone calls: a systematic review and lessons from all surgical specialties

OBJECTIVE Postoperative telephone calls are a simple intervention that can be used to improve communication with patients, potentially affecting patient safety and satisfaction. Few studies in the neurosurgical literature have examined the effect of a postoperative telephone call on patient outcomes, although several exist across all surgical specialties. The authors performed a systematic review and analyzed studies published since 2000 to assess the effect of a postoperative telephone call or text message on patient safety and satisfaction across all surgical specialties. METHODS A search of PubMed-indexed articles was performed on June 12, 2021, and was narrowed by the inclusion criteria of studies from surgical specialties with > 50 adult patients published after 1999, in which a postoperative telephone call was made and its effects on safety and satisfaction were assessed. Exclusion criteria included dental, medical, and pediatric specialties; systematic reviews; meta-analyses; and non–English-language articles. Dual review was utilized. RESULTS Overall, 24 articles met inclusion criteria. The majority reported an increase in patient satisfaction scores after a postoperative telephone call was implemented, and half of the studies demonstrated an improvement in safety or outcomes. CONCLUSIONS Taken together, these studies demonstrate that implementation of a postoperative telephone call in a neurosurgical practice is a feasible way to enhance patient care. The major limitations of this study were the heterogeneous group of studies and the limited neurosurgery-specific studies.

A workflow to generate patient-specific three-dimensional augmented reality models from medical imaging data and example applications in urologic oncology

Augmented reality (AR) and virtual reality (VR) are burgeoning technologies that have the potential to greatly enhance patient care. Visualizing patient-specific three-dimensional (3D) imaging data in these enhanced virtual environments may improve surgeons’ understanding of anatomy and surgical pathology, thereby allowing for improved surgical planning, superior intra-operative guidance, and ultimately improved patient care. It is important that radiologists are familiar with these technologies, especially since the number of institutions utilizing VR and AR is increasing. This article gives an overview of AR and VR and describes the workflow required to create anatomical 3D models for use in AR using the Microsoft HoloLens device. Case examples in urologic oncology (prostate cancer and renal cancer) are provided which depict how AR has been used to guide surgery at our institution.

Evaluation and Management of Delirium

Delirium, sometimes referred to as encephalopathy, is an acute confusional state that is both common in hospitalized patients and associated with poor outcomes. For patients, families, and caregivers, delirium can be a traumatic experience. While delirium is one of the most common diagnoses encountered by the consulting neurologist, the majority of the time it will have been previously unrecognized as such by the care team. Neurologic syndromes such as dementia or aphasia can either be misdiagnosed as delirium or may coexist with it, necessitating careful neurologic assessment. Once the diagnosis of delirium has been established, a careful evaluation for predisposing and precipitating factors can help uncover modifiable contributors, which should be addressed as part of a multicomponent, primarily nonpharmacologic intervention. Importantly, delirium management, which begins with comprehensive prevention, should emphasize the humanity of the delirious patient and the challenges of caring for this vulnerable population. When considered, delirium represents an important opportunity for the neurologist to substantially enhance patient care.

Descriptive Mapping of Road Traffic Accidents Reported to Red Crescent, Saudi Arabia

Introduction: Traffic accidents continue to have serious health and economic consequences all around the globe. Despite significant efforts to enhance road safety, the number of traffic accidents has continuously risen over the past three decades. Objective: This current study was conducted to determine the cause, injuries, and management problems of road traffic accidents, so that they may be addressed to enhance patient care and reduce morbidity and mortality. Method: The descriptive study used retrospective record-based data from the Saudi Red Crescent Authority from the duration of 2016-2020. Information collected included: age, sex, incidence by area, frequency in city limits, type of incidence, source of information about the incidence, and distribution of nationality. Results: The study revealed that males suffered more accidents (88.5%) than females (11.5%). When we observed these incidences in various areas of Saudi Arabia, it was found that the capital city of Riyadh (21.4%) had the highest incidences, followed by Makkah (15.2%). Conclusion: The scope of the issue of traffic accidents, as well as the resulting loss of human and economic resources, is immense. To address this issue, a national plan must be implemented. The main focus should be on accident prevention, which should be accomplished via health education. Keywords: Accident, Saudi Arabia, Road Traffic, Red Crescent, Survey