Postoperative and postdischarge nausea and vomiting following ambulatory eye, head, and neck surgeries: a retrospective cohort study comparing incidence and associated factors.

Background: Ambulatory surgery is often followed by the development of nausea and/or vomiting (N/V). Although risk factors for postoperative nausea and vomiting (PONV) are frequently discussed, the distinction between PONV and postdischarge nausea and vomiting (PDNV) is unclear. This is especially troublesome given the potential consequences of postdischarge nausea and vomiting (PDNV), which include major discomfort and hospital readmission.

Financial Impact of a Radiology Safety Net Program for Resolution of Clinically Necessary Follow-up Imaging Recommendations.

Objective: Health care safety net (SN) programs can potentially improve patient safety and decrease risk associated with missed or delayed follow-up care, although they require financial resources. This study aimed to assess whether the revenue generated from completion of clinically necessary recommendations for additional imaging (RAI) made possible by an IT-enabled SN program could fund the required additional labor resources.

Methods: Clinically necessary RAI generated October 21, 2019, to September 24, 2021, were tracked to resolution as of April 13, 2023.

What Went Right? A Mixed-Methods Study of Positive Feedback Data in a Hospital-Wide Mortality Review Survey.

Background: Toxic work culture contributes to healthcare worker burnout and attrition, but little is known about how healthcare organizations can systematically create and promote a culture of civility and collegiality.

Objective: To analyze peer-to-peer positive feedback collected as part of a systematized mortality review survey to identify themes and recognition dynamics that can inform positive organizational culture change.

Design: Convergent mixed-methods study design.

Impact of an Automated Closed-Loop Communication and Tracking Tool on the Rate of Recommendations for Additional Imaging in Thoracic Radiology Reports.

Objective: Assess the effects of feedback reports and implementing a closed-loop communication system on rates of recommendations for additional imaging (RAIs) in thoracic radiology reports.

Methods: In this retrospective, institutional review board-approved study at an academic quaternary care hospital, we analyzed 176,498 thoracic radiology reports during a pre-intervention (baseline) period from April 1, 2018, to November 30, 2018; a feedback report only period from December 1, 2018, to September 30, 2019; and a closed-loop communication system plus feedback report (IT intervention) period from October 1, 2019, to December 31, 2020, promoting explicit documentation of rationale, time frame, and imaging modality for RAI, defined as complete RAI. A previously validated natural language processing tool was used to classify reports with an RAI.

Development and External Validation of an Artificial Intelligence Model for Identifying Radiology Reports Containing Recommendations for Additional Imaging.

Reported rates of recommendations for additional imaging (RAIs) in radiology reports are low. Bidirectional encoder representations from transformers (BERT), a deep learning model pretrained to understand language context and ambiguity, has potential for identifying RAIs and thereby assisting large-scale quality improvement efforts. The purpose of this study was to develop and externally validate an artificial intelligence (AI)-based model for identifying radiology reports containing RAIs.

Development and Assessment of an Information Technology Intervention to Improve the Clarity of Radiologist Follow-up Recommendations.

Importance: It is challenging to ensure timely performance of radiologist-recommended additional imaging when radiologist recommendation language is incomplete or ambiguous.

Objective: To evaluate whether voluntary use of an information technology tool with forced structured entry of recommendation attributes was associated with improved completeness of recommendations for additional imaging over time.

Design, Setting, And Participants: This cohort study of imaging report data was performed at an academic quaternary care center in Boston, Massachusetts, and included consecutive adults with radiology examinations performed from September 12 to 13, 2019 (taxonomy validation), October 14 to 17, 2019 (before intervention), April 5 to 7, 2021 (1 week after intervention), and April 4 to 7, 2022 (1 year after intervention), with reports containing recommendations for additional imaging.

Predictors of Completion of Clinically Necessary Radiologist-Recommended Follow-Up Imaging: Assessment Using an Automated Closed-Loop Communication and Tracking Tool.

Patients with adverse social determinants of health may be at increased risk of not completing clinically necessary follow-up imaging. The purpose of this study was to use an automated closed-loop communication and tracking tool to identify patient-, referrer-, and imaging-related factors associated with lack of completion of radiologist-recommended follow-up imaging. This retrospective study was performed at a single academic health system.

A Prospective Intervention to Reduce Burnout Among Academic Radiologists.

Rationale And Objectives: Few studies have examined what constitutes effective interventions to reduce burnout among radiologists. We compared self-reported burnout among academic medical center radiologists before and after a series of departmental initiatives intended to increase wellbeing and professional satisfaction.

Materials And Methods: This Institutional Review Board-approved, prospective study took place 2017-2019 in a tertiary academic medical center.

Patient Experience Scores for Radiologists: Comparison With Nonradiologist Physicians and Changes After Public Posting in an Institutional Online Provider Directory.

Patients are increasingly using online information regarding patient experiences to guide care decisions. The purpose of our study was to compare patient experience scores between radiologists and nonradiologist physicians and to assess changes in scores after their public posting in an online physician directory. This retrospective study included data collected from May 1, 2017, to November 30, 2018, at a single large academic medical center.

Collaborative Case Review: A Systems-Based Approach to Patient Safety Event Investigation and Analysis.

Objectives: The aims of the study were to assess a system-based approach to event investigation and analysis-collaborative case reviews (CCRs)-and to measure impact of clinical specialty on strength of action items prescribed.

Methods: A fully integrated CCR process, co-led by radiology and an institutional patient safety program, was implemented on November 1, 2017, at our large academic medical center for evaluating adverse events involving radiology. Quality and safety teams performed reviews for events identified with other departments who maintained their existing processes.

Coronavirus disease 2019 (COVID-19) screening system utilizing daily symptom attestation helps identify hospital employees who should be tested to protect patients and coworkers.

Objective: To investigate the effectiveness of a daily attestation system used by employees of a multi-institutional academic medical center, which comprised of symptom-screening, self-referrals to the Occupational Health Services team, and/or a severe acute respiratory coronavirus virus 2 (SARS-CoV-2) test.

Design: We conducted a retrospective cohort study of all employee attestations and SARS-CoV-2 tests performed between March and June 2020.

Setting: A large multi-institutional academic medical center, including both inpatient and ambulatory settings.

Exacerbation of Inequities in Use of Diagnostic Radiology During the Early Stages of Reopening After COVID-19.

Objective: Assess diagnostic radiology examination utilization and associated social determinants of health during the early stages of reopening after state-mandated shutdown of nonurgent services because of coronavirus disease 2019 (COVID-19).

Methods: This institutional review board-approved, retrospective study assessed all patients with diagnostic radiology examinations performed at an academic medical center with eight affiliated outpatient facilities before (January 1, 2020, to March 8, 2020) and after (June 7, 2020, to July 15, 2020) the COVID-19 shutdown. Examinations during the shut down (March 9, 2020, to June 6, 2020) were excluded.

Addressing the caste system in U.S. healthcare in the era of COVID-19.

In healthcare, we find an industry that typifies the unique blend of racism, classism, and other forms of structural discrimination that comprise the U.S. caste system-the artificially-constructed and legally-reinforced social hierarchy for assigning worth and determining opportunity for individuals based on race, class, and other factors.

Closing the Loop on Unscheduled Diagnostic Imaging Orders: A Systems-Based Approach.

Purpose: The aims of this study were to (1) describe the System for Coordinating Orders for Radiology Exams (SCORE), the objective of which is to manage unscheduled orders for outpatient diagnostic imaging in an electronic health record (EHR) with embedded computerized physician order entry; (2) assess the impact of SCORE and other related factors (eg, demographics) on the rate of unscheduled orders; and (3) assess the clinical necessity of orders canceled, expired, scheduled, and performed.

Methods: This institutional review board-approved retrospective study was conducted at a large academic institution between October 1, 2017, and July 1, 2019. The design and implementation of SCORE are described, including people (eg, competencies), processes (eg, standardized procedures), and tools (eg, EHR interfaces, dashboard).

Reducing Medication Waste While Improving Access to Sugammadex: A Quality Improvement Project in Medication Stewardship.

The relatively high cost of sugammadex compared to neostigmine limits its widespread use to reverse neuromuscular blockade, despite its faster onset and more complete clinical effect. While ensuring timely access to sugammadex is important in improving perioperative safety, it is also vital to control unnecessary spending. We describe a quality improvement initiative to reduce excess spending on sugammadex while improving access for anesthesia providers.

Unscheduled Radiologic Examination Orders in the Electronic Health Record: A Novel Resource for Targeting Ambulatory Diagnostic Errors in Radiology.

Purpose: The aim of this study was to assess the prevalence of unscheduled radiologic examination orders in an electronic health record, and the proportion of unscheduled orders that are clinically necessary, by modality.

Methods: This retrospective study was conducted from January to October 2016 at an academic institution. All unscheduled radiologic examination orders were retrieved for seven modalities (CT, MR, ultrasound, obstetric ultrasound, bone densitometry, mammography, and fluoroscopy).

Factors Associated With Optimal Follow-up in Women With BI-RADS 3 Breast Findings.

Objective: Assess rate of and factors associated with optimal follow-up in patients with BI-RADS 3 breast findings.

Methods: This Institutional Review Board-approved, retrospective cohort study, performed at an academic medical center, included all women undergoing breast imaging (ultrasound and mammography) in 2016. Index reports for unique patients with an assessment of BI-RADS 3 (retrieved via natural language processing) comprised the study population.

Successful intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve, a multidisciplinary approach: The Massachusetts Eye and Ear Infirmary monitoring collaborative protocol with experience in over 3000 cases.

Background: Although intraoperative nerve monitoring (IONM) is utilized increasingly, the information on the related anesthesia technique is limited. This study presents an up-to-date clinical algorithm, including setup and troubleshooting of an IONM system, endotracheal tube placement, and anesthetic parameters. To our knowledge, this is the first interdisciplinary collaborative protocol for monitored neck surgery based on the published evidence and clinical experience.

Relationship between occurrence of surgical complications and hospital finances.

Importance: The effect of surgical complications on hospital finances is unclear.

Objective: To determine the relationship between major surgical complications and per-encounter hospital costs and revenues by payer type.

Design, Setting, And Participants: Retrospective analysis of administrative data for all inpatient surgical discharges during 2010 from a nonprofit 12-hospital system in the southern United States.

Specialized ambulatory anesthesia teams contribute to decreased ambulatory surgery recovery room length of stay.

Background: Many institutions have organized specialized groups of ambulatory surgery anesthesiologists with the aim of improving ambulatory surgery patient care and efficiency. We hypothesized that specialized ambulatory anesthesia teams produce better patient outcomes such as lower postoperative nausea and vomiting (PONV) rates, lower postoperative pain scores, and shorter postanesthesia care unit (PACU) lengths of stay (LOS).

Methods: In this prospective observational study, we collected outcomes data on 1,299 patients including incidence of PONV, PACU LOS, maximum and average pain scores, amount of postoperative opioid use, and rescue antiemetic use.

Presence of anesthesia resident trainees in day surgery unit has mixed effects on operating room efficiency measures.

Background: Three competing goals at academic medical centers are to increase efficiency, to optimize clinical care, and to train residents. The goal of this project was to compare day surgery operating room (OR) efficiency measures for anesthesiologists working alone, working with residents, and working with certified nurse anesthetists in a tertiary multisubspecialty teaching hospital to determine if trainees significantly impact OR efficiency.

Methods: We retrospectively evaluated operating room times data for 2,427 day surgery cases, comparing first case on-time starts, anesthesia-controlled times, induction times, emergence times, and turnover times for the 3 anesthesiologist groups.