ACR Statement on Safe Resumption of Routine Radiology Care During the Coronavirus Disease 2019 (COVID-19) Pandemic.

The ACR recognizes that radiology practices are grappling with when and how to safely resume routine radiology care during the coronavirus disease 2019 (COVID-19) pandemic. Although it is unclear how long the pandemic will last, it may persist for many months. Throughout this time, it will be important to perform safe, comprehensive, and effective care for patients with and patients without COVID-19, recognizing that asymptomatic transmission is common with this disease. Local idiosyncrasies prevent a single prescriptive strategy. However, general considerations can be applied to most practice environments. A comprehensive strategy will include consideration of local COVID-19 statistics; availability of personal protective equipment; local, state, and federal government mandates; institutional regulatory guidance; local safety measures; health care worker availability; patient and health care worker risk factors; factors specific to the indication(s) for radiology care; and examination or procedure acuity. An accurate risk-benefit analysis of postponing versus performing a given routine radiology examination or procedure often is not possible because of many unknown and complex factors. However, this is the overriding principle: If the risk of illness or death to a health care worker or patient from health care-acquired COVID-19 is greater than the risk of illness or death from delaying radiology care, the care should be delayed; however, if the opposite is true, the radiology care should proceed in a timely fashion.

Un Servicio de Neurología de un hospital terciario en la pandemia COVID-19 / A neurology department at a tertiary-level hospital during the COVID-19 pandemic

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SCAI/ACVP expert consensus statement on cardiovascular catheterization laboratory economics: If the cath lab is your home you should understand its finances: This statement was endorsed by the Alliance of Cardiovascular Professionals (ACVP) in April 2019.

This article is intended for any physician, administrator, or cardiovascular catheterization laboratory (CCL) staff member who desires a fundamental understanding of finances and economics of CCLs in the United States. The authors' goal is to illuminate general economic principles of CCL operations and provide details that can be used immediately by CCL leaders. Any article on economics in medicine should start by acknowledging the primacy of the principles of medical ethics. While physicians have been trained to act in the best interests of their patients and avoid actions that would harm patients it is vitally important that all professionals in the CCL focus on patients' needs. Caregivers both at the bedside and in the office must consider how their actions will affect not only the patient they are treating at the time, but others as well. If the best interests of a patient were to conflict with any recommendation in this article, the former should prevail. KEY POINTS: To be successful and financially viable under current payment systems, CCL physicians, and managers must optimize the outcomes and efficiency of care by aligning CCL leadership, strategy, organization, processes, personnel, and culture. Optimizing a CCL's operating margin (profitability) requires maximizing revenues and minimizing expenses. CCL managers often focus on expense reduction; they should also pay attention to revenue generation. Expense reduction depends on efficiency (on-time starts, short turn-over time, smooth day-to-day schedules), identifying cost-effective materials, and negotiating their price downward. Revenue optimization requires accurate documentation and coding of procedures, comorbidities, and complications. In fee-for-service and bundled payment reimbursement systems, higher volumes of procedures yield higher revenues. New procedures that improve patient care but are expensive can usually be justified by negotiating with vendors for lower prices and including the "halo effect" of collateral services that accompany the new procedure. Fiscal considerations should never eclipse quality concerns. High quality CCL care that prevents complications, increases efficiency, reduces waste, and eliminates unnecessary procedures represents a win for patients, physicians, and CCL administrators.

Availability of essential medicines and pharmaceutical inventory management practice at health centers of Adama town, Ethiopia.

BACKGROUND: Good inventory management practices in the health facilities are one of the critical aspects that influence the availability of essential medicines (EMs). This study aimed to assess EMs availability and inventory management practices at health centers (HCs) of Adama town, Ethiopia. METHOD: Institution based cross sectional survey was conducted among six HCs in Adama Town from March 19 to April 12, 2017. Self-administered questionnaire and observational checklists were used to collect quantitative information. Eleven tracer drugs (TDs) that were selected by the Federal ministry of health and included in the TD list of the HCs were used to assess the availability of EMs at the time of the survey; and during the past 12 months. The data were entered and analyzed using SPSS version 21. The accuracy of record keeping was assessed using inventory management assessment tool (IMAT) indicators. RESULT: Five HCs had Essential drug list and the procurement was made as per the list. Out of six HCs, four of them procured EMs from both pharmaceutical fund and supply agency (PFSA) of Ethiopia and private suppliers. Stock status of PFSA and transportation were the major challenges during the procurement process. The overall average availability of TDs on the day of the survey was 76.3%. Average length of stock out days for TDs during the past 12 months from each HC was 40.6 days. Among the TDs assessed at HCs, oral rehydrating salt was stock outed for 144 days while paracetamol was stock outed only for 1.4 days. The discrepancy of TDs between physical count and on bincard for which physical inventory less than the balance on bincard ranges from 0 to 33.3%. CONCLUSION: The availability of EMs was low and there was also poor inventory management practice in some of the HCs during the study period.

Practical considerations for establishing and maintaining a magnetic resonance imaging safety program in a pediatric practice.

Magnetic resonance imaging is a multipurpose imaging modality that is largely safe, given the lack of ionizing radiation. However there are electromagnetic and biological effects on human tissue when exposed to magnetic environments, and hence there is a risk of adverse events occurring with these exams. It is imperative to understand these risks and develop methods to minimize them and prevent consequent adverse events. Implementing these safety practices in pediatric MR imaging has been somewhat limited because of gaps in information and knowledge among the personnel who are closely involved in the MR environment. The American College of Radiology has provided guidelines on MR safety practices that are helpful in minimizing such adverse events. This article provides an overview of the issues related to MR safety and practical ways to implement them across different health care facilities.

Clinical practice visits: a rapid review.

BACKGROUND: Practice visits are a peer review activity where one or more healthcare providers visit the practice of another in the same field. The purpose of this exercise is for visitors to observe and review a host's practice in a non-punitive manner and provide them with constructive feedback as required; ultimately to improve practice quality and patient care. METHODS: A rapid review of three biomedical databases was conducted to identify relevant literature published up until 9 April 2018. There were no limits placed on publication date or publication type. Two authors were responsible for study selection and data extraction using a priori inclusion criteria and extraction templates. Study details and key findings were reported narratively and in tables. RESULTS: A total of nine publications, reporting outcomes for eight study groups, were identified as eligible for inclusion in this rapid review. Of these eight, six were observational studies, one was a longitudinal study and one was a randomized controlled trial. Practice visits were considered useful in identifying areas of improvement in professional practice; however, the rate at which these improvements were elicited varied greatly between the included studies. Overall, both hosts and visitors gained insight from the practice visit process and in general their experiences were positive. CONCLUSIONS: Based on the evidence provided by the included studies, recommendations for an effective practice visit can be made. Importantly, the poor quality and age of the literature from which these recommendations are based should be considered.

Using an action learning methodology to develop skills of health managers: experiences from KwaZulu-Natal, South Africa.

BACKGROUND: Strong management skills are key to improving performance of health systems. Action learning, a technique to develop management skills, has been used successfully with health managers but not usually among lower level managers or in low and middle-income countries (LMICs). METHODS: This study uses a qualitative approach to explore experiences, successes and challenges of using an action learning approach to improve skills of managers in neonatal units in KwaZulu-Natal (KZN), South Africa. Eight action learning groups were convened with neonatal unit managers from all 39 district hospitals in KZN, each group had 4-6 participants. Meetings were conducted by a facilitator trained in action learning techniques, and groups met a minimum of ten times over a one-year period. After completion of the intervention, 14 in-depth interviews were conducted with purposively selected action learning participants. Data was transcribed and analysed using framework analysis. RESULTS: Neonatal unit managers found that action learning generated a sense of empowerment in their abilities, trust and confidence among participants was nurtured, problem solving and critical thinking skills were developed, and a continuous support system was created. The action learning process led to several positive changes in neonatal units, which enhanced the quality of care for patients. A number of challenges were also identified, mainly relating to administrative issues such as the provision of a skilled facilitator, permission to attend action learning meetings and logistical issues, including transport and other financial implications. CONCLUSIONS: This paper illustrates that action learning can be an effective and practical method to support public health workers to manage their health units despite the challenges associated with the method. Time, energy and financial resources used to facilitate action learning for this cadre of health workers is rewarded by improved skills of managers and better quality of care for patients.

Radiology Report Value Equation.

Value in medicine is defined as the ratio of quality and service and health care outcomes to the costs and inefficiencies of providing care. Creating patient-centered value in radiology reporting requires radiologists to provide accurate diagnostic interpretations in an accessible format with useful advice on further imaging, as well as report-embedded reference materials desired by the referring provider. The value- and service-centered radiologist provides urgent communications when appropriate and is readily available for report consultations. Indirect costs or inefficiencies embedded in report style can erode value. Value is preserved when radiologists strive for concise, clear, and timely reporting. ©RSNA, 2018.

Acing the Joint Commission Regulatory Visit: Running an Effective and Compliant Safety Program.

Ensuring the safety of patients and staff is a core effort of all health care organizations. Many regulatory agencies, from The Joint Commission to the Occupational Safety and Health Administration, provide policies and guidelines, with relevant metrics to be achieved. Data on safety can be obtained through a variety of mechanisms, including gemba walks, team discussion during safety huddles, audits, and individual employee entries in safety reporting systems. Data can be organized on a scorecard that provides an at-a-glance view of progress and early warning signs of practice drift. In this article, relevant policies are outlined, and instruction on how to achieve compliance with national patient safety goals and regulations that ensure staff safety and Joint Commission ever-readiness are described. Additional critical components of a safety program, such as department commitment, a just culture, and human factors engineering, are discussed. ©RSNA, 2018.

Strategies for Implementing a Standardized Structured Radiology Reporting Program.

Radiology practices are increasingly implementing standardized report templates to overcome the drawbacks of individual templates. However, implementing a standardized structured reporting program is not necessarily straightforward. This article provides practical guidance for radiologists who wish to implement standardized structured reporting in their practice. Challenges that radiology groups encounter tend to fall into two categories: technical and organizational. Defining and carrying out technical work can be tedious but tends to be relatively straightforward, whereas overcoming organizational challenges often requires changes in individuals' strongly held values, beliefs, roles, and relationships. Established organizational change models can help frame the organizational strategy to implement a standardized structured reporting program. Once leadership support is secured, a standardized structured reporting committee can be convened to establish report priorities, standards, design principles, and guidelines. Report standards help to establish the common framework upon which all report templates are constructed, helping to ensure report consistency. By using these standards, committee members can create reports relevant to their subspecialties, which can then be edited for formatting and content. Once report templates have been developed, edited, and published, an abbreviated form of the same process can be used to maintain the reports, which can be accomplished with much less effort than that initially required to create the templates. After standardized structured report templates are implemented and become embedded in practice, most radiologists eventually appreciate the merits of the program. ©RSNA, 2018.

Psychometric Analysis and Qualitative Review of an Outpatient Radiology-Specific Patient Satisfaction Survey: A Call for Collaboration in Validating a Survey Instrument.

PURPOSE: The aim of this study was to perform a psychometric analysis of the constructs and reliability of an outpatient radiology-specific patient satisfaction survey and identify factors that drive patient experience so that radiology practices can improve the quality of their diagnostic imaging services. METHODS: This retrospective study examined responses to eight patient satisfaction questions from a survey originally developed by a nascent marketing team and then administered at five outpatient imaging centers from January 7, 2013, to November 11, 2015. Patients' responses were reviewed to identify factors that affected patient experience, and a psychometric analysis of the survey instrument itself was performed, including exploratory factor analyses and reliability testing. Patient responses were compared among sites, examination types, and questions. Free-text comments were qualitatively categorized and compared by examination type. RESULTS: In total, 6,512 surveys were completed among 137,059 patient encounters. Using exploratory factor analyses of the eight survey questions, three relevant patient experience constructs were derived: (1) front office experience, (2) intake experience, and (3) examination experience. Overall, good scale reliability was observed. Perceived quality of care had the most positive ratings; wait time had the most nonpositive ratings. Of 2,024 free-text comments, 1,859 were positive (most pertaining to staff), and 155 were negative (most pertaining to convenience). MRI patients were most likely to share negative comments, typically regarding the examination experience itself. CONCLUSIONS: Psychometric analysis of a patient survey derived three core patient experience constructs: front office experience, intake experience, and examination experience. The survey indicates the need to decrease wait times, streamline the registration process, and improve patient comfort during MRI examinations.

Supervision and autonomy of ophthalmology residents in the outpatient Clinic in the United States: a survey of ACGME-accredited programs.

BACKGROUND: The development and demonstration of incremental trainee autonomy is required by the ACGME. However, there is scant published research concerning autonomy of ophthalmology residents in the outpatient clinic setting. This study explored the landscape of resident ophthalmology outpatient clinics in the United States. METHODS: A link to an online survey using the QualtricsTM platform was emailed to the program directors of all 115 ACGME-accredited ophthalmology programs in the United States. Survey questions explored whether resident training programs hosted a continuity clinic where residents would see their own patients, and if so, the degree of faculty supervision provided therein. Metrics such as size of the resident program, number of faculty and clinic setting were also recorded. Correlations between the degree of faculty supervision and other metrics were explored. RESULTS: The response rate was 94%; 69% of respondents indicated that their trainees hosted continuity clinics. Of those programs, 30% required a faculty member to see each patient treated by a resident, while 42% expected the faculty member to at least discuss (if not see) each patient. All programs expected some degree of faculty interaction based upon circumstances such as the level of training of the resident or complexity of the clinical situation. 67% of programs that tracked the contribution of the clinic to resident surgical caseloads reported that these clinics provided more than half of the resident surgical volumes. More ¾ of resident clinics were located in urban settings. The degree of faculty supervision did not correlate to any of the other metrics evaluated. CONCLUSIONS: The majority of ophthalmology resident training programs in the United States host a continuity clinic located in an urban environment where residents follow their own patients. Furthermore, most of these clinics require supervising faculty to review both the patients seen and the medical documentation created by the resident encounters. The different degrees of faculty supervision outlined by this survey might provide a useful guide presuming they can be correlated with validated metrics of educational quality. Finally, this study could provide an adjunctive resource to current international efforts to standardize ophthalmic residency education.

Actitudes y barreras en el asma inicialmente no controlada en España. Estudio Abanico / Attitudes and barriers uncontrolled asthma in Spain. Abanico study

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Developing and Implementing an Audit Program for Physician Practices.

The word "audit" generates fear in any situation. Many practices do not audit-sometimes because they are so overwhelmed with just day-to-day management, but sometimes because they would rather not know of issues that they do not wish to confront. Even practices that currently audit may have the wrong focus. Common errors in auditing include performing internal audits only, choosing the wrong auditor, auditing based on the wrong parameters, not repaying or resubmitting after an audit, not performing follow-up education, and thinking that attorney-client privilege provides unlimited protection. Although practices should perform some internal auditing, if this is the only auditing done, there is the risk of the "fox watching the henhouse" effect.