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Naimi S, Ødegaard KJ, Jenssen KK, Lauritzen PM. Quality of referrals for lower extremity ultrasonography and computed tomography pulmonary angiography and associations with positive findings of venous thromboembolism. Radiography (Lond) 2024; 30:799-805. [PMID: 38493553 DOI: 10.1016/j.radi.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION The referral is the basis for radiologists' assessment of modality, protocol and urgency, and insufficient information may threaten patient safety. The aim of this study was to assess the completeness of referrals for lower extremity venous duplex ultrasonography (LEVDUS) and computed tomography pulmonary angiography (CTPA), and to investigate associations between the provided clinical information including risk factors, symptoms and lab results in the referrals and positive findings of deep vein thrombosis (DVT) and pulmonary embolism (PE), respectively. METHODS Referrals for LEVDUS (801) and CTPA (800) performed from 2016 to 2019 were obtained. Three categories of clinical information from the referrals were recorded: symptoms, risk factors and laboratory results, as well as positive imaging findings of venous thromboembolism (VTE). Referral completeness was rated from zero to three according to how many categories of clinical information the referral provided. RESULTS Information from all three clinical information categories was provided in 15% and 25% of referrals for LEVDUS and CTPA, respectively, while 2% and 10% of referrals did not contain any clinical information. Symptoms were provided most often (85% for LEVDUS and 94% for CTPA). Provided information about risk factors was significantly associated with positive findings for LEVDUS, (p = 0.02) and CTPA (p < 0.001). CONCLUSION A great majority of referrals failed to provide one or more categories of clinical information. Risk factors were associated with a positive finding of VTE on LEVDUS and CTPA. IMPLICATIONS FOR PRACTICE Improving clinical information in referrals may improve justification, patient safety and quality of radiology services.
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Affiliation(s)
- S Naimi
- Department of Life Sciences and Health, Oslo Metropolitan University, P.O. Box 4 St. Olavs Plass, NO-0130 Oslo, Norway.
| | - K J Ødegaard
- Department of Radiology, Lovisenberg Diaconal Hospital, Postboks 4970 Nydalen, NO-0440 Oslo, Norway.
| | - K K Jenssen
- Department of Orthopedic Surgery, Lovisenberg Diaconal Hospital, Postboks 4970 Nydalen, NO-0440 Oslo, Norway.
| | - P M Lauritzen
- Department of Life Sciences and Health, Oslo Metropolitan University, P.O. Box 4 St. Olavs Plass, NO-0130 Oslo, Norway; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Postboks 4956 Nydalen, NO-0424 Oslo, Norway.
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Nigatu AM, Yilma TM, Gezie LD, Gebrewold Y, Gullslett MK, Mengiste SA, Tilahun B. Medical imaging consultation practices and challenges at public hospitals in the Amhara regional state, Northwest Ethiopia: a descriptive phenomenological study. BMC Health Serv Res 2023; 23:787. [PMID: 37488569 PMCID: PMC10367423 DOI: 10.1186/s12913-023-09652-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/06/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Medical imaging plays a vital role in the accurate diagnosis, treatment and outcome prediction of many diseases and injuries. However, in many African countries, deserving populations do not have access to the proper medical imaging specialists' services. As a result, clinicians continue to struggle to provide medical imaging via consultation. However, little is known about conventional referral consultation practices and their challenges. This study, therefore, aimed to explore the practice and challenges of medical imaging service consultation among health professionals and patients in the context of the Ethiopian public healthcare delivery system. METHODS Descriptive phenomenological study was employed to explore the practice of medical imaging service consultation among health professionals and patients in public hospitals of Amhara region from October 12, 2021 to December 29, 2021. Semi-structured interview guides were prepared separately for key-informant and in-depth interviews. A total of 21 participants (6 hospital managers, 4 medical directors, 4 department heads, 3 medical imaging coordinators and 4 patients) were selected using the maximum variation sampling technique. All interviews were audio-recorded, transcribed verbatim and subjected to inductive thematic analysis using Open Code 4.02 software. RESULTS Six major themes emerged following the thematic analysis: (1) medical image service delivery practices; (2) medical imaging consultation modalities; (3) benefits and drawbacks of the consultation modalities; (4) challenges; (5) challenge mitigation strategies; and (6) future recommendations. Image films, compact disks, and telegram apps were the consultation modalities used by the referring clinicians to send the medical images to radiologists. Frequent failure of imaging machines, delayed equipment maintenance, inadequate infrastructure, shortage of budget, lack of radiologists, and low-quality of printed image films were among the challenges influencing the medical imaging consultation service. CONCLUSIONS This research explored onsite and referral imaging consultation practices. However, there are many challenges encountered by the referring clinicians and the radiologists during the consultation process. These challenges could potentially affect clinicians' ability to provide timely diagnosis and treatment services which would ultimately affects patient health status and service delivery. Virtual consultation via teleradiology and enhancing clinicians' competence through long-term and short-term trainings are recommended to improve the referral consultation practice.
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Affiliation(s)
- Araya Mesfin Nigatu
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Tesfahun Melese Yilma
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Yonathan Gebrewold
- Department of Radiology, College of Medicine, Author's Information, University of Gondar, Gondar, Ethiopia
| | | | | | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Janke AT, Overbeek DL, Kocher KE, Levy PD. Exploring the Potential of Predictive Analytics and Big Data in Emergency Care. Ann Emerg Med 2015. [PMID: 26215667 DOI: 10.1016/j.annemergmed.2015.06.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Clinical research often focuses on resource-intensive causal inference, whereas the potential of predictive analytics with constantly increasing big data sources remains largely unexplored. Basic prediction, divorced from causal inference, is much easier with big data. Emergency care may benefit from this simpler application of big data. Historically, predictive analytics have played an important role in emergency care as simple heuristics for risk stratification. These tools generally follow a standard approach: parsimonious criteria, easy computability, and independent validation with distinct populations. Simplicity in a prediction tool is valuable, but technological advances make it no longer a necessity. Emergency care could benefit from clinical predictions built using data science tools with abundant potential input variables available in electronic medical records. Patients' risks could be stratified more precisely with large pools of data and lower resource requirements for comparing each clinical encounter to those that came before it, benefiting clinical decisionmaking and health systems operations. The largest value of predictive analytics comes early in the clinical encounter, in which diagnostic and prognostic uncertainty are high and resource-committing decisions need to be made. We propose an agenda for widening the application of predictive analytics in emergency care. Throughout, we express cautious optimism because there are myriad challenges related to database infrastructure, practitioner uptake, and patient acceptance. The quality of routinely compiled clinical data will remain an important limitation. Complementing big data sources with prospective data may be necessary if predictive analytics are to achieve their full potential to improve care quality in the emergency department.
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Affiliation(s)
| | - Daniel L Overbeek
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
| | - Keith E Kocher
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Phillip D Levy
- Department of Emergency Medicine and Cardiovascular Research Institute, Wayne State University, Detroit, MI
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Qahtani SA, Kandeel AY, Breault S, Jouannic AM, Qanadli SD. Prevalence of Acute Coronary Syndrome in Patients Suspected for Pulmonary Embolism or Acute Aortic Syndrome: Rationale for the Triple Rule-Out Concept. J Clin Med Res 2015; 7:627-31. [PMID: 26124909 PMCID: PMC4471750 DOI: 10.14740/jocmr2197w] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The aims of the study were to evaluate the prevalence of acute coronary syndrome (ACS) among patients presenting with atypical chest pain who are evaluated for acute aortic syndrome (AAS) or pulmonary embolism (PE) with computed tomoangiography (CTA) and discuss the rationale for the use of triple rule-out (TRO) protocol for triaging these patients. METHODS This study is a retrospective analysis of patients presenting with atypical chest pain and evaluated with thoracic (CTA), for suspicion of AAS/PE. Two physicians reviewed patient files for demographic characteristics, initial CT and final clinical diagnosis. Patients were classified according to CTA finding into AAS, PE and other diagnoses and according to final clinical diagnosis into AAS, PE, ACS and other diagnoses. RESULTS Four hundred and sixty-seven patients were evaluated: 396 (84.8%) patients for clinical suspicion of PE and 71 (15.2%) patients for suspicion of AAS. The prevalence of ACS and AAS was low among the PE patients: 5.5% and 0.5% respectively (P = 0.0001), while the prevalence of ACS and PE was 18.3% and 5.6% among AAS patients (P = 0.14 and P = 0.34 respectively). CONCLUSION The prevalence of ACS and AAS among patients suspected clinically of having PE is limited while the prevalence of ACS and PE among patients suspected clinically of having AAS is significant. Accordingly patients suspected for PE could be evaluated with dedicated PE CTA while those suspected for AAS should still be triaged using TRO protocol.
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Affiliation(s)
- Saad Al Qahtani
- Department of Radiology & Medical Imaging, Armed Forces Hospital, Southern Region, Saudi Arabia
| | - Ahmed Y Kandeel
- Department of Radiology & Medical Imaging, Armed Forces Hospital, Southern Region, Saudi Arabia
| | - Stephane Breault
- Cardio-Thoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Switzerland
| | - Anne-Marie Jouannic
- Cardio-Thoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Switzerland ; Quantitative Medical Imaging Laboratory, Department of Radiology, University Hospital of Lausanne, Switzerland
| | - Salah D Qanadli
- Cardio-Thoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Switzerland ; Quantitative Medical Imaging Laboratory, Department of Radiology, University Hospital of Lausanne, Switzerland
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Gupta A, Ip IK, Raja AS, Andruchow JE, Sodickson A, Khorasani R. Effect of clinical decision support on documented guideline adherence for head CT in emergency department patients with mild traumatic brain injury. J Am Med Inform Assoc 2014; 21:e347-51. [PMID: 24534635 PMCID: PMC4173181 DOI: 10.1136/amiajnl-2013-002536] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/31/2014] [Accepted: 02/03/2014] [Indexed: 11/04/2022] Open
Abstract
Imaging utilization in emergency departments (EDs) has increased significantly. More than half of the 1.2 million patients with mild traumatic brain injury (MTBI) presenting to US EDs receive head CT. While evidence-based guidelines can help emergency clinicians decide whether to obtain head CT in these patients, adoption of these guidelines has been highly variable. Promulgation of imaging efficiency guidelines by the National Quality Forum has intensified the need for performance reporting, but measuring adherence to these imaging guidelines currently requires labor-intensive and potentially inaccurate manual chart review. We implemented clinical decision support (CDS) based on published evidence to guide emergency clinicians towards appropriate head CT use in patients with MTBI and automated data capture needed for unambiguous guideline adherence metrics. Implementation of the CDS was associated with a 56% relative increase in documented adherence to evidence-based guidelines for imaging in ED patients with MTBI.
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Affiliation(s)
- Anurag Gupta
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, Massachusetts, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ivan K Ip
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, Massachusetts, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ali S Raja
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, Massachusetts, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - James E Andruchow
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, Massachusetts, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Aaron Sodickson
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, Massachusetts, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, Massachusetts, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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The use of decision support to measure documented adherence to a national imaging quality measure. Acad Radiol 2014; 21:378-83. [PMID: 24507424 DOI: 10.1016/j.acra.2013.10.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/24/2013] [Accepted: 10/28/2013] [Indexed: 01/24/2023]
Abstract
RATIONALE AND OBJECTIVES Present methods for measuring adherence to national imaging quality measures often require a resource-intensive chart review. Computerized decision support systems may allow for automated capture of these data. We sought to determine the feasibility of measuring adherence to a national quality measure (NQM) regarding computed tomography pulmonary angiograms (CTPAs) for pulmonary embolism using measure-targeted clinical decision support and whether the associated increased burden of data captured required by this system would affect the use and yield of CTs. MATERIALS AND METHODS This institutional review board-approved prospective cohort study enrolled patients from September 1, 2009, through November 30, 2011, in the emergency department (ED) of a 776-bed quaternary-care adults-only academic medical center. Our intervention consisted of an NQM-targeted clinical decision support tool for CTPAs, which required mandatory input of the Wells criteria and serum D-dimer level. The primary outcome was the documented adherence to the quality measure prior and subsequent to the intervention, and the secondary outcomes were the use and yield of CTPAs. RESULTS A total of 1209 patients with suspected PE (2.0% of 58,795 ED visits) were imaged by CTPA during the 12-month control period, and 1212 patients were imaged in the 12 months after the quarter during which the intervention was implemented (2.0% of 59,478 ED visits, P = .84). Documented baseline adherence to the NQM was 56.9% based on a structured review of the provider notes. After implementation, documented adherence increased to 75.6% (P < .01). CTPA yield remained unchanged and was 10.4% during the control period and 10.1% after the intervention (P = .88). CONCLUSIONS Implementation of a clinical decision support tool significantly improved documented adherence to an NQM, enabling automated measurement of provider adherence to evidence without the need for resource-intensive chart review. It did not adversely affect the use or yield of CTPAs.
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Cronin P, Rawson JV. Health services research in radiology: meeting the needs of the professions and the patients. Acad Radiol 2013; 20:1061-2. [PMID: 23931416 DOI: 10.1016/j.acra.2013.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 06/03/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
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