Trauma radiology teaching for foundation doctors working within the Scottish Trauma Network improves radiology requests and patient safety: a multidepartmental quality improvement project.

The importance of radiology in trauma management is particularly relevant today as Scotland develops its Scottish Trauma Network. Trauma and radiology are scarcely covered in the 2016 and 2021 Foundation Programme Curriculum. Trauma is a significant and endemic public health challenge, while radiology is ever growing in use as a diagnostic and interventional tool. Currently, the majority of radiological investigation requests in trauma are made by foundation doctors. Accordingly, there is an urgent need to ensure foundation doctors are adequately trained in trauma radiology. This prospective, multidepartmental quality improvement project at a single major trauma centre primarily analysed the impact of trauma radiology teaching on the quality of foundation doctors' radiology requests according to Ionising Radiation Medical Exposure Regulations (IRMER) criteria. As a secondary outcome, the impact of teaching on patient safety was also evaluated. 50 foundation doctors across three departments dealing with trauma patients had their trauma radiology requests analysed before and after the intervention of trauma-focused radiology teaching. Results showed cancelled and altered radiology requests decreased from 20% to 5% and from 25% to 10%, respectively, with a p value of 0.01. This translated to fewer delays in trauma patients receiving radiological investigations. The foundation curriculum would benefit from the introduction of trauma radiology teaching for its foundation doctors, in parallel to the demands of a growing national trauma network. Education globally improves radiology request quality by raising awareness and respect of IRMER criteria and ultimately leads to positive changes for patient safety.

Pediatric Nasal Reconstruction by Washio Procedure.

The use of the Washio retroauricular flap for nasal reconstruction has been infrequently covered in recent literature, particularly concerning the pediatric population. A retrospective study was conducted between 2014 and 2018 and included all pediatric patients who underwent a Washio retroauricular flap procedure for nasal reconstruction operated on by the same surgeon at a referral center for pediatric plastic and maxillofacial surgery. The mean age at the time of the first stage of the Washio procedure was just under 8 years of age (range: 6 years 3 months-8 years 10 months). The Washio retroauricular flap procedure was successfully employed in three patients with three different anatomical defects, including the nasal alae, nasal tip, and columella, without postoperative healing complications. Arguably, the Washio method is sufficiently versatile to be used in various defect types, allows space and planning for subsequent surgical corrections, avoids additional visible scarring of the face, and spares flaps that may be required at the end of the growth, such as the pedicled forehead flap. It is a safe procedure, provided that at least a two-stage procedure is performed, and a progressive postoperative verticalization is prescribed to limit venous drainage complications.