Reducing Unnecessary Portable Pelvic Radiographs in Trauma Patients: A Resident-Driven Quality Improvement Initiative

Langer, Jessica M.; Tsai, Emily B.; Luhar, Aarti; McWilliams, J.; Motamedi, Kambiz

doi:10.1016/j.jacr.2015.02.015

Cited by 4 publications

(5 citation statements)

References 5 publications

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“…The majority of included studies targeted physicians (51%, n = 38) 14–51 . Provider teams in dyads or multidisciplinary groups of physicians, nurses, and other health care providers were targeted in 30 studies (40.5%) 52–81 . Other studies targeted nurses (n = 2), 82,83 social workers (n = 1), 84 occupational therapists (n = 1), 85 or medical trainees (n = 2) 86,87 .…”

Section: Resultsmentioning

confidence: 99%

Quality of Reporting on Guideline, Protocol, or Algorithm Implementation in Adult Trauma Centers

Conn¹,

Nathens

Perrier

et al. 2019

Annals of Surgery

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Section: Resultsmentioning

confidence: 99%

Quality of Reporting on Guideline, Protocol, or Algorithm Implementation in Adult Trauma Centers

Conn¹,

Nathens

Perrier

et al. 2019

Annals of Surgery

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“…Health-care improvement through the reduction of unnecessary medical imaging tests has been extensively analyzed in previous quality assurance projects. [15][16][17][18] Our study is unique in examining the effect of guidelines specific to the request of mobile chest radiographs as opposed to standard departmental exams. The Canadian Agency for Drugs and Technologies has identified this to be an area within medical imaging that lacks information regarding clinical effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary Development of Mobile Radiography Guidelines Reduced the Number of Inappropriate Mobile Exams in Patients Receiving Chest Radiographs in British Columbia

et al. 2020

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Aim: To decrease the number of mobile chest radiograph requests for inpatients in British Columbia who are medically able to tolerate transport to the main department by introducing and implementing request criteria. Method: Concerns regarding inappropriate mobile exam requests in patients receiving chest radiography were surveyed at 28 medical imaging sites. In response, a multidisciplinary team composed a set of mobile radiography request guidelines incorporating feedback from all sites. These were successfully implemented along with in-person education to 21 sites. The number of adult annual mobile chest radiographs was tracked from 2014 to 2018, and informal feedback was obtained from participating sites. Results: The percentage of mobile chest radiographs of all chest radiographs performed between 2014 and 2018 decreased by 3.2%, while the total number of all chest radiographs performed during this time, including both departmental and mobile, increased by 1.9%. Sites reported positive engagement with the initiative and expressed need for ongoing education to optimize its effect. Conclusion: Implementation of request guidelines with in-person education helped to reduce inappropriate mobile exams in patients receiving chest radiographs in British Columbia between 2014 and 2018. These guidelines promote patient safety through reduced radiation exposure, empower radiographers to mitigate inappropriate requests, and help to optimize use of limited hospital resources by reducing inappropriate mobile exams where routine departmental exams are more suitable.

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“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] The median duration of the interventions was 11 months with 7 projects having fewer than 12 months of follow-up, 9 projects having no follow-up beyond 1 year, and only 2 projects having more than 12 months of follow-up. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Sustainability was rarely cited as a clear aim, although multiple studies cite it as a limitation or challenge. [16][17][18] Furthermore, these studies actually may overestimate sustainability of resident QI given publication bias, with sustained interventions being more likely to be published and cited.…”

Section: Discussionmentioning

confidence: 99%

“…Residents are in a unique position to engage in QI efforts given their frontline role in the health care system, and many successful resident-led QI initiatives have been published in recent literature. 3-20 However, most lack follow-up beyond the year of implementation. Success and sustainability of resident QI initiatives face fundamental barriers including competing clinical obligations, distribution of learners across multiple sites, and frequent turnover of residents as they move from site to site or graduate from the program.…”

mentioning

confidence: 99%

“…Success and sustainability of resident QI initiatives face fundamental barriers including competing clinical obligations, distribution of learners across multiple sites, and frequent turnover of residents as they move from site to site or graduate from the program. 3-18 There is increasing recognition that QI initiatives that are not sustained can result in frontline staff developing cynicism and resistance to QI. 21 Although resident engagement in QI is increasing, there is a paucity of literature evaluating the sustainability of resident-led QI initiatives and the effect of sustainability on resident perceptions of QI.…”

mentioning

confidence: 99%

See 1 more Smart Citation

A Discharge Time-Out: A Case Study on Physician–Nurse Discharge Communication and the Challenge of Sustainability in Resident-Led Quality Improvement

et al. 2018

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Resident-led quality improvement (QI) is an important component of resident education yet sustainability of improvement and impact on resident education have rarely been explored. This study describes a resident-led intervention to improve nursing (RN)–provider (MD) communication at discharge—the Discharge Time-Out (DTO)— and explores its uptake and sustainability. One year later, residents were surveyed regarding QI self-efficacy and planned QI involvement. Baseline verbal RN–MD communication at discharge was rare. During DTO implementation, rates of structured communication averaged 56% (341/608) with several months >70%. During the monitoring phase, this fell to 45% and did not recover (833/1852). Participating residents reported increased QI self-efficacy ( P < .05) and increased likelihood of participating in future QI ( P < .05). The DTO increased RN–MD communication but was not sustained. Resident-led QI should explicitly address sustainability to achieve improvement and educational objectives. To foster resident education and avoid short-lived, low-impact projects, increased attention should be given to sustainability of resident-led QI.

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Reducing Unnecessary Portable Pelvic Radiographs in Trauma Patients: A Resident-Driven Quality Improvement Initiative

Cited by 4 publications

References 5 publications

Quality of Reporting on Guideline, Protocol, or Algorithm Implementation in Adult Trauma Centers

Quality of Reporting on Guideline, Protocol, or Algorithm Implementation in Adult Trauma Centers

Multidisciplinary Development of Mobile Radiography Guidelines Reduced the Number of Inappropriate Mobile Exams in Patients Receiving Chest Radiographs in British Columbia

A Discharge Time-Out: A Case Study on Physician–Nurse Discharge Communication and the Challenge of Sustainability in Resident-Led Quality Improvement

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