Breast Imaging Second Opinion Consultation: A Single Institution’s Process of Improvement and Reform

2020 ◽  
Vol 2 (3) ◽  
pp. 232-239
Author(s):  
Luke Freiburg ◽  
Sonya Bhole ◽  
Elona Liko Hazizi ◽  
Sarah M Friedewald
Keyword(s):  
Quality Improvement ◽  
Breast Imaging ◽  
Tertiary Care ◽  
Turnaround Time ◽  
Second Opinion ◽  
Final Report ◽  
Process Data ◽  
Improvement Project ◽  
Report Turnaround Time ◽  
Before And After

Abstract Objective To review a single institution’s second opinion breast imaging process, data tracking, and metrics before and after implementing quality improvement changes and the effect on report turnaround time. Methods This Institutional Review Board approved retrospective quality improvement project was performed at a tertiary-care academic medical center and included patients 18 years or older who submitted their outside facility imaging for reinterpretation (any combination of mammography, breast ultrasonography, and/or magnetic resonance imaging performed within the last six months) with finalized second opinion reports between June 1, 2016, and July 17, 2017. Significant intradepartmental changes were implemented March 2017 with the goal to improve second opinion report turnaround time. Key metrics from 399 studies were analyzed before and after implemented changes. Two-sided Fisher’s exact test was used to assess the significance of results. Results After department interventions, the percentage of outside reports available at the time of surgical consultation improved from 82% (213/259) to 91% (127/140), an 11% improvement (P < 0.05). The average number of days from initial second opinion consultation to the availability of final report improved from 10.2 days to 9 days, a 12% improvement. Prior to the changes, the number of days it took a radiologist to complete a report varied from 1 to 4 days, but afterwards was consistently 1 day or less. Conclusion Implementation of second opinion intradepartmental changes demonstrated a significant improvement in report turnaround time and the number of finalized reports available at the time of surgical consultation. An efficient second opinion process is crucial to a breast imaging center, as it ultimately expedites patient surgical and oncological care.

scholarly journals Impact of an in-house emergency radiologist on report turnaround time

CJEM ◽  
2015 ◽  
Vol 17 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Leslie Lamb ◽  
Paria Kashani ◽  
John Ryan ◽  
Guy Hebert ◽  
Adnan Sheikh ◽  
...  
Keyword(s):  
Patient Care ◽  
Emergency Radiology ◽  
Time Frame ◽  
Turnaround Time ◽  
Time Interval ◽  
Final Report ◽  
Radiology Resident ◽  
Cross Sectional ◽  
Patient Disposition ◽  
Report Turnaround Time

AbstractBackgroundOne of the many challenges facing emergency departments (EDs) across North America is timely access to emergency radiology services. Academic institutions, which are typically also regional referral centres, frequently require cross-sectional studies to be performed 24 hours a day with expedited final reports to accelerate patient care and ED flow.ObjectiveThe purpose of this study was to determine if the presence of an in-house radiologist, in addition to a radiology resident dedicated to the ED, had a significant impact on report turnaround time.MethodsPreliminary and final report turnaround times, provided by the radiology resident and staff, respectively, for patients undergoing computed tomography or ultrasonography of their abdomen/pelvis in 2008 (before the implementation of emergency radiology in-house staff service) were compared to those performed during the same time frame in 2009 and 2010 (after staffing protocols were changed).ResultsA total of 1,624 reports were reviewed. Overall, there was no statistically significant decrease in the preliminary report turnaround times between 2008 and 2009 (p = 0.1102), 2009 and 2010 (p = 0.6232), or 2008 and 2010 (p = 0.0890), although times consistently decreased from a median of 2.40 hours to 2.08 hours to 2.05 hours (2008 to 2009 to 2010). There was a statistically significant decrease in final report turnaround times between 2008 and 2009 (p < 0.0001), 2009 and 2010 (p < 0.0011), and 2008 and 2010 (p < 0.0001). Median final report times decreased from 5.00 hours to 3.08 hours to 2.75 hours in 2008, 2009, and 2010, respectively. There was also a significant decrease in the time interval between preliminary and final reports between 2008 and 2009 (p < 0.0001) and 2008 and 2010 (p < 0.0001) but no significant change between 2009 and 2010 (p = 0.4144).ConclusionOur results indicate that the presence of a dedicated ED radiologist significantly reduces final report turnaround time and thus may positively impact the time to ED patient disposition. Patient care is improved when attending radiologists are immediately available to read complex films, both in terms of health care outcomes and regarding the need for repeat testing. Providing emergency physicians with accurate imaging findings as rapidly as possible facilitates effective and timely management and thus optimizes patient care.

scholarly journals Surgical Pathology Resident Rotation Restructuring at a Tertiary Care Academic Center

2017 ◽  
Vol 4 ◽  
pp. 237428951773634
Author(s):  
Chelsea R. Mehr ◽  
Amrom E. Obstfeld ◽  
Amanda C. Barrett ◽  
Kathleen T. Montone ◽  
Lauren E. Schwartz
Keyword(s):  
Resident Education ◽  
Tertiary Care ◽  
Turnaround Time ◽  
Surgical Pathology ◽  
Primary Sources ◽  
Road Map ◽  
Academic Center ◽  
Organ Systems ◽  
Before And After ◽  
Time Required

Changes in the field of pathology and resident education necessitate ongoing evaluation of residency training. Evolutionary change is particularly important for surgical pathology rotations, which form the core of anatomic pathology training programs. In the past, we organized this rotation based on subjective insight. When faced with the recent need to restructure the rotation, we strove for a more evidence-based process. Our approach involved 2 primary sources of data. We quantified the number of cases and blocks submitted per case type to estimate workload and surveyed residents about the time required to gross specimens in all organ systems. A multidisciplinary committee including faculty, residents, and staff evaluated the results and used the data to model how various changes to the rotation would affect resident workload, turnaround time, and other variables. Finally, we identified rotation structures that equally distributed work and created a point-based system that capped grossing time for residents of different experience. Following implementation, we retrospectively compared turnaround time and duty hour violations before and after these changes and surveyed residents about their experiences with both systems. We evaluated the accuracy of the point-based system by examining grossing times and comparing them to the assigned point values. We found overall improvement in the rotation following the implementation. As there is essentially no literature on the subject of surgical pathology rotation organization, we hope that our experience will provide a road map to improve pathology resident education at other institutions.

Effectiveness of Probiotic for Primary Prevention of Clostridium difficile Infection: A Single-Center Before-and-After Quality Improvement Intervention at a Tertiary-Care Medical Center

2018 ◽  
Vol 39 (07) ◽  
pp. 765-770 ◽  
Author(s):  
William E. Trick ◽  
Stephen J. Sokalski ◽  
Stuart Johnson ◽  
Kristen L. Bunnell ◽  
Joseph Levato ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Primary Prevention ◽  
Clostridium Difficile ◽  
Incidence Rate ◽  
Tertiary Care ◽  
Prophylactic Antibiotic ◽  
Quality Improvement Intervention ◽  
Tertiary Care Medical Center ◽  
Before And After ◽  
Improvement Intervention

OBJECTIVETo evaluate probiotics for the primary prevention of Clostridium difficile infection (CDI) among hospital inpatients.DESIGNA before-and-after quality improvement intervention comparing 12-month baseline and intervention periods.SETTINGA 694-bed teaching hospital.INTERVENTIONWe administered a multispecies probiotic comprising L. acidophilus (CL1285), L. casei (LBC80R), and L. rhamnosus (CLR2) to eligible antibiotic recipients within 12 hours of initial antibiotic receipt through 5 days after final dose. We excluded (1) all patients on neonatal, pediatric and oncology wards; (2) all individuals receiving perioperative prophylactic antibiotic recipients; (3) all those restricted from oral intake; and (4) those with pancreatitis, leukopenia, or posttransplant. We defined CDI by symptoms plus C. difficile toxin detection by polymerase chain reaction. Our primary outcome was hospital-onset CDI incidence on eligible hospital units, analyzed using segmented regression.RESULTSThe study included 251 CDI episodes among 360,016 patient days during the baseline and intervention periods, and the incidence rate was 7.0 per 10,000 patient days. The incidence rate was similar during baseline and intervention periods (6.9 vs 7.0 per 10,000 patient days; P=.95). However, compared to the first 6 months of the intervention, we detected a significant decrease in CDI during the final 6 months (incidence rate ratio, 0.6; 95% confidence interval, 0.4–0.9; P=.009). Testing intensity remained stable between the baseline and intervention periods: 19% versus 20% of stools tested were C. difficile positive by PCR, respectively. From medical record reviews, only 26% of eligible patients received a probiotic per the protocol.CONCLUSIONSDespite poor adherence to the protocol, there was a reduction in the incidence of CDI during the intervention, which was delayed ~6 months after introducing probiotic for primary prevention.Infect Control Hosp Epidemiol 2018;765–770

Reducing the Contamination Rate and the Unnecessary Requesting of Blood Culture Test through Quality Improvement Project

2021 ◽  
Vol 30 (1) ◽  
pp. 87-91
Author(s):  
Tamer Mohamed ◽  
Ashraf A Askar ◽  
Jamila Chahed
Keyword(s):  
Quality Improvement ◽  
Blood Culture ◽  
Armed Forces ◽  
Blood Cultures ◽  
Quality Improvement Project ◽  
Contamination Rate ◽  
Improvement Project ◽  
Culture Test ◽  
Negative Results ◽  
Before And After

Background: Blood stream infections are major leading causes of morbidity and mortality in hospitalized patients. Increasing the awareness of the clinicians and nurses about the proper protocol of blood culture test is very important in reducing the contamination rate and the unnecessary requesting of blood culture. Objectives: to reduce the contamination rate and the unnecessary requesting of blood culture from different departments through implementation of hospital wide Quality Improvement Project (QIP). Methodology: Blood cultures were tested in the Microbiology Laboratory of Najran Armed Forces hospital, Saudi Arabia, in the period from June 2019 to July 2020 and their results were compared before and after the implementation of the QIP. Results: The comparison between the blood cultures results before and after QIP implementation showed statistically significant (19.6%) reduction in the contamination rate, (14%) reduction in the total number of blood culture requests and (11.6%) reduction in the negative results rate. Conclusion: The reduction in the total number, negative results and contamination rate of blood culture test after QIP implementation were considered as performance indicators that the recommendations of QIP were effective and implemented strictly.

scholarly journals P023: Code Resus - using a quality improvement approach to improve health care provider response during resuscitations

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S86-S86
Author(s):  
L.B. Chartier ◽  
S. Hansen ◽  
D. Lim ◽  
S. Yi ◽  
B. McGovern ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Care Providers ◽  
Rating Scale ◽  
Tertiary Care ◽  
Care Hospital ◽  
Care Providers ◽  
Change Initiatives ◽  
Chi Square ◽  
Before And After

Introduction: In order to achieve the best possible outcomes for patients requiring resuscitation (PRRs) in the emergency department (ED), health care providers (HCPs) must provide an efficient, multi-disciplinary and coordinated response. A quality improvement (QI) project was undertaken to improve HCP response to PRRs at two tertiary care hospital EDs in Toronto. Methods: We conducted a before-and-after mixed-method survey to evaluate the perception of the adequacy of HCP response and clarity of HCP role when responding to PRRs. The results were compared using the Chi-square test. Qualitative responses to the first survey were also used to inform the development of the QI project. Through interviews of key stakeholders and with continuous input from front-line ED HCPs, a multi-disciplinary team modified the ED resuscitation protocol. This included standardized pre-hospital communication form with paramedics, ED-wide overhead announcement of ‘Code Resus’, dedicated HCPs assigned to respond to PRRs, and specific duties assigned to each responder. Change initiatives were reinforced through education and posters in the ED. Six months after implementation, a second survey was conducted to evaluate the sustained effects of the intervention. Results: Baseline measures indicated that 16 of 52 (30.8%) nurses surveyed believed their role was often or always apparent to themselves and others when they attended to a PRR (on a 5-point rating scale). This proportion increased to 35 of 55 (63.6%) nurses in the post-implementation survey (p < 0.001). Regarding adequacy of the number of HCPs responding to PRRs, 17 of 39 (43.6%) physicians and 23 of 53 (43.4%) nurses surveyed thought the appropriate number of HCPs responded to PRRs; the remainder thought that there were too few or too many HCPs. In the post-implementation survey, 34 of 41 (82.9%) physicians (p < 0.001) and 36 of 56 (64.3%) nurses (p = 0.029) surveyed felt that the appropriate number of HCPs attended to PRRs. Conclusion: Using a quality improvement approach, we identified and quantified perceived deficiencies in HCP response to PRRs in the ED. Through feedback-based modifications of the ED resuscitation protocol and by engaging HCP stakeholders, change initiatives were implemented to improve HCP response. As a result, this project achieved significant and sustained improvements in HCPs’ perceived response to PRRs.

Barriers to receipt of novel oral oncolytics: A single-institution quality improvement investigation

2019 ◽  
Vol 26 (2) ◽  
pp. 279-285
Author(s):  
Ann A Wang ◽  
Christopher Tapia ◽  
Yasin Bhanji ◽  
Christopher Campbell ◽  
Daniel Larsen ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Care Center ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Wait Times ◽  
Prescription Data ◽  
Electronic Prescription ◽  
Improvement Project ◽  
Pharmacy Claims ◽  
Oral Oncolytics

Introduction Novel oral oncolytic agents have become the standard of care and first-line therapies for many malignancies. However, issues impacting access to these drugs are not well explored. As part of a quality improvement project in a large tertiary academic institution, we aim to identify potential barriers that delay treatment for patients who are prescribed novel oral oncolytics. Methods This was a retrospective review of adults who were newly prescribed a novel oral oncolytic for Food and Drug Administration-approved indications at a single tertiary care center. Patients were identified via electronic prescription data (e-Scribe). Demographics, insurance information, and prescription dates were extracted from the electronic medical record and pharmacy claims data. Statistical analyses were performed to determine whether time-to-receipt was associated with insurance category, pharmacy transfers, cost assistance, and drug prescribed. Results Of the 270 successfully filled prescriptions, the mean time-to-receipt was 7.3 ± 10.3 days (range: 0–109 days). Patients with Medicare experienced longer time-to-receipt (9.1 ± 13.1 days) compared to patients with commercial insurance (4.4 ± 3.3). Uninsured patients experienced the longest time-to-receipt (15.7 ± 7.8 days) overall. Pharmacy transfers and cost assistance programs were also significantly associated with longer time-to-receipt. Ten prescriptions remained unfilled 90 days after the study period and were considered abandoned. Conclusion Insurance has a significant effect on the time-to-receipt of newly prescribed novel oral oncolytics. Pharmacy transfers and applying for cost assistance are also associated with longer wait times for patients. Our retrospective analysis identifies areas of improvement for future interventions to reduce wait times for patients receiving novel oral oncolytics.

scholarly journals Prevalence of Iron Deficiency in Pregnancy: A Single Centre Canadian Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4896-4896
Author(s):  
Grace Tang ◽  
Andrea Lausman ◽  
Jessica Petrucci ◽  
Jameel Abdulrehman ◽  
Rosane Nisenbaum ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Iron Deficiency ◽  
Pregnant Women ◽  
Serum Ferritin ◽  
Iron Status ◽  
Tertiary Care ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Iron Deficient ◽  
In Pregnancy

Abstract Background Iron deficiency (ID) is the most common and widespread nutritional deficiency in both developing and developed countries (WHO, 2001; Mei et al., 2011). Women of child bearing age are at the highest risk, but this risk increases even more during pregnancy. The expansion of blood volume, growth of the fetus and placenta increase demand for iron to approximately 5.0mg/day by the third trimester (Met et al., 2011). Common symptoms of ID during pregnancy include fatigue, shortness of breath, and difficulty concentrating (WHO, 2001). Poor prenatal iron status is associated with diminished cognitive performance, language ability, and motor functions in the child (Tamura et al, 2002). For the mother, it is associated with risk of blood transfusion and post-partum depression. Despite international recommendations and guidelines on the management of ID in pregnancy, it remains a problem of epidemic proportions and is often unrecognized and left untreated. To increase awareness of ID, a quality improvement project, IRON Deficiency project in Pregnancy: Maternal Iron Optimization (IRON MOM) was implemented January 1st, 2017 at St. Michael's Hospital (SMH), in Toronto, Canada. Phase 1 of the project involved adapting lab requisitions and workflow in the obstetrics clinic to incorporate routine measurement of ferritin in week 12, 16 and 28 of pregnancy. As part of the IRON MOM, laboratory requisitions were modified to include ferritin as part of routine screening for all pregnant women. Objective The primary objective of this study was to assess the prevalence of ID in pregnant women consistently screened for ID after the implementation of the IRON MOM quality improvement project at a tertiary hospital in Toronto, Canada. Methods Administrative laboratory data was collected from the electronic medical record system at SMH, Toronto, Canada between January 1 and December 31, 2017. Suboptimal iron stores was defined as serum ferritin between 30-50μg/L. ID was defined as serum ferritin between 15-29μg/L, and severe ID was defined as <15μg/L. Significant anemia was defined as hemoglobin levels <100 g/L. Descriptive statistics were used to calculate proportions. SAS version 9.4 was used to perform the analyses. Results In 2017, 2400 ferritin tests were completed on pregnant women at our institution. A total of 76.8% (1844/2400) of tests demonstrated iron deficiency with a ferritin <30μg/L. Of those, 30.2% (726/2400) had ferritin between 15-29μg/L, and 46.6% (1118/2400) were severely iron deficient with a ferritin <15μg/L (Figure 1). 3282 hemoglobin checks, at delivery, occurred in this same one-year period and 10.5% (345/3282) were significantly anemic (<100 g/L). Of those, 6.2% (204/3282) had hemoglobin levels between 90-99g/L, 2.6% (85/3282) had hemoglobin levels between 80-89g/L, and 1.7% (56/3282) had hemoglobin levels <80g/L. Conclusion We found an extremely high prevalence of ID in our pregnant patient population. This confirms that ID remains an underappreciated problem, even at a tertiary care centre. Our findings highlight a tremendous gap in awareness, which demands strategies to improve knowledge translation. Future directions include the simplification and digitization of IRON MOM to empower pregnant patients to advocate for their care. Figure 1. Figure 1. Disclosures Lausman: Ferring: Other: gave a talk.

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