Ultrasound in legal medicine—a missed opportunity or simply too late? A narrative review of ultrasonic applications in forensic contexts

Objectives Conventional autopsies remain the gold standard of postmortem healthcare quality assurance and help gathering extended knowledge on diseases. In answer to constantly declining autopsy rates non- or minimally invasive autopsy methods were introduced. Ultrasound is a well-established tool for imaging commonly used in clinical practice. This narrative review aims to summarize the current literature regarding the feasibility and validity of ultrasound in a forensic context. Material and methods A PubMed database search was carried out. Abstracts were scanned for pre-defined ex- and inclusion criteria, followed by a snowball search procedure applied to the primarily included articles. Results Forty-five publications met our inclusion criteria. The selected articles concern the feasibility of ultrasound in pre- or postmortem settings, forensic age estimation, and minimally invasive approaches. For imaging, ultrasound was deemed a reliable tool for the examination of epiphyses und superficial wounds, with limitations regarding internal organs and image quality due to postmortem changes. Ultrasound-guided minimally invasive approaches yielded higher success rates for adequate tissue sampling. Many investigations were carried out in low- and middle-income countries focusing on infectious diseases. Conclusion Ultrasound seems a promising but underutilized imaging tool in legal medicine to date. Promising approaches on its feasibility have been conducted. Especially for minimally invasive methods, ultrasound offered significant improvements on qualified biopsy sampling and thus appropriate diagnostics. Moreover, ultrasonic evaluation of epiphyses for age estimation offered valuable results. Nevertheless, further assessment of ultrasonic feasibility in forensic contexts is needed.

Implementing Lean Management Techniques at a Radiation Oncology Department

Objectives: Lean management (LM) principles were first developed by a Japanese manufacturing company to maximise value and minimise waste in the automotive industry. However, these principles can also be applied in the healthcare sector. This study aimed to illustrate the process of implementing LM principles in a radiation oncology department to streamline workflow and identify and reduce waste. Methods: This study took place in the Department of Radiation Oncology, Royal Hospital, Muscat, Oman, in December 2016. A value stream map (VSM) was created for the chain of processes followed in the department. A waste analysis was conducted to determine which processes did not add value for the patient or healthcare provider. Results: Based on the VSM analysis, only six out of 13 steps were found to be of value. Necessary and unnecessary non-value-adding activities were identified. Sources of waste included parking and registration. In addition, variabilities in workload were noted. Conclusion: Overall, LM principles improve workflow, reduce waste and enhance patient and staff satisfaction. In the current study, the application of LM principles helped to improve value in a radiation oncology department.Keywords: Health Services Administration; Healthcare Quality Assurance; Total Quality Management; Organization and Administration; Efficiency; Oman.

Towards a framework for teaching about information technology risk in health care: Simulating threats to health data and patient safety

In this paper the author describes work towards developing an integrative framework for educating health information technology professionals about technology risk. The framework considers multiple sources of risk to health data quality and integrity that can result from the use of health information technology (HIT) and can be used to teach health professional students about these risks when using health technologies. This framework encompasses issues and problems that may arise from varied sources, including intentional alterations (e.g. resulting from hacking and security breaches) as well as unintentional breaches and corruption of data (e.g. resulting from technical problems, or from technology-induced errors). The framework that is described has several levels: the level of human factors and usability of HIT, the level of monitoring of security and accuracy, the HIT architectural level, the level of operational and physical checks, the level of healthcare quality assurance policies and the data risk management strategies level. Approaches to monitoring and simulation of risk are also discussed, including a discussion of an innovative approach to monitoring potential quality issues. This is followed by a discussion of the application (using computer simulations) to educate both students and health information technology professionals about the impact and spread of technology-induced and related types of data errors involving HIT.

Achieve Sustainable Hospital Excellence Through 5-S in an Emergency Department in Hong Kong

5-S is the first step towards TQM. Over the last century, the Japanese have formalised the technique and named it as 5-S Practice. Since 1993, Sam Ho has improved and defined its terms in English/Chinese and developed the world's first 5-S Audit Checklist. In the article, an emergency department of a Hong Kong hospital was examined against 5-S 50-point Checklist for the improvement of their quality assurance systems towards its accreditation process with Australian standards. The findings evidently reveal that the impact of 5-S on hospital quality assurance in the unit are positive. Riding on the above scenario, the research aim is to identify whether the 5-S practice is a suitable and effective tool for healthcare quality assurance in an emergency setting which is led towards its accreditation process set by other mechanisms.

An integrated approach for prioritized process improvement

Purpose – The purpose of this paper is to propose an integrated framework to simultaneously identify and improve healthcare processes that are important from the healthcare provider's and patient's perspectives. Design/methodology/approach – A modified quality function deployment (QFD) chart is introduced to the field of healthcare quality assurance. A healthcare service example is used to demonstrate the utility of the proposed chart. Findings – The proposed framework is versatile and can be used in a wide variety of healthcare quality improvement contexts, wherein, two different perspectives are needed to be considered for identifying and improving critical healthcare processes. Practical implications – The modified QFD chart used in conjunction with the stacked Pareto chart will facilitate the identification of key performance metrics from the patient's and the hospital's perspectives. Subsequently, the chief contributory factors at different levels are identified in a very efficient manner. Originality/value – Healthcare quality improvement professionals will be able to use the proposed modified QFD chart in association with stacked Pareto chart for effective quality assurance.

Value-added laboratory medicine in an era of managed care

Clinical laboratory consultants (M.D.s and Ph.D.s) must add value and medical relevance to the healthcare system to earn and maintain their roles in an era of managed care. Service opportunities include new and expanded roles in system-wide (a) managing of point-of-care testing, (b) informatics and information systems, (c) clinical consultation, (d) resource management, (e) management of utilization, (f) improving healthcare quality assurance, and (g) technology assessment and implementation. Hypothesis-driven research focused on the linkage between the laboratory and outcome analysis, clinical practice guidelines, total quality improvement, technology assessment, and healthcare policy provides major opportunities to complete for expanding research support. Changes in clinical laboratory consultant training are necessary to provide the knowledge, skills, and experience required to provide value-added and medically relevant services. Clinical laboratory consultants with Ph.D. degrees should initially be trained broadly in all areas of the laboratory, with emphasis on system-wide issues, and then trained as specialized scientists.