After-hours radiology reporting in an Australian tertiary hospital: Factors influencing the rate of discrepancy for computed tomography reporting.

INTRODUCTION: Demand for after-hours radiology services across Australia has been rapidly increasing for many years. Public hospital radiology departments are generally staffed by trainees after hours, often 1-2 doctors. This study reviewed 1 year of after-hours data at a tertiary hospital in Sydney, to determine overall discrepancy rates and factors which influenced the rate of discrepancy after hours. Overall radiology and after-hours case volumes are increasing, and the goal was to ensure that our department practices are within safe limits at current staffing levels. METHODS: After-hours computed tomography scan reports issued by registrars were reviewed over 1 year between 01 January 2019 and 01 January 2020. Data recorded included overall case numbers on each shift, discrepancy rates and rates of clinically significant discrepancy. Caseload was measured by equivalent ascribed reporting time as described by Pitman et al. (2018). RESULTS: There were 10,886 cases reported after hours during the study period and 1,412 discrepancies (13% cases). Of these, 300 (3.7%) were clinically significant. Factors that increased the rate of significant discrepancy included shifts with caseloads greater than 3 h of equivalent consultant reporting time per 8-h shift and the radiology trainee's level of training. The frequency of discrepancy for trauma cases was similar to non-trauma after adjusting for study type; however, the frequency of significant discrepancy was higher. CONCLUSION: In all instances, the rates of discrepancy and clinically significant discrepancy remained well within ranges previously described.

Intraocular pressure during femtosecond laser pretreatment: comparison of glaucomatous eyes and nonglaucomatous eyes.

PURPOSE: To compare changes in intraocular pressure (IOP) during femtosecond laser pretreatment of cataract between glaucomatous eyes and nonglaucomatous eyes. SETTING: Launceston Eye Institute and Launceston Eye Hospital, Launceston, Australia. DESIGN: Nonrandomized interventional prospective case series. METHODS: Patients with clinically stable primary open-angle glaucoma (POAG) having femtosecond laser pretreatment were compared with a concurrent cohort of patients with healthy eyes having the same procedure. Pretreatment was performed using a fluid-filled optical docking system (Liquid Optics Interface). With the patient supine, the IOP was measured at 4 time points using a rebound tonometer (Icare Pro). RESULTS: The study comprised 143 eyes of 97 patients. Forty-three eyes (30.1%) had documented glaucoma. The mean baseline IOP was 20.2 mm Hg ± 4.2 (SD) in glaucomatous eyes and 18.9 ± 4.0 mm Hg in nonglaucomatous eyes (P = .06). The mean change in IOP values between each time frame and baseline was as follows: vacuum-on, 13.8 ± 9.9 mm Hg and 11.1 ± 6.9 mm Hg, respectively (P = .06); after treatment, 17.4 ± 7.4 mm Hg and 14.1 ± 7.2 mm Hg, respectively (P = .014); after undocking of vacuum, 9.9 ± 5.4 mm Hg and 8.7 ± 5.7 mm Hg, respectively (P = .24). CONCLUSIONS: Femtosecond pretreatment caused a greater transient rise in IOP after treatment and a higher residual IOP after vacuum undocking in glaucomatous eyes than in nonglaucomatous eyes. This is well tolerated short term; however, long-term implications for eyes with glaucoma are unknown at present. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Effect of femtosecond laser-assisted cataract surgery on the corneal endothelium.

PURPOSE: To compare the effect on the corneal endothelium of femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery. SETTING: Private clinic, Tasmania, Australia. DESIGN: Prospective comparative cohort study. METHODS: Femtosecond laser-assisted cataract surgery (study group) or conventional phacoemulsification (control group) was performed. The central corneal thickness, central 3.0 mm corneal volume, volume stress index, and central endothelial cell density (ECD) were measured preoperatively and 1 day, 3 weeks, and 6 months postoperatively. RESULTS: The study group comprised 405 eyes and the control group, 215 eyes. Postoperative corneal edema was significantly less in the study group at 1 day and 3 weeks. However, the difference was negligible at 6 months. The study group had significant reductions in ECD loss compared with the control group [corrected] at 3 weeks but not at 6 months (6-month mean -150 cells/mm(2) ± 244 [SD] versus -149 cells/mm(2) ± 233). Eyes in the study group with laser-automated corneal incisions had greater endothelial cell loss at 6 months than eyes in the study group with manual corneal incisions and eyes in the control group (P<.0001). Eyes in the study group with zero effective phaco time and manually created corneal incisions had statistically significantly less endothelial cell loss at 6 months than the other groups (P<.0001). CONCLUSIONS: Femtosecond laser pretreatment for cataract surgery was associated with a significant reduction in early postoperative corneal edema and endothelial cell loss compared with conventional phacoemulsification; however, the difference diminished with time. Laser-automated corneal incisions seemed to adversely affect the corneal endothelial cells. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.