Journal of patient safety
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Journal of patient safety · Sep 2014
Emergency department experience with nonoral contrast computed tomography in the evaluation of patients for appendicitis.
The American College of Radiology lists oral contrast as an institution-specific option in the evaluation of right lower quadrant pain. Previous literature indicates that an accurate assessment for appendicitis can be made by CT using IV contrast alone, with significant time savings from withholding oral contrast. Before 2010, the protocol for CT use in the evaluation of possible appendicitis or undifferentiated abdominal pain routinely included oral contrast. The purpose of this study was to determine the incidence of repeat CT scans with oral contrast for the purpose of arriving at a final disposition in patients undergoing evaluation for abdominal pain. This analysis was also to determine if the general surgery service was willing and able to make accurate clinical determinations to operate without the use of oral contrast. ⋯ Abdominal CT scan without the use of oral contrast is accurate to allow for appropriate decision making by emergency physicians and general surgeons. In our series, no patients required repeat scanning. Further assessment by larger studies is appropriate.
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Journal of patient safety · Jun 2014
Operating room clinicians' ratings of workload: a vignette simulation study.
Increased clinician workload is associated with medical errors and patient harm. The Quality and Workload Assessment Tool (QWAT) measures anticipated (pre-case) and perceived (post-case) clinical workload during actual surgical procedures using ratings of individual and team case difficulty from every operating room (OR) team member. The purpose of this study was to examine the QWAT ratings of OR clinicians who were not present in the OR but who read vignettes compiled from actual case documentation to assess interrater reliability and agreement with ratings made by clinicians involved in the actual cases. ⋯ The case difficulty items on the QWAT seem to be sufficiently reliable and valid to be used in other studies of anticipated and perceived clinical workload of surgeons. Perhaps because of the limitations of the clinical documentation shown to anesthesia providers and OR nurses in the current vignette study, more evidence needs to be gathered to demonstrate the criterion-related validity of the QWAT difficulty items for assessing the workload of nonsurgeon OR clinicians.
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Journal of patient safety · Jun 2014
Case ReportsPostoperative stroke after hemiarthroplasty for femoral neck fracture: a report of 2 cases and review of literature.
Femoral neck fractures in the elderly comprise a significant number of orthopedic surgical cases at a major trauma center. These patients are immediately incapacitated, and surgical fixation can help increase mobility, restore independence, and reduce morbidity and mortality. However, operative treatment carries its own inherent risks including infections, deep vein thromboses, and intraoperative cardiovascular collapse. Cerebrovascular stroke is a relatively uncommon occurrence after hip fractures. ⋯ General anesthesia in the setting of decreased cardiac function (decreased ejection fraction and output) carries the risk for ischemic injury to the brain from decreased cerebral perfusion. Risk factors including advanced age, history of coronary artery disease, atherosclerotic disease, and atrial fibrillation increase the risk for perioperative stroke. Furthermore, it is known that during the cementing of implants, microemboli can be released, which must be considered in patients with preoperative heart disease. As a result, consideration of using a noncemented implant or cementing without pressurizing in this clinical scenario should be an important aspect of the preoperative plan in an at-risk patient. Further studies are needed that can elucidate a causal relationship.
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Journal of patient safety · Jun 2014
A retrospective review of crisis events in diagnostic radiology: an analysis of frequency, demographics, etiologies, and outcomes.
The aim of this study was to determine the underlying characteristics of inpatients sustaining crisis events in the radiology department (RD). ⋯ Inpatient deterioration in the RD often occurred early in the course of the patient's hospitalization, with more than 40% taking place in the first 24 hours of admission. The MET seemed to have a positive impact on many patients, allowing a substantial percentage of studies to be completed. Interpretation of those studies often identified the etiology of the deterioration. Further study of outside hospital transfers, emergency department admissions, and intensive care unit patients who deteriorate in the RD is warranted to clarify risk factors and to identify early signs of deterioration.
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Journal of patient safety · Mar 2014
The introduction of an integrated early warning score observation chart-a picture paints a thousand words.
Previous studies have demonstrated that abnormal physiological observations are often recorded on patients' observation charts but not acted on, with ensuing negative consequences. To address this issue within our hospital, traditional charts with a graphic depiction of observations were replaced with new charts combining early warning scores (EWS) with numerically depicted observations. However, the replacement did not include a graphic display of observations in the form of trend graphs. The present study compared the speed and accuracy of data interpretation between the 2 charts. ⋯ Graphic display of data is associated with faster and more accurate assimilation of information. Hence, charts combining EWS with graphic portrayal of observation trends may contribute to earlier recognition of sick patients.