Electronic Request Research Articles

Implementation of an electronic CT head request pro forma for acute stroke: Does this improve workflow and diagnostic accuracy?

Background: King’s College Hospital is a busy neuroscience, trauma and hyperacute stroke centre with a high volume of computed tomography (CT) head requests. As part of the hospital’s acute stroke pathway, radiographers can justify head CT scans for acute stroke. Adequate request information facilitates justification and aids radiological interpretation, but also allows prioritisation of scans, particularly when the patient is a potential candidate for time-critical stroke treatments such as mechanical thrombectomy and thrombolysis.

OA04 Paediatric APS - children are not just small adults

OA04 Paediatric APS - children are not just small adults

Innovations in Fatality Management During the COVID-19 Pandemic.

Innovations in Fatality Management During the COVID-19 Pandemic.

290 ‘Save Blood' - Strategies to Reduce Inappropriate Routine Bloods Tests in a Surgical Department

Abstract Aim To quantify the number of inappropriate blood tests in our 72-bed Surgical Department and identify strategies that reduce the number of unnecessary electronic blood test requests. This should reduce patient harm, demands on staff time, laboratory processing burden and financial expenditure. Method Each audit involved logging all blood tests for every surgical inpatient over two consecutive days. Upon reviewing the clinical records, it was decided whether tests were clinically indicated or ‘inappropriate’. Following a baseline audit, three interventions were sequentially introduced over a one-year period, and the department re-audited after each: (1) educational sessions with junior medical staff and creation of ordering guidelines, (2) poster presentations, and (3) policing of requests by middle-grade doctors and removal of electronic blood test ordering bundles. Results Across the baseline audit to interventions 1–3, numbers of patients with at least one inappropriate test were recorded as 45/73 (62%), 51/63 (81%), 41/57 (72%), and 27/32 (84%), accruing totals of 363, 289, 303, and 149 inappropriate tests respectively. This gave an overall reduction in the rate of inappropriate blood tests per patient per day from a baseline of 0.9, to 0.9 then 0.8 to 0.5 with successive interventions. Conclusions Despite the innovation of electronic ordering systems enabling close audit of test schedules, inappropriate tests remain common. Educational sessions for junior doctors, written guidelines, and poster presentations had little influence on this. However, rationalising electronic order bundles and involving senior doctors in decision-making, almost halved the rate of inappropriate tests. These more effective strategies will be disseminated throughout our hospital.

An Interdisciplinary Dashboard to Streamline Medication Processing at Patient Discharge: A Quality Improvement Initiative.

The purpose of this quality improvement project was to develop and evaluate the use of an electronic medication request dashboard to reduce the amount of time required for medication processing and decrease time lost to workflow interruptions during patient discharge. Delayed discharges are associated with increased health care costs and adverse patient outcomes. Processing of medication requests at discharge contributes to these delays and to workflow interruptions for nursing and pharmacy staff at the project site. Electronic dashboards have been successfully implemented in multiple medical settings to streamline patient processing and enhance communication. The Human Protections Office at Carl R. Darnall Army Medical Center (Fort Hood, TX) reviewed and approved the project with a non-human research determination. A multi-disciplinary workgroup with representatives from nursing, pharmacy, and health information technology (HIT) was formed to develop the dashboard. Based on a logic flow diagram of the desired communication, HIT created a medication request form and status dashboard using SharePoint and Nintex workflows. The dashboard was implemented for a 30-day pilot on a 25-bed medical/surgical nursing unit. The time required for medication processing, the time from discharge order to patient exit, the number of phone calls between nursing and pharmacy, and the usability of the medication request process were measured before and after implementation. The results were analyzed with descriptive statistics and evaluated for statistical significance with a P value ≤.05. With implementation of the dashboard, the average medication processing time decreased from 125 minutes to 48 minutes (P < .0001), and the average patient discharge time decreased from 137 minutes to 117 minutes (P = .002). The usability score of the medication request process increased from 40 to 87 for nursing (P < .0001) and from 62 to 85 for pharmacy (P = .003). The total number of voice calls between nursing and pharmacy decreased from 1,115 to 434, while the total time on voice calls decreased from 33 hours and 50 minutes to 13 hours and 19 minutes (P < .0001). The electronic dashboard is an effective method to enhance interdisciplinary communication during patient discharge and significantly reduces medication processing times. However, despite the medication processing time decreasing by over an hour, the discharge time only decreased by 20 minutes. Additional investigation is needed to evaluate other contributors to delayed discharge. A key limitation of this study was the convenience sampling used over a 30-day pilot on a single unit. The process has since been adopted by the entire hospital, and additional analysis could better reveal the impact to the organization. This communication system shows high usability and reduces phone call interruptions for both nursing and pharmacy staff. Additionally, this technology could easily be applied to other communication pathways or request processes across military medicine.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Extracranial Cerebrovascular System.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Extracranial Cerebrovascular System.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Neonatal and Infant Spine.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Neonatal and Infant Spine.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum.

Optimization of Antibiotic Prophylaxis Delivery for Pediatric Surgical Procedures.

To optimize prophylactic antibiotic timing and delivery across all surgeries performed at a single large pediatric tertiary care center. A multidisciplinary surgical quality team conducted a quality improvement initiative from July 2015 to December 2019 by using the A3 problem-solving method to identify and evaluate interventions for appropriate antibiotic administration. The primary outcome measure was the percentage of surgical encounters for pediatric patients with appropriate timing of antibiotic administration before surgical incision. Surgical site infection rates was the secondary outcome. Intervention effectiveness was assessed by using statistical process control. A total of 32 192 eligible surgical cases for pediatric patients were completed during the study period. Identified barriers to timely perioperative antibiotic administration included failure to order antibiotics before the surgical date and lack of antibiotic availability in the operating room at the time of administration. Resulting sequential interventions included updating institutional guidelines to reflect procedure-specific antibiotic choices and clarifying timing of administration to optimize pharmacokinetics, creating a hard-stop antibiotic order within electronic health record case requests, optimizing pharmacy and nursing workflow, and implementing an automatic antibiotic prophylaxis timer in the operating room. Administration of prophylactic antibiotics during the recommended preincision time window significantly improved; the correct timing was recorded in 38.6% of preintervention cases versus 94.0% at the conclusion of rollout of the sequential interventions (P < .001). Surgical site infection rates remained stable. Here we demonstrate utility of the A3 problem-solving schematic to successfully optimize prophylactic antibiotic timing and delivery in the surgical setting for pediatric patients by implementing systems-based interventions.

Alternative Forms of Current Business Communication: Text Structure and Composition Evolution

The article deals with the structure and composition of texts of current electronic business communication. The research materials included electronic business letters (initial requests in the sphere of travel and hotel service), initial requests on the pharmaceutical, engineering, and technological Internet forums, and Instagram business communication texts in the sphere of education, real estate, and food. The messages demonstrated evolution of both structure and text architectonics of business letters. The main research methods included monitoring and description combined with the method of comparative language analysis. The structure and composition of electronic business letters and requests on the Internet forums and social networks proved different from traditional business letters due to the text-generating online algorithms. Internet users seem unable to perceive business e-mails, web-forum requests, or social network messages as a segmentable text. Electronic business communication is currently undergoing deformalization and style hybridization as a result of electronic communication peculiarities and liberalization.

Decision support system through automatic algorithms and electronic request in diagnosis of anaemia for primary care patients.

IntroductionAn appropriate management of anaemia laboratory tests is crucial for a correct diagnosis and treatment. A non-sequential “shotgun” approach (where every anaemia related test is ordered) causes workload and cost increases and could be potentially harmful. We have implemented a Decision Support System through our laboratory information system (LIMS) based on reflexive algorithms and automatic generation of interpretative reports specifically in diagnosis of anaemia for primary care patients.Materials and methodsWhen a request contained an “Anaemia Suspicion Study” profile, more than twenty automatic reflexive rules were activated in our LIMS based upon laboratory results. These rules normally involved the addition of reflexive tests. A final report was automatically generated for each interpretation which was always reviewed for their validity by two staff pathologists. We measured the impact of this system in the ordering of most common anaemia related tests and if a proper treatment was established based on the interpretive report.ResultsFrom all the studies performed, only 12% were positive being “iron deficiency” and “anaemia of chronic disease” the most frequent causes, 62% and 17%, respectively. Proper treatment was established in 88% of these anaemic patients. Total iron, transferrin, ferritin, folate and vitamin B12 demand decreased substantially after implementation representing a cost reduction of 40% only for these five tests.ConclusionsOur system has easily improved patient outcomes, advising on individual clinical cases. We have also noticeably reduced the number of over-requested tests and laboratory costs.

Seeking Strategies to Optimize Blood Utilization: The Preliminary Experience with Implementing a Patient Blood Management Program in a Greek Tertiary Hospital.

Objectives: Our aim was to assess blood utilization after implementation of a patient blood management (PBM) program in a Greek tertiary hospital. Methods: An electronic transfusion request form and a prospective audit of transfusion practice were implemented. After the one-year implementation period, a retrospective review was performed to assess transfusion practice in medical patients. Results: Pre-PBM, a total of 9478 RBC units were transfused (mean: 1.75 units per patient) compared with 9289 transfused units (mean: 1.57 units per patient) post-PBM. Regarding the post-PBM period, the mean hemoglobin (Hb) level of the 3099 medical patients without comorbidities transfused was 7.19 ± 0.79 gr/dL. Among them, 2065 (66.6%) had Hb levels >7.0 gr/dL, while 167 (5.3%) had Hb levels >8.0 gr/dL. In addition, 331 (25.3%) of the transfused patients with comorbidities had Hb >8.0 gr/dL. The Hb transfusion thresholds significantly differed across the clinics (p < 0.001), while 21.8% of all medical non-bleeding patients received more than one RBC unit transfusion. Conclusion: A poor adherence with the restrictive transfusion threshold of 7.0 gr/dL was observed. The adoption of a less strict threshold might be a temporary step to allow physicians to become familiar with the program and be informed on the safety and advantages of the restrictive transfusion strategy.

P104 Orion xTask: Improving neurosurgical workflow using an electronic tasks system

IntroductionThe dominant form of communication within hospitals remains the antiquated paging system. Pitfalls to pagers include: overwhelming volume of non-urgent bleeps; inability to prioritise at the point-of-bleep; no written record of communication - potentially compromising patient safety.Orion xTask, an electronic tasks system, was implemented at Cambridge neurosurgery in April 2019 to mitigate some of these pitfalls.MethodsBleep logs, covering 2-months before and 4-months after xTask implementation with total 3181 bleeps, were obtained. xTask data for the same period (total 4195 electronic requests) was exported. Bleep response times for neurosurgery and for other specialties without xTask were collected. Questionnaires were distributed to nursing and medical staff.ResultsDaily averages of 14.4 in-hours and 23.7-out-of-hours electronic requests were made. The exception to greater out-of-hours utilisation was the ward without a dedicated doctor, where requests peaked in the morning. Prescription was most commonly requested (49%), followed by clinical review (17%).There were daily averages of 13.0 in-hours and 8.3 out-of-hours bleeps. Changes in bleep volume with xTask implementation were inconsistent: Calls to ward bleeps decreased (p = 0.044), but increased to the on-call (p = 0.042).Bleep response times, and (bleeped-)job completion times were significantly quicker for neurosurgery than for other specialties (p < 0.001).Nursing and doctors’ feedback was overwhelmingly positive, with agreement that xTask improves patient safety. xTask scored particularly highly on “Improves Communication”, “Improves Record Keeping” and “Useful Out-of-Hours”. Doctors indicated that xTask also “Helps Prioritisation” and “Facilitates Educational Opportunities”.ConclusionThe feedback and pattern-of-use indicates that Orion xTask successfully mitigates some of the pitfalls of pagers, thereby improving patient safety.

Zoology of domain walls in quasi-2D correlated charge density wave of 1T-TaS2

Domain walls in correlated charge density wave compounds such as 1T-TaS2 can have distinct localized states which govern physical properties and functionalities of emerging quantum phases. However, detailed atomic and electronic structures of domain walls have largely been elusive. We identify using scanning tunneling microscope and density functional theory calculations the atomic and electronic structures for a plethora of discommensuration domain walls in 1T-TaS2 quenched metastably with nanoscale domain wall networks. The domain walls exhibit various in-gap states within the Mott gap but metallic states appear in only particular types of domain walls. A systematic understanding of the domain-wall electronic property requests not only the electron counting but also including various intertwined interactions such as structural relaxation, electron correlation, and charge transfer. This work guides the domain wall engineering of the functionality in correlated van der Waals materials.

AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography.

AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography.

AIUM Practice Parameter for the Performance of Ultrasound Evaluations of the Prostate (and Surrounding Structures).

AIUM Practice Parameter for the Performance of Ultrasound Evaluations of the Prostate (and Surrounding Structures).

Management of lateral pelvic lymph nodes by Australasian colorectal surgeons: An insight from the west.

Lateral pelvic lymph node dissection (LPLND) for locally advanced low rectal cancer is a common practice in Japan. However, it is not widely performed in western countries. The aim of this survey study is to assess the current practice and management of lateral pelvic lymph nodes by colorectal surgeons in Australasia. The authors developed a survey to assess surgeons' assessment and management of lateral pelvic lymph nodes in patients with rectal cancer. The survey was run through the online RedCap® platform in 2019. An electronic link and request to complete the survey was sent to specialist surgeons of the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). Ninety-two colorectal surgeons completed the online survey (32% response rate). Eighty percent of participants consider malignant lateral pelvic lymph nodes to represent locoregional and resectable disease. In patients with clinically malignant lateral pelvic lymph nodes on preoperative imaging the majority of respondents (92%) recommend neoadjuvant chemoradiotherapy and 86% would also recommend LPLND. Over half of the surgeons (57%) had no exposure to LPLND during fellowship training and approximately two thirds (62%) do not perform LPLND in their current practice. This study highlights the challenges in the management of the lateral pelvic lymph nodes in a western context. The majority of the participating Australasian colorectal surgeons consider malignant lateral pelvic lymph nodes to represent locoregional and resectable disease. The majority also recommend LPLND for clinically malignant lateral pelvic nodes. However, adequate training and experience with LPLND is limited.

Prospects to create and apply artificial intelligence in the activities of public authorities

The article is devoted to the research of conceptual sources to create and apply artificial intelligence in the activities of public authorities. The author systematizes scientific developments on application of artificial intelligence, robotics, computer technologies and other information tools in the activities of public authorities. The concept of "intellectual management" has been reviewed and its importance for implementation in the activities of public authorities has been determined. The history of global intellectual governance development is described. The world positive and negative experience of introducing cyberdemocracy, electronic government, electronic requests and other technologies in public administration was analyzed. Prospects for governance intellectualization in public authorities of the Russian Federation have been defined. It has been found that attempts to intellectualize governance are being actively introduced on a global scale, but this process is time-consuming and has many obstacles which the study is focused on.

A National Survey on Patient Provider Agreements When Prescribing Opioids for Chronic Pain.

Many national guidelines recommend the use of patient provider agreements (PPAs) when prescribing opioids for chronic pain. There are no standards for PPA content, readability, or administration processes. Conduct a national survey of providers who use PPAs to describe the process of administering them, assess views on their utility, and obtain PPAs to evaluate thematic content and readability. Cross-sectional electronic survey and request for PPAs. Registrants for the Safer/Competent Opioid Prescribing Education (SCOPE of Pain) Program between March 2013 and June 2017. Respondents' reports on how PPAs are administered and views on their usefulness. A sample of PPAs assessed for themes and readability. Using a convenience sample of 62,530 SCOPE of Pain registrants, we obtained a cohort of 430 individuals from 43 states who use PPAs. The majority of respondents worked in primary care (64%) and pain (18%) specialties. Reviewing PPAs with patients was primarily done by prescribers (80%), and the average perceived time to administer PPAs was 13 min. Although 66% of respondents thought PPAs were "often" or "always" worth the effort, only 28% considered them "often" or "always" effective in reducing opioid misuse. The PPA reading burden surpassed recommended patient education standards, with only 2.5% at or below fifth-grade reading level. PPAs focused more on rules and consequences of patients' non-compliance than on a shared treatment plan. Most respondents perceive patient provider agreements (PPAs) as time-consuming and minimally effective in reducing opioid misuse yet still view them as valuable. PPAs are written far above recommended reading levels and serve primarily to convey consequences of non-compliance. Because PPAs are recommended by national safer opioid prescribing guidelines as a risk mitigation strategy, it would be beneficial to develop a standard PPA and study its effectiveness.

The electronic evolution of corporate bond dealers

Technology transformed the trading of financial assets but has been slower to come to corporate bond trading. Combining proprietary data from MarketAxess with regulatory TRACE data, we investigate how electronic request for quote (RFQ) trading affects bond dealers and trading more generally. We demonstrate that electronic trading remains fairly small and segmented, but has wide-ranging effects on transaction costs and execution quality in both electronic and voice trading, and the interdealer market. We identify features particular to bond markets that have and could continue to limit electronic bond trading growth. We provide an intriguing portrait of a market in transition.