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A digital audit of emergency upper gastrointestinal fluoroscopy workflow in children with bilious vomiting
Bradley C Messiahs1, Richard D Pitcher1
1Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Insights
Urgent upper gastrointestinal (UGI) fluoroscopy for pediatric bilious vomiting is critical. This study analyzed UGI workflow times, finding reporting was the longest step, highlighting areas for improved pediatric emergency care delivery.
Area of Science:
- Pediatric Radiology
- Gastrointestinal Imaging
- Emergency Medicine Workflow Analysis
Background:
- Bilious vomiting in children necessitates prompt upper gastrointestinal (UGI) fluoroscopy to rule out life-threatening midgut malrotation with volvulus (MMWV).
- Limited data exist on the duration of critical workflow steps in emergency pediatric UGI examinations.
Purpose of the Study:
- To digitally audit the workflow of emergency UGI contrast studies in children presenting with bilious vomiting.
- To identify and quantify the duration of key time-critical workflow steps.
Main Methods:
- Retrospective analysis of 37 pediatric patients undergoing emergency UGI fluoroscopy for bilious vomiting (May 2012 - May 2019).
- Utilized radiology information system (RIS) timestamps to calculate median durations for 'approval', 'waiting', 'study', and 'reporting' times.
- Statistical analysis (ANOVA, Chi-squared) assessed associations between patient parameters and workflow durations.
Main Results:
- The median total time from request to report was 107 minutes.
- Reporting time (38 min) was the longest workflow step, while approval time (6 min) was the shortest.
- Abnormal C-loops and consultant referrals correlated with shorter approval times; neonatal waiting times were longer.
Conclusions:
- Radiology Information Systems (RIS) are effective tools for analyzing time-critical workflows in pediatric emergency imaging.
- Findings can guide interventions to optimize service delivery and reduce patient wait times for critical diagnostic procedures.
Background:
Bilious vomiting in children requires an urgent evaluation with upper gastrointestinal (UGI) fluoroscopy as it may herald life-threatening midgut malrotation with volvulus (MMWV). There are no published data available on the duration of time-critical UGI workflow steps.
Objectives:
A digital audit of workflow in emergency UGI contrast studies performed on children with bile-stained vomiting at a large South African teaching hospital.
Method:
A retrospective study was conducted from 01 May 2012 - 31 May 2019. A customised search of the institutional radiology information system (RIS) defined all children with bilious vomiting who underwent emergency UGI fluoroscopy. Extracted RIS timestamps were used to calculate the median duration of the 'approval', 'waiting', 'study' and 'reporting' times. One-way analysis of variance and Chi-squared tests assessed the association between key parameters and the duration of workflow steps, with 5% significance (p < 0.05).
Results:
Thirty-seven patients (n = 37) with median age 0.8 months were included, of whom 20 (54%) had an abnormal C-loop. The median 'total time' from physician request to report distribution was 107 min (interquartile range [IQR]: 67-173). The median 'approval' (6 min; IQR: 1-15) and 'reporting' (38 min; IQR: 17-91) times were the shortest and longest workflow steps, respectively. Abnormal C-loops (p = 0.04) and consultant referrals (p = 0.03) were associated with shorter 'approval' times. The neonatal 'waiting' time was significantly longer than that for older patients (p = 0.02).
Conclusion:
The modern RIS is an excellent tool for time-critical workflow analyses, which can inform interventions for improved service delivery.
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