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Audit of imaging of TIA'S (transient ischaemic attacks) in James Cook University Hospital Middlesbrough
S14
Abstracts / Clinical Radiology 67 (2012) S11–S20
assesses the radiologist report after x-ray confirmation of tube placement following initial insertion prior to feeding. Standard, indicator and target: When the request indicates check nasogastric tube placement, the radiologist reporting the chest x-ray must document: 1. Position of the nasogastric tube and tip, 2. Whether it is safe to proceed with the administration of any liquids via the tube. Target for each is 100% Methodology: 54 chest x-ray reports with indication for nasogastric tube placement reviewed from January to March 2012. Following are assessed 1. Grade of person reporting the x-ray 2. Wording in chest x-ray indicating position of tip of nasogastric tube and whether safe/ unsafe for feeding assessed. Results of 1st audit round: 1. Radiology report states position of nasogastric tube - 100% 2. Radiology report states whether safe to proceed with administration of liquids via the tube 74% 1st action plan: Present audit results to Radiology Audit forum and remind NPSA guideline to reporting. Re-audit in 6 months.
Imaging of pituitary macroadenomas after surgery in neuroradiology department James Cook University Hospital Middlesbrough Authors: Elena A. Cora, Rajeev Padmanabhan, Lauren Harris Background to the audit: Pituitary adenomas are the most common tumours in the sellar region accounting for 10-15% of all intracranial tumours. Tumours over 10mm are defined as macroadenomas. This audit analysed the local practice in follow-up imaging of post-surgical pituitary adenoma cases. Standard, indicator and target: The standard used is the RCR guidance: Recommendations for Cross-Sectional Imaging in Cancer Management (Ref No: RCR(06)1). We specifically looked at the MRI sequences advised for macroadenomas and noted that contrast is not recommended. Methodology: Retrospective audit on imaging of macroadenomas after surgery. Consecutive cases were identified by doing a keyword search in the neuroradiological database. Data acquired on: 1. MRI scan sequences 2. Contrast administration Results of 1st audit round: 88% of patients had the MRI sequences recommended by the RCR. 97% of patients received contrast. 1st action plan: Stop using contrast in these patients as this would benefit the department financially and will also help to increase the availability of the MR machine for other studies. The radiographers and radiologists were educated with regards to this. Results of 2nd round: 100% of patients had the MRI sequences recommended. 6% of patients received contrast. 2nd action plan: Reinforce the positive results of the second audit and remind radiographers and radiologists that contrast is not needed. Develop a pro-forma to be used locally that the radiographers could easily refer to if needed.
Methodology: A retrospective study of 51 consecutive cases (between 23/5/2011 to 05/09/2011) where the radiology request cards mentioned TIA as the diagnosis. Referrals were assessed for: 1. Source of referral (stroke specialist or else) 2. The time from symptoms onset to imaging based on the patient's risk category (ABCD2 score) 3. Modality of brain imaging Results of 1st audit round: All patients had imaging done within the recommended time period. CT scanning was used almost exclusively as the primary intracranial imaging modality. NICE recommends DWI MRI as the investigation of choice in TIA. Only 4 patients in the high risk group and 3 in the low risk group had an MRI after initial negative CT scans. 4 patients had contraindications for MRI scanning. 90% of patients were assessed by a stroke physician. The source of referral did not have any effect on this imaging pathway. 1st action plan: Increase awareness of NICE guidance in TIA imaging. Presentation to the hospital management in order to increase the funding for MRI Improve access to MR scanning Re-audit in 6 months.
Breast screening assessment: the introduction of double consultant clinics Authors: Joanna Dixon, L.G. Lunt Background to the audit: Plans to extend the NHS Breast Screening Programme to a wider population will result in more patients being recalled to assessment clinic. To cope with increasing demand attempts must be made to maximise clinic efficiency without compromising care in this vulnerable patient group. Double consultant clinics have economic and clinical benefits over single clinics, this audit aims to show there is no negative impact on patients in terms of duration of clinic appointment or time spent awaiting preliminary results. Standard, indicator and target: Local standards were derived from current practice (single clinics). (1) Average appointment duration for patients discharged from clinic at first attendance ¼ 00:13:37 (hh:mm:ss). (2) Average waiting time for preliminary results following biopsy ¼ 01:37:00. Target: Indicators for double clinics should not exceed those of single clinics. Methodology: Data collected from 80 single clinics (452 patients, Oct 09Sept 10) to determine the local standard and 74 double clinics (718 patients, Sept 09-Dec 10). Results of 1st audit round: Standard (1) is less for double clinics (00:12:42) than single clinics (00:13:37). Standard (2) is less for double clinics (01:31:38) than single clinics (01:37:00). The implementation of double consultant clinics does not increase the average appointment duration or the time waited for preliminary results. 1st action plan: Full implementation of double clinics with a view to reaudit to ensure sustained improvement.
MRI staging of locally advanced rectal cancer post chemoradiotherapy: comparison with postoperative histology Audit of imaging of TIA'S (transient ischaemic attacks) in James Cook University Hospital Middlesbrough Authors: Elena A. Cora, Rajeev Padmanabhan Background to the audit: TIA is a neurological syndrome suggestive of a stroke that resolves within 24 hours. A large proportion of patients with TIA proceed to stroke. This audit looks at the current practice in imaging of TIA patients in our hospital. Standard, indicator and target: NICE guidance document CG68 (2008) subsection 1.2- Imaging in people who have had a suspected TIA or nondisabling stroke.
Authors: Catriona Farrell, Karthik Gopal Background to the audit: Combined chemoradiotherapy treatment (CCRT) is used in the treatment of some extra-mural rectal cancers to reduce the risk of involvement of the circumferential resection margin at surgical excision and hence reduce risk of recurrence. Standard, indicator and target: This audit compared MRI staging of rectal cancer after treatment with CCRT with the histological staging of the resected tumour. Published data from other centres were used as a standard to assess local performance.
Abstracts / Clinical Radiology 67 (2012) S11–S20
assesses the radiologist report after x-ray confirmation of tube placement following initial insertion prior to feeding. Standard, indicator and target: When the request indicates check nasogastric tube placement, the radiologist reporting the chest x-ray must document: 1. Position of the nasogastric tube and tip, 2. Whether it is safe to proceed with the administration of any liquids via the tube. Target for each is 100% Methodology: 54 chest x-ray reports with indication for nasogastric tube placement reviewed from January to March 2012. Following are assessed 1. Grade of person reporting the x-ray 2. Wording in chest x-ray indicating position of tip of nasogastric tube and whether safe/ unsafe for feeding assessed. Results of 1st audit round: 1. Radiology report states position of nasogastric tube - 100% 2. Radiology report states whether safe to proceed with administration of liquids via the tube 74% 1st action plan: Present audit results to Radiology Audit forum and remind NPSA guideline to reporting. Re-audit in 6 months.
Imaging of pituitary macroadenomas after surgery in neuroradiology department James Cook University Hospital Middlesbrough Authors: Elena A. Cora, Rajeev Padmanabhan, Lauren Harris Background to the audit: Pituitary adenomas are the most common tumours in the sellar region accounting for 10-15% of all intracranial tumours. Tumours over 10mm are defined as macroadenomas. This audit analysed the local practice in follow-up imaging of post-surgical pituitary adenoma cases. Standard, indicator and target: The standard used is the RCR guidance: Recommendations for Cross-Sectional Imaging in Cancer Management (Ref No: RCR(06)1). We specifically looked at the MRI sequences advised for macroadenomas and noted that contrast is not recommended. Methodology: Retrospective audit on imaging of macroadenomas after surgery. Consecutive cases were identified by doing a keyword search in the neuroradiological database. Data acquired on: 1. MRI scan sequences 2. Contrast administration Results of 1st audit round: 88% of patients had the MRI sequences recommended by the RCR. 97% of patients received contrast. 1st action plan: Stop using contrast in these patients as this would benefit the department financially and will also help to increase the availability of the MR machine for other studies. The radiographers and radiologists were educated with regards to this. Results of 2nd round: 100% of patients had the MRI sequences recommended. 6% of patients received contrast. 2nd action plan: Reinforce the positive results of the second audit and remind radiographers and radiologists that contrast is not needed. Develop a pro-forma to be used locally that the radiographers could easily refer to if needed.
Methodology: A retrospective study of 51 consecutive cases (between 23/5/2011 to 05/09/2011) where the radiology request cards mentioned TIA as the diagnosis. Referrals were assessed for: 1. Source of referral (stroke specialist or else) 2. The time from symptoms onset to imaging based on the patient's risk category (ABCD2 score) 3. Modality of brain imaging Results of 1st audit round: All patients had imaging done within the recommended time period. CT scanning was used almost exclusively as the primary intracranial imaging modality. NICE recommends DWI MRI as the investigation of choice in TIA. Only 4 patients in the high risk group and 3 in the low risk group had an MRI after initial negative CT scans. 4 patients had contraindications for MRI scanning. 90% of patients were assessed by a stroke physician. The source of referral did not have any effect on this imaging pathway. 1st action plan: Increase awareness of NICE guidance in TIA imaging. Presentation to the hospital management in order to increase the funding for MRI Improve access to MR scanning Re-audit in 6 months.
Breast screening assessment: the introduction of double consultant clinics Authors: Joanna Dixon, L.G. Lunt Background to the audit: Plans to extend the NHS Breast Screening Programme to a wider population will result in more patients being recalled to assessment clinic. To cope with increasing demand attempts must be made to maximise clinic efficiency without compromising care in this vulnerable patient group. Double consultant clinics have economic and clinical benefits over single clinics, this audit aims to show there is no negative impact on patients in terms of duration of clinic appointment or time spent awaiting preliminary results. Standard, indicator and target: Local standards were derived from current practice (single clinics). (1) Average appointment duration for patients discharged from clinic at first attendance ¼ 00:13:37 (hh:mm:ss). (2) Average waiting time for preliminary results following biopsy ¼ 01:37:00. Target: Indicators for double clinics should not exceed those of single clinics. Methodology: Data collected from 80 single clinics (452 patients, Oct 09Sept 10) to determine the local standard and 74 double clinics (718 patients, Sept 09-Dec 10). Results of 1st audit round: Standard (1) is less for double clinics (00:12:42) than single clinics (00:13:37). Standard (2) is less for double clinics (01:31:38) than single clinics (01:37:00). The implementation of double consultant clinics does not increase the average appointment duration or the time waited for preliminary results. 1st action plan: Full implementation of double clinics with a view to reaudit to ensure sustained improvement.
MRI staging of locally advanced rectal cancer post chemoradiotherapy: comparison with postoperative histology Audit of imaging of TIA'S (transient ischaemic attacks) in James Cook University Hospital Middlesbrough Authors: Elena A. Cora, Rajeev Padmanabhan Background to the audit: TIA is a neurological syndrome suggestive of a stroke that resolves within 24 hours. A large proportion of patients with TIA proceed to stroke. This audit looks at the current practice in imaging of TIA patients in our hospital. Standard, indicator and target: NICE guidance document CG68 (2008) subsection 1.2- Imaging in people who have had a suspected TIA or nondisabling stroke.
Authors: Catriona Farrell, Karthik Gopal Background to the audit: Combined chemoradiotherapy treatment (CCRT) is used in the treatment of some extra-mural rectal cancers to reduce the risk of involvement of the circumferential resection margin at surgical excision and hence reduce risk of recurrence. Standard, indicator and target: This audit compared MRI staging of rectal cancer after treatment with CCRT with the histological staging of the resected tumour. Published data from other centres were used as a standard to assess local performance.