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Preoperative assessment clinic in interventional radiology. Provision of high-quality service and improving patient experience
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Abstract / Clinical Radiology 71 (2016) S11eS25
2nd action plan: Multiple further measures were taken including engagement with patient safety/management representatives, consultants and ward staff. Ultimately the medical director emailed all directorates advising all of the ZAPPP policy and asking for compliance. Subsequent reaudit showed 85% of patients to be adequately prepared. Improvement measures are ongoing. The use of DEXA in hip fracture patients with a history of previous fragility fracture: a retrospective study Authors: Elisabeth Bell, Robin Proctor Background to the audit: Osteoporosis is under-diagnosed and undertreated, with secondary prevention of fracture widely neglected. Sustaining a fragility fracture can double the risk of future fractures. Standard: British Orthopaedic Association The care of patients with fragility fracture Standard 5 e all patients presenting with fragility fracture should be assessed to determine their need for antiresorptive therapy to prevent future osteoporotic fractures.1 Indicator: All patients aged 50 years and over presenting to hospital with fragility fracture should undergo assessment for osteoporosis by axial bone densitometry. The number of patients with a previous fragility fracture who did not undergo dual energy X-ray absorptiometry (DEXA) before suffering a hip fracture. Target: 100% of patients aged 50 years and over that have sustained a fragility fracture should be offered a date for DEXA scan within 12 weeks of their fracture. Methodology: Using data collected from the National Hip Fracture Database, 100 consecutive hip fracture patients across the trust were identified. Patients with a previous fragility fracture identified on the radiology information system (RIS). This was substantiated by the radiological report. Exclusion criteria e patient does not live locally (therefore, no previous medical history), trauma, pathological fracture. The electronic patient record of all patients with a confirmed fragility fracture was accessed to ascertain whether a DEXA referral had been made. Results of 1st audit round: The audit showed only 15% of patients had a prior DEXA scan, suggesting that the trust was not adequately screening patients for osteoporosis. 1st action plan: Patients of 50+ years of age that have sustained a fragility fracture should be identified by an advanced nurse practitioner in osteoporotic care. This should be done using fracture clinic lists and radiology reports for nonacute presentations from GP referrals (i.e. vertebral collapse). Osteoporosis nurse to make DEXA request for all identified fragility fracture patients. References: 1. British Orthopaedic Association and the British Geriatrics Society. The care of patients with fragilty fracture. London: British Orthopaedic Association, 2007. 2. British Orthopaedic Association. Standards for trauma (BOAST) 9: fracture liaison services. London: British Orthopaedic Association, 2014. Preoperative assessment clinic in interventional radiology. Provision of high-quality service and improving patient experience Authors: Senan Alsanjari, Nikhil Prabhudesai, Alexander Chapman
Patel, Ashish
Mandavia, Shirish
Background to the audit: The Royal College of Radiologists (RCR) highlights the importance of nurse-led preoperative assessment clinics to assess patient suitability for treatment, optimise patient preparation and improve patient experiences1. Standard: No national standards for measuring patient experience undergoing interventional radiology (IR) procedures.
Indicator: Increasing cancellation rates for elective procedures due to inadequate pre-procedural preparations. Target: 1) Less than 5% cancellation rate on elective procedures. 2) 100% of patients should receive information leaflets. Methodology: 353 elective biopsies between 07/06/14e23/09/15 were analysed to determine the rates and reasons for cancellation. 40 patients including 15 angioplasties (currently pre-assessed by surgical nurses) and 25 biopsies (not currently pre-assessed) were surveyed between 01/09/15e31/10/15 to compare their patient experience. Results of 1st audit round: 10% cancellation rate for outpatient biopsies primarily due to inadequate pre-procedural preparation. 52% of biopsy patients received an information leaflet compared to 93% for angioplasty patients. 76% of biopsy patients felt they would have been less anxious if they had an opportunity to meet a member of the team prior to their procedure. 1st action plan: Introduction of a nurse-led pre-operative assessment clinic for elective IR procedures to provide an avenue for patients to have up-to-date bloods, information leaflets and an opportunity to ask questions. Governmental tariffs award trusts for each patient that is pre-assessed resulting in an increase departmental funding. Results of 2nd audit round: 100% of re-audited patients (n¼34) received a pre-procedural information leaflet, felt more informed and less anxious about their procedure. The cancellation rate is currently 3%. 2nd action plan: Continue preoperative assessment clinic and re-audit in six months to ensure the service is maintaining high standards of care. References: 1) The Royal College of Nursing and The Royal College of Radiologists. Guidelines for nursing care in interventional radiology, second edition. London: The Royal College of Radiologists: 2014. Training reporting radiographers by continuous audit Authors: Daniel Taylor-Rowlands
Ward, Peter GP.
Stoddart, Diane
Sparks, Geida
Background to the audit: 88% of UK radiology departments are unable to meet reporting demand.1 Insufficient number of radiologists despite rising demand for imaging.1 Reporting radiographers needed for musculoskeletal (MSK) and chest radiographs Standard: Reporting radiographers discrepancy rate equivalent to that of radiologists.2 Indicator: Code 5 Complete agreement. Code 4 Style issue. Code 3 Clinically debatable discrepancy. Code 2 Clinically significant discrepancy. Code 1 Unequivocal risk of morbidity. Target: > 95% Code 4 and 5. < 3% Code 3. < 1% Code 1 and 2. Methodology: Training radiographers to issue reports (radiographer one: MSK, radiographer 2: chest X-rays). All reports coded for discrepancy by radiologist before (amending and) validating. Discrepancies assessed monthly. Radiographers leave ‘difficult’ cases for radiologist. Results of 1st audit round: Radiographer 1 (Rad 1): Code 5 rose from 63% to 96% over eight months. Code 3 fell from 9% to 2%. No code 1 or 2.
Abstract / Clinical Radiology 71 (2016) S11eS25
2nd action plan: Multiple further measures were taken including engagement with patient safety/management representatives, consultants and ward staff. Ultimately the medical director emailed all directorates advising all of the ZAPPP policy and asking for compliance. Subsequent reaudit showed 85% of patients to be adequately prepared. Improvement measures are ongoing. The use of DEXA in hip fracture patients with a history of previous fragility fracture: a retrospective study Authors: Elisabeth Bell, Robin Proctor Background to the audit: Osteoporosis is under-diagnosed and undertreated, with secondary prevention of fracture widely neglected. Sustaining a fragility fracture can double the risk of future fractures. Standard: British Orthopaedic Association The care of patients with fragility fracture Standard 5 e all patients presenting with fragility fracture should be assessed to determine their need for antiresorptive therapy to prevent future osteoporotic fractures.1 Indicator: All patients aged 50 years and over presenting to hospital with fragility fracture should undergo assessment for osteoporosis by axial bone densitometry. The number of patients with a previous fragility fracture who did not undergo dual energy X-ray absorptiometry (DEXA) before suffering a hip fracture. Target: 100% of patients aged 50 years and over that have sustained a fragility fracture should be offered a date for DEXA scan within 12 weeks of their fracture. Methodology: Using data collected from the National Hip Fracture Database, 100 consecutive hip fracture patients across the trust were identified. Patients with a previous fragility fracture identified on the radiology information system (RIS). This was substantiated by the radiological report. Exclusion criteria e patient does not live locally (therefore, no previous medical history), trauma, pathological fracture. The electronic patient record of all patients with a confirmed fragility fracture was accessed to ascertain whether a DEXA referral had been made. Results of 1st audit round: The audit showed only 15% of patients had a prior DEXA scan, suggesting that the trust was not adequately screening patients for osteoporosis. 1st action plan: Patients of 50+ years of age that have sustained a fragility fracture should be identified by an advanced nurse practitioner in osteoporotic care. This should be done using fracture clinic lists and radiology reports for nonacute presentations from GP referrals (i.e. vertebral collapse). Osteoporosis nurse to make DEXA request for all identified fragility fracture patients. References: 1. British Orthopaedic Association and the British Geriatrics Society. The care of patients with fragilty fracture. London: British Orthopaedic Association, 2007. 2. British Orthopaedic Association. Standards for trauma (BOAST) 9: fracture liaison services. London: British Orthopaedic Association, 2014. Preoperative assessment clinic in interventional radiology. Provision of high-quality service and improving patient experience Authors: Senan Alsanjari, Nikhil Prabhudesai, Alexander Chapman
Patel, Ashish
Mandavia, Shirish
Background to the audit: The Royal College of Radiologists (RCR) highlights the importance of nurse-led preoperative assessment clinics to assess patient suitability for treatment, optimise patient preparation and improve patient experiences1. Standard: No national standards for measuring patient experience undergoing interventional radiology (IR) procedures.
Indicator: Increasing cancellation rates for elective procedures due to inadequate pre-procedural preparations. Target: 1) Less than 5% cancellation rate on elective procedures. 2) 100% of patients should receive information leaflets. Methodology: 353 elective biopsies between 07/06/14e23/09/15 were analysed to determine the rates and reasons for cancellation. 40 patients including 15 angioplasties (currently pre-assessed by surgical nurses) and 25 biopsies (not currently pre-assessed) were surveyed between 01/09/15e31/10/15 to compare their patient experience. Results of 1st audit round: 10% cancellation rate for outpatient biopsies primarily due to inadequate pre-procedural preparation. 52% of biopsy patients received an information leaflet compared to 93% for angioplasty patients. 76% of biopsy patients felt they would have been less anxious if they had an opportunity to meet a member of the team prior to their procedure. 1st action plan: Introduction of a nurse-led pre-operative assessment clinic for elective IR procedures to provide an avenue for patients to have up-to-date bloods, information leaflets and an opportunity to ask questions. Governmental tariffs award trusts for each patient that is pre-assessed resulting in an increase departmental funding. Results of 2nd audit round: 100% of re-audited patients (n¼34) received a pre-procedural information leaflet, felt more informed and less anxious about their procedure. The cancellation rate is currently 3%. 2nd action plan: Continue preoperative assessment clinic and re-audit in six months to ensure the service is maintaining high standards of care. References: 1) The Royal College of Nursing and The Royal College of Radiologists. Guidelines for nursing care in interventional radiology, second edition. London: The Royal College of Radiologists: 2014. Training reporting radiographers by continuous audit Authors: Daniel Taylor-Rowlands
Ward, Peter GP.
Stoddart, Diane
Sparks, Geida
Background to the audit: 88% of UK radiology departments are unable to meet reporting demand.1 Insufficient number of radiologists despite rising demand for imaging.1 Reporting radiographers needed for musculoskeletal (MSK) and chest radiographs Standard: Reporting radiographers discrepancy rate equivalent to that of radiologists.2 Indicator: Code 5 Complete agreement. Code 4 Style issue. Code 3 Clinically debatable discrepancy. Code 2 Clinically significant discrepancy. Code 1 Unequivocal risk of morbidity. Target: > 95% Code 4 and 5. < 3% Code 3. < 1% Code 1 and 2. Methodology: Training radiographers to issue reports (radiographer one: MSK, radiographer 2: chest X-rays). All reports coded for discrepancy by radiologist before (amending and) validating. Discrepancies assessed monthly. Radiographers leave ‘difficult’ cases for radiologist. Results of 1st audit round: Radiographer 1 (Rad 1): Code 5 rose from 63% to 96% over eight months. Code 3 fell from 9% to 2%. No code 1 or 2.