The Experts below are selected from a list of 324 Experts worldwide ranked by ideXlab platform
J. C. Goslings - One of the best experts on this subject based on the ideXlab platform.
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Cost-effectiveness of trauma CT in the trauma room versus the Radiology Department: the REACT trial
European radiology, 2012Co-Authors: T. P. Saltzherr, J. C. Goslings, F. C. Bakker, L. F. M. Beenen, M. Olff, K. Meijssen, F. F. Asselman, J. B. Reitsma, Marcel G. W. DijkgraafAbstract:Objective To determine the cost-effectiveness of trauma room CT compared with CT performed at the Radiology Department.
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randomized clinical trial comparing the effect of computed tomography in the trauma room versus the Radiology Department on injury outcomes
British Journal of Surgery, 2012Co-Authors: T. P. Saltzherr, L. F. M. Beenen, Marcel G. W. Dijkgraaf, Fred C Bakker, Johannes B Reitsma, J. C. GoslingsAbstract:BACKGROUND: Computed tomography (CT) of injured patients in the Radiology Department requires potentially dangerous and time-consuming patient transports and transfers. It was hypothesized that CT in the trauma room would improve patient outcome and workflow. METHODS: A randomized trial compared the effect of locating a CT scanner in the trauma room versus the Radiology Department in two Dutch trauma hospitals. Injured patients aged at least 16 years were assigned randomly to one of these hospitals at the time of transport. The primary outcome measure was the number of non-institutionalized days within the first year after randomization. Subgroup analyses were performed in patients with multiple trauma or severe traumatic brain injury (TBI). RESULTS: Some 1124 patients were included, of whom 1045 were available for analysis. The median number of non-institutionalized days was 360 days in the intervention group versus 362 days for the control group (P = 0.068). The time from arrival to the first CT imaging was 13 min shorter in the intervention group (36 versus 49 min; P Language: en
Marcel G. W. Dijkgraaf - One of the best experts on this subject based on the ideXlab platform.
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Cost-effectiveness of trauma CT in the trauma room versus the Radiology Department: the REACT trial
European radiology, 2012Co-Authors: T. P. Saltzherr, J. C. Goslings, F. C. Bakker, L. F. M. Beenen, M. Olff, K. Meijssen, F. F. Asselman, J. B. Reitsma, Marcel G. W. DijkgraafAbstract:Objective To determine the cost-effectiveness of trauma room CT compared with CT performed at the Radiology Department.
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randomized clinical trial comparing the effect of computed tomography in the trauma room versus the Radiology Department on injury outcomes
British Journal of Surgery, 2012Co-Authors: T. P. Saltzherr, L. F. M. Beenen, Marcel G. W. Dijkgraaf, Fred C Bakker, Johannes B Reitsma, J. C. GoslingsAbstract:BACKGROUND: Computed tomography (CT) of injured patients in the Radiology Department requires potentially dangerous and time-consuming patient transports and transfers. It was hypothesized that CT in the trauma room would improve patient outcome and workflow. METHODS: A randomized trial compared the effect of locating a CT scanner in the trauma room versus the Radiology Department in two Dutch trauma hospitals. Injured patients aged at least 16 years were assigned randomly to one of these hospitals at the time of transport. The primary outcome measure was the number of non-institutionalized days within the first year after randomization. Subgroup analyses were performed in patients with multiple trauma or severe traumatic brain injury (TBI). RESULTS: Some 1124 patients were included, of whom 1045 were available for analysis. The median number of non-institutionalized days was 360 days in the intervention group versus 362 days for the control group (P = 0.068). The time from arrival to the first CT imaging was 13 min shorter in the intervention group (36 versus 49 min; P Language: en
T. P. Saltzherr - One of the best experts on this subject based on the ideXlab platform.
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Cost-effectiveness of trauma CT in the trauma room versus the Radiology Department: the REACT trial
European radiology, 2012Co-Authors: T. P. Saltzherr, J. C. Goslings, F. C. Bakker, L. F. M. Beenen, M. Olff, K. Meijssen, F. F. Asselman, J. B. Reitsma, Marcel G. W. DijkgraafAbstract:Objective To determine the cost-effectiveness of trauma room CT compared with CT performed at the Radiology Department.
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randomized clinical trial comparing the effect of computed tomography in the trauma room versus the Radiology Department on injury outcomes
British Journal of Surgery, 2012Co-Authors: T. P. Saltzherr, L. F. M. Beenen, Marcel G. W. Dijkgraaf, Fred C Bakker, Johannes B Reitsma, J. C. GoslingsAbstract:BACKGROUND: Computed tomography (CT) of injured patients in the Radiology Department requires potentially dangerous and time-consuming patient transports and transfers. It was hypothesized that CT in the trauma room would improve patient outcome and workflow. METHODS: A randomized trial compared the effect of locating a CT scanner in the trauma room versus the Radiology Department in two Dutch trauma hospitals. Injured patients aged at least 16 years were assigned randomly to one of these hospitals at the time of transport. The primary outcome measure was the number of non-institutionalized days within the first year after randomization. Subgroup analyses were performed in patients with multiple trauma or severe traumatic brain injury (TBI). RESULTS: Some 1124 patients were included, of whom 1045 were available for analysis. The median number of non-institutionalized days was 360 days in the intervention group versus 362 days for the control group (P = 0.068). The time from arrival to the first CT imaging was 13 min shorter in the intervention group (36 versus 49 min; P Language: en
Marilyn Hravnak - One of the best experts on this subject based on the ideXlab platform.
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patients in the Radiology Department may be at an increased risk of developing critical instability
Journal of Radiology Nursing, 2015Co-Authors: Lora K. Ott, Sunday Clark, Leslie A Hoffman, Michael R Pinsky, Sean P Clarke, Dianxu Ren, Marilyn HravnakAbstract:The purpose of this study was to calculate the event rate for in-patients in the Radiology Department (RD) developing instability leading to calls for Medical Emergency Team assistance (MET-RD) compared to general ward (MET-W) patients. A retrospective comparison was done of MET-RD and MET-W calls in 2009 in a U.S. tertiary hospital with a well-established MET system. MET-RD and MET-W event rates represented as MET calls/hour/1000 admissions, adjusted for length of stay (LOS); rates also calculated for RD modalities. There were 31,320 hospital ward admissions had 1,230 MET-W, and among 149,569 Radiology admissions there were 56 MET-RD. When adjusted for LOS, the MET-RD event rate was 2 times higher than the MET-W rate (0.48 vs. 0.24 events/hour/1000 admissions). Event rates differed by procedure: computed tomography (CT) had 38% of MET-RDs (event rate 0.89); magnetic resonance imaging (MRI) accounted for 27% (event rate 1.56). Nuclear medicine had 1% of RD admissions but these patients accounted for 5% of MET-RD (event rate 1.53). Interventional Radiology (IR) had 6% of RD admissions but 16% of MET-RD (event rate 0.61). While general x-ray comprised 63% of RD admissions, only 11% of MET-RD involved their care (event rate 0.09). In conclusion, the overall MET-RD event rate was twice the MET-W event rate; CT, MRI and IR rates were 3.7-6.5 times higher than on wards. RD patients are at increased risk for a MET call compared to ward patients when the time at risk is considered. Increased surveillance of RD patients is warranted.
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medical emergency team calls in the Radiology Department patient characteristics and outcomes
BMJ Quality & Safety, 2012Co-Authors: Lora K. Ott, Sunday Clark, Leslie A Hoffman, Michael R Pinsky, Sean P Clarke, Dianxu Ren, Marilyn HravnakAbstract:Objective We sought to identify the characteristics of patients who experience medical emergency team calls in the Radiology Department (MET-RD) and the relationship between these characteristics and patient outcomes. Design/participants Retrospective review of 111 inpatient MET-RD calls (May 2008–April 2010). Setting Academic medical centre with a well established MET system. Measurements The characteristics of patients before, during and after transport to Radiology were extracted from medical records and administrative databases. These characteristics were compared between patients with good and poor outcomes. Main results The majority of patients who experience MET-RD calls had a Charlson Comorbidity Index ≥4 and were from non-intensive care units (60%). Almost half (43%) of MET-RD calls occurred during patients9 first day in hospital. Patients commonly arrived with nasal cannula oxygen (38%), recent tachypnoea (28%) and tachycardia (34%). A minority (16%) fulfilled MET call criteria in the 12 h before the MET-RD. MET-RD etiologies were cardiac (41%), respiratory (29%) or neurological (25%), and occurred most frequently during CT (44%) and MRI (22%) testing. Post MET-RD, the majority of patients (70%) required a higher level of care. Death before discharge (25%) was associated with need for cardiovascular support prior to RD transport (p=0.02), need for RD monitoring (p=0.02) and need for heightened RD surveillance (p=0.04). Conclusions The majority of patients who experienced MET-RD calls came from non-intensive care units, with comorbidities and vital sign alterations prior to arrival at the RD. Risk appeared to be increased for those requiring CT and MRI. These findings suggest that prior identification of a subset of patients at risk of instability in the RD may be possible.
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abstract 18406 are medical emergency team call event rates to the Radiology Department greater than to the general hospital wards
Circulation, 2011Co-Authors: Lora K. Ott, Sunday Clark, Leslie A Hoffman, Michael R Pinsky, Sean P Clarke, Dianxu Ren, Marilyn HravnakAbstract:Objective : To establish if hospital in-patients are at greater risk for requiring Medical Emergency Team (MET) assistance while in the Radiology Department, we determined the event rates of MET calls to the Radiology Department (MET-RD) and the general hospital wards (MET-W). Design/Participants : Retrospective review of in-patients experiencing a MET call in 2009. Setting : Tertiary care hospital with a well-established MET system admitting 32,000 patients and performing 160,000 in-patient Radiology (RD) procedures per year. Measurements : The number of MET-RD was adjusted for length of stay (LOS) to determine the number of MET-RD/hour/1000 RD admissions. The number of MET-W was adjusted for LOS to determine the number of MET-W/hour/1000 hospital admissions. Main Results : The MET-RD event rate was slightly higher than MET-W (0.42 v. 0.31 events/hour/1000 hospital admissions) but not statistically different (p=0.73). The overall average LOS in the RD (LOS-RD) was 58 min. General x-ray (XR) comprised 63% of RD admissions but only 11% of MET-RD (LOS 40 min, XR event rate 0.09). Event rates and LOS in the Radiology specialty modality areas revealed that 38% of MET-RDs occurred in computed tomography (CT) (average CT LOS 47 min) and an event rate (0.94) over twice the RD average. Magnetic resonance imaging (MRI) represented only 5% of the RD admissions but had 27% of MET-RD (average MRI LOS-RD 90 minutes) and an event rate (1.43) that was 3.5 times higher than the RD average. The longest LOS-RD was in Nuclear medicine (NM; 111 minutes) and represented only 1% of RD admissions but 5% of MET-RD, with an NM event rate (1.34) that was 3.2 times higher than the RD average. Analysis of event rates for the combined RD specialty modalities (minus XR) revealed an average RD specialty modality event rate that was significantly higher when compared to MET-W (0.76 v. 0.31, p=.007). Conclusions : Although overall MET-RD event rates were similar to MET-W, they were unevenly distributed across patients receiving CT, MRI and NM studies. The combined event rate in the RD specialty modalities suggest increased MET risk for patients in these areas, which may have implications for RD surveillance practices.
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Patients’ Instability, Emergency Response, and Outcomes in the Radiology Department
American journal of critical care : an official publication American Association of Critical-Care Nurses, 2011Co-Authors: Lora K. Ott, Marilyn Hravnak, Sunday Clark, Nikhil B. AmesurAbstract:Hospitalized patients who require diagnostic testing and procedures in the Radiology Department range from “stable” patients admitted for elective surgery to highly unstable critically ill patients who require a high level of human and technological monitoring and physiological support, including mechanical ventilation and hemodynamic support. Patients may be at risk for cardiopulmonary instability while undergoing diagnostic testing, and in some, that instability may progress to cardiorespiratory collapse. When instability occurs, one rescue intervention involves activation of a medical emergency team (MET) to bring a team of critical care providers to the imaging site. Although published reports describing MET activations and outcomes on clinical units within the hospital are fairly extensive,1-3 little is known about MET activations in diagnostic testing areas such as the Radiology Department. More information about the precursors of such events could lead to earlier detection of cardiopulmonary instability and improved outcomes in patients who require activation of the MET in the Radiology Department (RD-MET), inform interventions to prevent the need for RD-MET activation, and alter systems of care in the Radiology Department. Rapid response to patients’ instability has driven the establishment of METs, whose goal is to bring a cadre of critical care providers to the bedsides of patients in unstable condition outside of the intensive care unit (ICU). Once cardiopulmonary instability is recognized, the MET provides a rapidly available secondary system of ICU level support to all units throughout the hospital. MET systems usually provide hospital staff with a preset list of criteria to serve as “triggers” to initiate a MET call, and staff are both educated and encouraged to use this resource.4,5 The success of the MET is dependent on early recognition of deterioration in a patient’s condition, rapid response by the bedside providers, and aggressive intervention to stabilize and rescue patients to prevent further deterioration in their condition.1,2 The onset of cardiopulmonary instability is rarely acute, but shows a cyclic pattern of change. Early detection of deterioration in patients’ condition is key to successful intervention and may prevent complications.6,7 The onset of cardiopulmonary instability is rarely acute, but demonstrates a cyclic pattern of change with patients’ heart rate, blood pressure, respiratory rate, and oxygen saturation moving above and below accepted parameters, sometimes for hours before deterioration in their condition is acknowledged. Clinical antecedents to patients’ cardiopulmonary instability have been detected 6 to 8 hours before recognized cardiorespiratory collapse.8,9 Owing to the cyclic pattern of these dynamic variables, cardiopulmonary instability may be missed by the intermittent clinical evaluation that may occur in the Radiology Department. Additionally, research has shown that patients being cared for in areas where the direct care providers are not specifically trained for their care requirements and diagnosis may be at greater risk for unrecognized cardiopulmonary instability and the need for MET activation.3 This situation often may occur in the Radiology Department, when patients at various levels of acuity receive care from staff members who are not familiar with their prior care needs, stability level, or particular diagnosis. The purpose of this pilot study was to describe the reasons for RD-MET activation for hospitalized inpatients, the temporal attributes of RD-MET involvement, the characteristics of inpatients who experience RD-MET interventions, and the characteristics associated with outcomes after RD-MET activation.
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intrahospital transport to the Radiology Department risk for adverse events nursing surveillance utilization of a met and practice implications
Journal of Radiology Nursing, 2011Co-Authors: Lora K. Ott, Leslie A Hoffman, Marilyn HravnakAbstract:Abstract Nurses providing care in the Radiology Department (RD) are challenged by the broad scope of conditions and varied acuity of patients served by this unit. Nurses must facilitate the required diagnostic testing and simultaneously provide the surveillance necessary to detect physiologic changes signaling the need for rescue interventions. When instability occurs, one method of rescue involves activation of a medical emergency team (MET) to bring an experienced cadre of critical care providers to the unstable patient. Despite recognition that the RD can be a high-risk area, there is little in the literature specific to the surveillance of RD patients, risk for and prevention of adverse events, MET activation or the management of patient instability specific to the RD. The purpose of this article is to examine what is known regarding risk for adverse events during intrahospital transport, utilization of a MET as a rescue intervention, and practice implications.
Michael P. Recht - One of the best experts on this subject based on the ideXlab platform.
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Surveying Academic Radiology Department Chairs Regarding New and Effective Strategies for Medical Student Recruitment.
AJR. American journal of roentgenology, 2016Co-Authors: Michael L. Francavilla, Elizabeth Kagan Arleo, Edward I. Bluth, Christopher M. Straus, Sravanthi Reddy, Michael P. RechtAbstract:The number of 4th-year medical student applications to the field of diagnostic Radiology has decreased from 2009 to 2015. The purpose of this study was to learn how Radiology Departments are recruiting medical students. An anonymous online survey hyperlink was distributed to the members of the Society of Chairs of Academic Radiology Departments regarding both innovative and proven recruitment strategies. The results were synthesized with a recently published survey of medical students about factors influencing them to go into Radiology. Forty of 126 Radiology Departments completed the survey. Most felt that Radiology exposure and curricula require alteration given recent downward trends in medical student applications. A majority (79%) had changed their outreach to medical students in response to these trends. The responding Department chairs felt that interactive learning while on rotation was the most important strategy for recruitment. The presence of a diversity program, dedicated medical school educator, or rotating daily assignment for students did not affect the likelihood of filling residency spots in the main match. Many Radiology Departments are changing their outreach to medical students to improve recruitment. Effective strategies to focus on include early active outreach by involving students in the Radiology Department, thereby framing radiologists as clinicians.
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focused process improvement events sustainability of impact on process and performance in an academic Radiology Department
Journal of The American College of Radiology, 2015Co-Authors: Andrew B Rosenkrantz, Kirk Lawson, Rosina Ally, David Chen, Frank Donno, Steven Rittberg, Joan Rodriguez, Michael P. RechtAbstract:Abstract Purpose To evaluate sustainability of impact of rapid, focused process improvement (PI) events on process and performance within an academic Radiology Department. Methods Our Department conducted PI during 2011 and 2012 in CT, MRI, ultrasound, breast imaging, and research billing. PI entailed participation by all stakeholders, facilitation by the Department chair, collection of baseline data, meetings during several weeks, definition of performance metrics, creation of an improvement plan, and prompt implementation. We explore common themes among PI events regarding initial impact and durability of changes. We also assess performance in each area pre-PI, immediately post-PI, and at the time of the current study. Results All PI events achieved an immediate improvement in performance metrics, often entailing both examination volumes and on-time performance. IT-based solutions, process standardization, and redefinition of staff responsibilities were often central in these changes, and participants consistently expressed improved internal leadership and problem-solving ability. Major environmental changes commonly occurred after PI, including a natural disaster with equipment loss, a change in location or services offered, and new enterprise-wide electronic medical record system incorporating new billing and Radiology informatics systems, requiring flexibility in the PI implementation plan. Only one PI team conducted regular post-PI follow-up meetings. Sustained improvement was frequently, but not universally, observed: in the long-term following initial PI, measures of examination volume showed continued progressive improvements, whereas measures of operational efficiency remained stable or occasionally declined. Conclusions Focused PI is generally effective in achieving performance improvement, although a changing environment influences the sustainability of impact. Thus, continued process evaluation and ongoing workflow modifications are warranted.