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A digital audit of emergency upper gastrointestinal fluoroscopy workflow in children with bilious vomiting.

Authors
  • Messiahs, Bradley C1
  • Pitcher, Richard D1
  • 1 Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. , (South Africa)
Type
Published Article
Journal
SA journal of radiology
Publication Date
Jan 01, 2022
Volume
26
Issue
1
Pages
2300–2300
Identifiers
DOI: 10.4102/sajr.v26i1.2300
PMID: 35402008
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. A digital audit of workflow in emergency UGI contrast studies performed on children with bile-stained vomiting at a large South African teaching hospital. 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). 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). The modern RIS is an excellent tool for time-critical workflow analyses, which can inform interventions for improved service delivery. © 2022. The Authors.

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