1
|
Gottlieb M, Patel D, Marks A, Peksa GD. Ultrasound for the diagnosis of shoulder dislocation and reduction: A systematic review and meta-analysis. Acad Emerg Med 2022; 29:999-1007. [PMID: 35094451 DOI: 10.1111/acem.14454] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/27/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Shoulder dislocations are a common injury prompting presentation to the emergency department. Point-of-care ultrasound (POCUS) is a diagnostic tool for shoulder dislocations, which has the potential to reduce time to diagnosis and reduction, radiation exposure, and health care costs. This systematic review sought to evaluate the diagnostic accuracy of POCUS for diagnosing shoulder dislocations. METHODS We searched PubMed, Scopus, CINAHL, LILACS, the Cochrane databases, Google Scholar, and bibliographies of selected articles for all prospective and randomized controlled trials evaluating the diagnostic accuracy of POCUS for identifying shoulder dislocations. We dual-extracted data into a predefined worksheet and performed quality analysis using the QUADAS-2 tool. We performed a meta-analysis with subgroup analyses by technique and transducer type. As a secondary outcome, we assessed the diagnostic accuracy of identifying associated fractures. RESULTS Ten studies met our inclusion criteria, comprising 1,836 assessments with 636 dislocations (34.6%). Overall, POCUS was 100% (95% confidence interval [CI], 85.6%-100%) sensitive and 100% (95% CI, 79.4%-100%) specific for the diagnosis of shoulder dislocation with a LR+ of 11,254.8 (95% CI, 3.9-3.3e7) and a LR- of <0.1 (95% CI, < 0.1-0.2). When compared with the anterior/lateral technique, the posterior technique had greater sensitivity but no difference in specificity. There was no difference between transducer types. POCUS was also 96.8% (95% CI, 92.6%-98.7%) sensitive and 99.7% (95% CI, 92.5%-100%) specific for the diagnosis of associated fractures. CONCLUSIONS POCUS is a sensitive and specific tool for the rapid identification of shoulder dislocations and reductions, as well as for the detection of associated fractures. POCUS should be considered as an alternate diagnostic tool for the diagnosis and management of shoulder dislocations.
Collapse
Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine Rush University Medical Center Chicago Illinois USA
| | - Daven Patel
- Department of Emergency Medicine Rush University Medical Center Chicago Illinois USA
| | - Amy Marks
- Department of Emergency Medicine Rush University Medical Center Chicago Illinois USA
| | - Gary D. Peksa
- Department of Emergency Medicine Rush University Medical Center Chicago Illinois USA
| |
Collapse
|
2
|
Jessome R. Improving patient flow in diagnostic imaging: a case report. J Med Imaging Radiat Sci 2020; 51:678-688. [PMID: 32950432 PMCID: PMC7495148 DOI: 10.1016/j.jmir.2020.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/30/2020] [Accepted: 08/13/2020] [Indexed: 10/31/2022]
Abstract
INTRODUCTION This case study focuses on Erie Shores Healthcare, a small Canadian hospital with a busy emergency department (ED) who acts as the sole provider of outpatient diagnostic imaging (DI) services to the community. The hospital is experiencing bottlenecks when balancing outpatient diagnostic procedures with inpatient and urgent ED requests in the X-Ray department, creating the need for increased overtime and missed breaks, as well as frustrations amongst patients, staff and physicians. CASE AND OUTCOMES To alleviate these issues and improve patient flow, this case study aims to identify options for increasing efficiency, improving adaptive workflow and decreasing wait times during peak hours in X-Ray. DISCUSSION After a literature review, key components were narrowed down to include the following Lean Methods: floor plan evaluation with spaghetti diagrams, collection of benchmarking data from similar Canadian sites, and a real-time Client Flow Analysis. The potential benefits of Technologist Assistants (TA) and DI-dedicated porters are also explored. CONCLUSION Lean methodology is an effective way to evaluate and improve patient flow in DI. Healthcare organizations should take advantage of key redevelopment projects and technological advancements to maximize their departmental efficiency.
Collapse
Affiliation(s)
- Rebecca Jessome
- McMaster University, DeGroote School of Business, Hamilton, ON; McMaster University, Faculty of Health Sciences, Hamilton, ON.
| |
Collapse
|
3
|
Olwanda E, Shen J, Kahn JG, Bryant-Comstock K, Huchko MJ. Comparison of patient flow and provider efficiency of two delivery strategies for HPV-based cervical cancer screening in Western Kenya: a time and motion study. Glob Health Action 2018; 11:1451455. [PMID: 29589991 PMCID: PMC5912439 DOI: 10.1080/16549716.2018.1451455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Improving patient flow and reducing over-crowding can improve quality, promptness of care, and patient satisfaction. Given low utilization of preventive care in low-resource countries, improved patient flows are especially important in these settings. Objective: Compare patient flow and provider efficiency between two cervical cancer screening strategies via self-collected human papillomavirus (HPV). Methods: We collected time and motion data for patients screened for cervical cancer in 12 communities in rural Migori County, Kenya as part of a larger cluster randomized trial. Six communities were randomized to screening in community health campaigns (CHCs) and six to screening at government clinics. We quantified patient flow: duration spent on each active stage of screening and wait times, and the number of patients arriving at CHCs and clinics each hour of the day. In addition, for four CHCs, we collected time and motion data for providers, and measured provider efficiency as a ratio of active (service delivery) time to total time spent at the clinic. Results: Total duration of screening visits, at CHCs and clinics was 42 and 87 minutes, respectively (p < 0.001 for difference). Total active time lasted longer at CHCs, with a mean of 28 minutes per patient versus 15 minutes at clinics, largely due to differences in duration for group education (p < 0.001). Wait time for registration at clinics was 36 minutes, explaining most of the difference between settings, but sometimes incorporated other health services. Conclusions: There is a substantial difference in patient flow at clinics compared to CHCs. Shorter duration at CHCs suggests that the model is favorable for patients in limiting time spent on screening. Future cervical cancer screening programs designed for scale-up should consider how this advantage may enhance satisfaction and uptake. For clinic-based screening programs, efforts could be made towards reducing registration wait times.
Collapse
Affiliation(s)
- Easter Olwanda
- a Center for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya
| | - Jennifer Shen
- b Institute for Health Policy Studies , University of California , San Francisco , CA , USA
| | - James G Kahn
- b Institute for Health Policy Studies , University of California , San Francisco , CA , USA
| | | | - Megan J Huchko
- c Duke Global Health Institute , Duke University , Durham , NC , USA.,d Department of Obstetrics and Gynecology , Duke University , Durham , NC , USA
| |
Collapse
|
4
|
Are all after-hours diagnostic imaging appropriate? An Australian Emergency Department pilot study. Ann Med Surg (Lond) 2016; 12:75-78. [PMID: 27942379 PMCID: PMC5134081 DOI: 10.1016/j.amsu.2016.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This study was aimed at determining the extent to which after-hours diagnostic imaging is appropriate within the case hospital's Emergency Department. This was amid growing concerns of the inappropriateness of some medical investigations within the Australian health-care system. METHODS After-hours referral data and patient notes were used in reviewing the clinical case. Diagnostic imaging was deemed appropriate if reflective of clinical guidelines, and if not reflective, whether the investigation changed the patient's ongoing management. RESULTS Results indicated that 96.37% of after-hours diagnostic imaging adhered to clinical guidelines and was appropriately requested, with 95.85% changing the ongoing management of the patient. The most sought after diagnostic imaging procedures were Chest X-Ray (30.83%), and CT Brain (16.58%), with 99.16% and 98.44 appropriateness respectively. Chest pain (14.49%) and motor vehicle accidents (8.12%) were the leading reason for ordering after-hours imaging. CONCLUSION This study provided an Emergency Department example as it relates to after-hours diagnostic imaging appropriateness. This study found that most after-hours referrals were appropriate.
Collapse
|
5
|
Abstract
OBJECTIVE The purpose of this study was to quantify and integrate key emergency department (ED) and radiology department workflow time intervals within the ED length of stay (LOS) for patients presenting with acute abdomen who require CT. MATERIALS AND METHODS An 11-month retrospective review was performed of all patients presenting to the ED with an acute abdomen who required abdominal CT. Nine key time points associated with ED LOS and CT workflow were collected: triage, physician assessment, CT request, porter schedule, CT start, CT complete, provision of first CT report, ED disposition decision, and physical discharge. The median and 90th percentile times for each interval were reported. RESULTS Ninety-six percent (2194/2292) of ED encounters during the study period met the inclusion criteria. The median ED LOS was 9.22 hours (90th percentile, 15.7 hours). Intervals associated with CT workflow accounted for 29% of the total LOS. Radiology turnaround time accounted for 32% of the entire CT workflow interval. Timeline analysis found three unique patterns of ED disposition: disposition after initial imaging report, disposition before report, and disposition before CT. CONCLUSION To our knowledge, this study is the first to quantify the contribution of CT-related workflow time intervals within the context of ED LOS. We have shown that patients do not have identical ED transit pathways, and this may under- or overestimate time interval calculations. These results show the importance of site-specific ED LOS timeline analysis to identify potential targets for quality improvement and serve as baseline targets for measuring future quality improvement initiatives.
Collapse
|
6
|
Is there an association between radiologist turnaround time of emergency department abdominal CT studies and radiologic report quality? Emerg Radiol 2013; 21:5-10. [DOI: 10.1007/s10140-013-1164-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/19/2013] [Indexed: 11/29/2022]
|
7
|
Fernandes CM. Quality in emergency medicine: progress to date, challenges to come. CAN J EMERG MED 2013; 15:255-60. [DOI: 10.2310/8000.2012.120971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
8
|
Fernandes CM. La qualité en médecine d'urgence: progrès réalisés jusqu'à maintenant, défis à venir. CAN J EMERG MED 2013. [DOI: 10.2310/8000.120971f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
9
|
Pakmehr S, Petersen RW, Quinlivan JA. Barriers to the 4-h rule: What causes delays for gynaecology patients in the emergency department? Aust N Z J Obstet Gynaecol 2012; 53:46-50. [DOI: 10.1111/ajo.12025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/25/2012] [Indexed: 11/28/2022]
|
10
|
Breil B, Fritz F, Thiemann V, Dugas M. Mapping turnaround times (TAT) to a generic timeline: a systematic review of TAT definitions in clinical domains. BMC Med Inform Decis Mak 2011; 11:34. [PMID: 21609424 PMCID: PMC3125312 DOI: 10.1186/1472-6947-11-34] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 05/24/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Assessing turnaround times can help to analyse workflows in hospital information systems. This paper presents a systematic review of literature concerning different turnaround time definitions. Our objectives were to collect relevant literature with respect to this kind of process times in hospitals and their respective domains. We then analysed the existing definitions and summarised them in an appropriate format. METHODS Our search strategy was based on Pubmed queries and manual reviews of the bibliographies of retrieved articles. Studies were included if precise definitions of turnaround times were available. A generic timeline was designed through a consensus process to provide an overview of these definitions. RESULTS More than 1000 articles were analysed and resulted in 122 papers. Of those, 162 turnaround time definitions in different clinical domains were identified. Starting and end points vary between these domains. To illustrate those turnaround time definitions, a generic timeline was constructed using preferred terms derived from the identified definitions. The consensus process resulted in the following 15 terms: admission, order, biopsy/examination, receipt of specimen in laboratory, procedure completion, interpretation, dictation, transcription, verification, report available, delivery, physician views report, treatment, discharge and discharge letter sent. Based on this analysis, several standard terms for turnaround time definitions are proposed. CONCLUSION Using turnaround times to benchmark clinical workflows is still difficult, because even within the same clinical domain many different definitions exist. Mapping of turnaround time definitions to a generic timeline is feasible.
Collapse
Affiliation(s)
- Bernhard Breil
- Institute of Medical Informatics, University of Münster, Domagkstraße 9, 48149 Münster, Germany
| | - Fleur Fritz
- Institute of Medical Informatics, University of Münster, Domagkstraße 9, 48149 Münster, Germany
| | - Volker Thiemann
- Institute of Medical Informatics, University of Münster, Domagkstraße 9, 48149 Münster, Germany
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, Domagkstraße 9, 48149 Münster, Germany
| |
Collapse
|
11
|
Forero R, McCarthy S, Hillman K. Access block and emergency department overcrowding. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:216. [PMID: 21457507 PMCID: PMC3219412 DOI: 10.1186/cc9998] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Roberto Forero
- The Simpson Center for Health Systems Research, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
| | | | | |
Collapse
|
12
|
Abstract
Bedside staff nurses are in a unique position to identify implementation problems and ways to improve compliance with evidence-based practice guidelines. The goal of this performance improvement project was to improve compliance with an evidence-based Acute Myocardial Infarction Rapid Rule Out pathway. The purpose of the article is to demonstrate how a bedside staff nurse was able to decrease wait times and length of stay for patients with low-risk chest pain while applying evidence-based practice.
Collapse
|
13
|
Siewert B, Kruskal JB, Eisenberg R, Hall F, Sosna J. Quality initiatives: quality improvement grand rounds at Beth Israel Deaconess Medical Center: CT colonography performance review after an adverse event. Radiographics 2009; 30:23-31. [PMID: 19901086 DOI: 10.1148/rg.301095125] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
As computed tomographic (CT) colonography is being used increasingly in clinical practice, an effective quality improvement process must be ensured. The quality improvement process is outlined for the reader by using an adverse event during CT colonography as an example. Components of this process are the approach to a sentinel event, performance of a root cause analysis, and development of strategies for minimizing errors after a serious adverse event. Important factors include indications and contraindications for the examination, proper imaging technique, training of personnel, complications of the procedure, and legal implications. Complications from CT colonography are rare. Attention must be paid to the correct technique for colonic insufflation, particularly in older patients and those who are symptomatic. Root cause analysis provides valuable tools for identification and implementation of improvements designed to avoid similar and other adverse events and to minimize damage.
Collapse
Affiliation(s)
- Bettina Siewert
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
| | | | | | | | | |
Collapse
|
14
|
Fisher J, Lotery H, Henderson C. Time in Motion—Testing Efficiency in the Dermatology Procedure Setting. Dermatol Surg 2009; 35:437-44; discussion 445. [DOI: 10.1111/j.1524-4725.2009.01076.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
15
|
Kruskal JB, Siewert B, Anderson SW, Eisenberg RL, Sosna J. Managing an Acute Adverse Event in a Radiology Department. Radiographics 2008; 28:1237-50. [DOI: 10.1148/rg.285085064] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|