Publicly available online educational videos regarding pediatric needle pain: a scoping review.

OBJECTIVES: The objectives of this scoping review were to: (1) identify publicly available educational videos on needle pain management; and (2) evaluate the content of these videos. METHODS: Reviewers screened publicly available educational videos on pediatric needle pain management available on YouTube and Google using a broad-based search strategy. Videos were categorized using the CRAAP Test: Current, Relevant, from a trustworthy source (Authority), Accurate and evidence-based, and for what Purpose does the source exist. RESULTS: Twenty-five relevant, educational videos were identified. The intended audience for most videos was parents (n=16, 64%), followed by clinicians (n=6, 24%) and children (n=3, 12%). Common examples of needle pain included immunizations or IV insertion, with interventions appropriate for infants through school-aged children. The most frequently described techniques were parent-guided distraction and behavioral factors such as comfort holds and parent demeanor. Most videos were Current (96%), Relevant (100%), created by a trustworthy source: Authority (76%), and all were Accurate, with Purpose relating to needle pain management. None of the videos addressed the unique needs of children with a preexisting diagnosis of needle phobia. DISCUSSION: Publicly available educational videos offer clinicians, parents, and children evidence-based techniques to manage pediatric needle pain. Further evaluation is needed to determine whether this form of education meets the needs of target audiences and whether this type of content can lead to improved management of pediatric needle pain.

Implementation of speech recognition in a community-based radiology practice: effect on report turnaround times.

PURPOSE: Large academic practices have reported important benefits with the implementation of speech recognition software (SRS). However, the applicability of these results has been questioned in the community hospital setting because of major differences in workflow. The aim of this study was to evaluate the impact of SRS on radiology report turnaround times (TATs) at a community-based hospital practice with no radiology training program. The secondary goal was to evaluate the impact of SRS on radiologist productivity. METHODS: SRS was implemented at a 150-bed community hospital between May 2011 and July 2011. Radiology report TATs and normalized radiologist productivity were determined during 5 months before and after SRS implementation. Median and 80th and 95th percentile report TATs were compared between the preimplementation and postimplementation periods. The trend in productivity was also assessed. RESULTS: Median and 80th and 95th percentile report TATs decreased multiple-fold between the preimplementation and postimplementation periods (median, from 24 to 1 hour; 80th percentile, from 60 to 10 hours; 95th percentile, from 165 to 33 hours; P < .0001). No significant trend in report TATs was appreciated beyond the initial implementation of the software, a sustained effect on TATs. Normalized radiologist productivity was stable throughout the study period. CONCLUSIONS: The implementation of SRS was associated with 24-fold improvement in the median radiology report TAT in a community hospital setting with no radiology trainees. Improvements were obtained without affecting normalized radiologist productivity.

Optimizing radiologist e-prescribing of CT oral contrast agent using a protocoling portal.

OBJECTIVE: The purpose of this study is to quantify the time expenditure associated with radiologist ordering of CT oral contrast media when using an integrated protocoling portal and to determine radiologists' perceptions of the ordering process. SUBJECTS AND METHODS: This prospective study was performed at a large academic tertiary care facility. Detailed timing information for CT inpatient oral contrast orders placed via the computerized physician order entry (CPOE) system was gathered over a 14-day period. Analyses evaluated the amount of physician time required for each component of the ordering process. Radiologists' perceptions of the ordering process were assessed by survey. Descriptive statistics and chi-square analysis were performed. RESULTS: A total of 96 oral contrast agent orders were placed by 13 radiologists during the study period. The average time necessary to create a protocol for each case was 40.4 seconds (average range by subject, 20.0-130.0 seconds; SD, 37.1 seconds), and the average total time to create and sign each contrast agent order was 27.2 seconds (range, 10.0-50.0 seconds; SD, 22.4 seconds). Overall, 52.5% (21/40) of survey respondents indicated that radiologist entry of oral contrast agent orders improved patient safety. A minority of respondents (15% [6/40]) indicated that contrast agent order entry was either very or extremely disruptive to workflow. CONCLUSION: Radiologist e-prescribing of CT oral contrast agents using CPOE can be embedded in a protocol workflow. Integration of health IT tools can help to optimize user acceptance and adoption.

Using informatics-enabled quality improvement techniques to meet health record documentation requirements in radiology reports.

PURPOSE: Medicare requires documented teaching physician involvement (attestation) in trainee-generated radiology reports. Automated attestation statement insertion in reports expedites the process but does not comply with requirements for active attestation. We evaluated an informatics-enabled quality improvement (QI) intervention to improve health record documentation requirements for active attestation. MATERIALS AND METHODS: Institutional review board approval was not needed for this QI project performed in a 776-bed tertiary/quaternary teaching hospital. The intervention consisted of (1) policy requiring staff radiologists to actively attest to trainee-generated reports by personally activating a "macro" in the reporting system and (2) a semiautomated process to detect reports missing attestation; radiologists received daily e-mail reminders until the attestation statement was inserted. A random sample of 600 of 123,561 trainee-generated radiology reports created 17 months after the intervention (May 2011) was manually reviewed to determine attestation policy adherence. The number of attestation statements added in response to reminders throughout the entire study period was also evaluated. Trend analysis of the number of report addenda containing solely the attestation statement (proxy for missing initial attestation) was performed. RESULTS: Of 600 reports, 594 (99%) contained the attestation statement. Monthly attestations in response to email notifications decreased from 585 to 227 by the sixth month, a 2.6-fold reduction (P < .01). No significant trend was observed the following year, indicating a sustained effect. CONCLUSION: Informatics-enabled QI techniques resulted in 99% adherence to our teaching physician attestation policy with sustained results. Similar approaches may help improve adherence to other mandated performance measures in radiology reports.

Exposing exposure: automated anatomy-specific CT radiation exposure extraction for quality assurance and radiation monitoring.

PURPOSE: To develop and validate an informatics toolkit that extracts anatomy-specific computed tomography (CT) radiation exposure metrics (volume CT dose index and dose-length product) from existing digital image archives through optical character recognition of CT dose report screen captures (dose screens) combined with Digital Imaging and Communications in Medicine attributes. MATERIALS AND METHODS: This institutional review board-approved HIPAA-compliant study was performed in a large urban health care delivery network. Data were drawn from a random sample of CT encounters that occurred between 2000 and 2010; images from these encounters were contained within the enterprise image archive, which encompassed images obtained at an adult academic tertiary referral hospital and its affiliated sites, including a cancer center, a community hospital, and outpatient imaging centers, as well as images imported from other facilities. Software was validated by using 150 randomly selected encounters for each major CT scanner manufacturer, with outcome measures of dose screen retrieval rate (proportion of correctly located dose screens) and anatomic assignment precision (proportion of extracted exposure data with correctly assigned anatomic region, such as head, chest, or abdomen and pelvis). The 95% binomial confidence intervals (CIs) were calculated for discrete proportions, and CIs were derived from the standard error of the mean for continuous variables. After validation, the informatics toolkit was used to populate an exposure repository from a cohort of 54 549 CT encounters; of which 29 948 had available dose screens. RESULTS: Validation yielded a dose screen retrieval rate of 99% (597 of 605 CT encounters; 95% CI: 98%, 100%) and an anatomic assignment precision of 94% (summed DLP fraction correct 563 in 600 CT encounters; 95% CI: 92%, 96%). Patient safety applications of the resulting data repository include benchmarking between institutions, CT protocol quality control and optimization, and cumulative patient- and anatomy-specific radiation exposure monitoring. CONCLUSION: Large-scale anatomy-specific radiation exposure data repositories can be created with high fidelity from existing digital image archives by using open-source informatics tools.

Large-scale automated assessment of radiologist adherence to the Physician Quality Reporting System for stroke.

PURPOSE: Physician Quality Reporting System (PQRS) measure 10 assesses the percentage of radiology reports for possible stroke that document the presence or absence of hemorrhage, mass, and acute infarction. Although it is an important report quality metric, determining adherence to this measure is often laborious, limiting its practical use. The aim of this study was to assess adherence to PQRS measure 10 using an automated approach to facilitate continuous measurement. A secondary goal was to identify explanatory variables that may affect adherence. METHODS: To determine measure adherence, a computerized algorithm was built, validated, and executed on 4,045 reports from CT and MRI examinations performed between January 2008 and October 2010 in patients with suspected stroke. Radiologist adherence was measured, accounting for differences in imaging modality, the presence of abnormalities, and trainee participation in report creation. RESULTS: Of 4,045 reports, 58.1% met the PQRS requirement, documenting all 3 components. Although the presence of infarct increased the chance of PQRS adherence (P < .001), the existence of hemorrhage had the opposite effect (P < .001). Reports that had trainee participation were more likely to be in accordance with PQRS standards (62% vs 47%, P < .001). After controlling for pertinent variables, more than 2-fold variation in individual PQRS adherence (27%-68%) remained (P < .001). CONCLUSIONS: A considerable portion of eligible radiology reports do not include all components proposed by PQRS measure 10. An important contributor to performance gaps resides in individual physician variability. By automating measurement and monitoring of radiologist PQRS performance, informatics tools may enable targeted interventions to improve report quality.

Effect of computerized clinical decision support on the use and yield of CT pulmonary angiography in the emergency department.

PURPOSE: To determine the effect of evidence-based clinical decision support (CDS) on the use and yield of computed tomographic (CT) pulmonary angiography for acute pulmonary embolism (PE) in the emergency department (ED). MATERIALS AND METHODS: Institutional review board approval was obtained for this HIPAA-compliant study, which was performed between October 1, 2003, and September 30, 2009, at a 793-bed quaternary care institution with 60,000 annual ED visits. Use (number of examinations per 1000 ED visits) and yield (percentage of examinations positive for acute PE) of CT pulmonary angiography were compared before and after CDS implementation in August 2007. The authors included all adult patients presenting to the ED and developed and validated a natural language processing tool to identify acute PE diagnoses. Linear trend analysis was used to assess for variation in CT pulmonary angiography use. Logistic regression was used to determine variation in yield after controlling for patient demographic and clinical characteristics. RESULTS: Of 338,230 patients presenting to the ED, 6838 (2.0%) underwent CT pulmonary angiography. Quarterly CT pulmonary angiography use increased 82.1% before CDS implementation, from 14.5 to 26.4 examinations per 1000 patients (P<.0001) between October 10, 2003, and July 31, 2007. After CDS implementation, quarterly use decreased 20.1%, from 26.4 to 21.1 examinations per 1000 patients between August 1, 2007, and September 30, 2009 (P=.0379). Overall, 686 (10.0%) of the CT pulmonary angiographic examinations performed during the 6-year period were positive for PE; subsequent to CDS implementation, yield by quarter increased 69.0%, from 5.8% to 9.8% (P=.0323). CONCLUSION: Implementation of evidence-based CDS in the ED was associated with a significant decrease in use, and increase in yield, of CT pulmonary angiography for the evaluation of acute PE.

Clinical supervision in psychiatric nursing. A self-actualizing process.

Clinical supervision, which can be viewed as a process of engaging in a potentially supportive, trusting, and respectful relationship with a colleague, can be the gateway to a self-actualizing process that assists the nurse in performing to his or her fullest potential by fostering the growth of skill development. Clinical supervision can be therapeutic as feelings and concerns are ventilated as they relate to the educational process of learning within nurse-patient relationships. Psychiatric nurses require an orientation to the clinical supervision to reduce any misconceptions and fears. Investing time in the self-actualizing process of clinical supervision is a symbol of the nurse's commitment to quality patient care.