IMPROVING DELAYS IN UPLOADING INTRAOPERATIVE IMAGES DURING TRAUMA SURGERY

Dr. Kajal Joshi, Mr. Alistair Scott Parker (Supervisor)

BACKGROUND :

Intra-operative images are an essential part of trauma surgeries, as they demonstrate the nature of the surgery, help in identifying intra-operative complications, and also form an important medico-legal record of the patient's fracture and surgery.

Reducing delays in uploading intra-operative imaging invariably helps the team make appropriate decisions on weight-bearing status, and streamlines discharge processes, without the need for unnecessary further check X-rays

AIM :

-To identify if there was a delay in uploading intra-operative images

-To quantify this delay by thorough data collection

-Liaise with radiographers team to combat any shortcomings or issues that they might face

-Create a system in which images were uploaded and available to view during the trauma meeting the next day by the next data collection cycle

METHODOLOGY:

DO : Collect records of all patients undergoing trauma surgery during a 2-week period. Review radiology software system next morning to check if intra-operative images have been uploaded on time before trauma meeting

PLAN : Find out if there are delays in uploading intra-operative images through data collection

Create a system in which intra-operative images are uploaded by the next day trauma meeting.

FINDINGS:

Cycle 1: October 2021 no. of surgeries requiring II: 31

Not uploaded on time: 12

Cycle 2: January 2022 no. of surgeries requiring II: 32

Not uploaded: 4

Uploaded on time: 19

Uploaded on time: 28

STUDY: Make a note of the number of intra-operative images that did not get uploaded on time.

Follow through over the next few days to check after how many days the images were uploaded

ACT: Liaise with the radiographers team to find out the issues they face while uploading images.

Discuss with the Radiographer Supervisor to come up with long term solutions for fixing the delays.

IMPLEMENTATION OF CHANGE:

The results of cycle one were discussed with the radiography team.

The issues raised by them were:

-PACS Port in trauma theatre was not working despite flagging it several times to IT services.

-Only one Wi-Fi enabled machine available, which was too bulky to operate.

Following the discussion, new Wi-Fi enabled machines were installed in theatres, which allowed images to be uploaded by the simple click of a button, instead of plugging it into a PACS port

LEARNING POINTS:

The importance of recording and uploading intra-operative images cannot be stressed enough.

It is an important medico-legal record that leads to significant delays in patient care, if not handled correctly

Working together and seeking opinions from other teams, namely, the radiographer team, and radiation supervisor, along with IT services shed light on the issues that they have faced, thereby leading to more efficient long-term solutions

The most important aspect of any QIP is maintaining the improvement that we have seen, hence, continuous monitoring via repeated cycles is a must kajal.joshi1@nhs.net scott.parker2@nhs.ne

References:

Facilitating

patient referrals by junior doctors and physician associates to the appropriate respiratory subspecialties

A.ODEKUNLE1, C.IOSIFIDIS1, N.ODELL1, S.CHOI1, J.HOLME1

1Manchester University NHS Foundation Trust

Introduction

One of the major duties of junior doctors and physicians associates (PAs) is referring patients to the necessary specialties and pathways. Doing this inappropriately or incorrectly may adversely affect patient safety, satisfaction and outcome of treatment. A report by the General Medical Council found that patients who were not satisfied with their referral experience were those that arrived at an appointment to see a doctor who was not expecting them or was unfamiliar with their case. In some cases, the referrals were lost entirely.1

AIMS a.To facilitate referrals by junior doctors and physicians associates to the appropriate respiratory subspecialties. b.To produce an easily accessible guide for referrals to the various respiratory subspecialties.

Sample population: junior doctors and physicians associates

Data collection: online self-administered questionnaire

Results

The third cycle of data collection showed that there was only one subspecialty (out of 17) that the majority of participants did not know how to refer to. This was a significant improvement from 12 and 4 subspecialties in the first and second cycles, respectively.

With all our standards of measurement, there was a positive impact of our interventions with each cycle. The standards measured were:

I am confident referring patients to all of the above respiratory subspecialties (A)

I find it easy to refer to all of the above respiratory subspecialties (B)

Information available regarding referrals to the above respiratory subspecialties are up-to-date (C)and easily accessible (D)

There is a simplified guide on referrals to the subspecialties (E)

Discussion

The following interventions were made after the first cycle: Production of a simplified guide explaining how to refer to various respiratory subspecialties. The guide was uploaded on to the Intranet, Induction mobile app, put on the Junior Doctors Briefings by the Chief Registrar and disseminated by emails to doctors and PAs.

Conclusion

This QIP has demonstrated a substantial beneficial impact as 75% of doctors and PAs that responded now feel confident in referring patients to the various respiratory subspecialties and 75% also agreed that a simplified, up-todate and easily accessible guide to referrals is available.