At Leeds General Infirmary, a busy tertiary centre for neurosurgery, there has been little visibility of the step-down status of the patients from intensive care to high dependency or from the latter to a ward bed. The only record of the current situation was limited to the paper notes of the bed managers. Furthermore, accuracy of electronic systems used for staffing levels and bed state were underused. There were gaps in information and furthermore information within the system was unreliable (together defined as ‘defects’). These defects mandated bed managers’ physical presence on each ward to obtain reliable data. This led to unwarranted critical care stays and resultant high rates (up to 40%) of elective operation cancellations requiring a critical care bed.The Leeds Improvement Method using principles of the Toyota Production System aimed to improve patient flow through critical care and to assess the impact on elective case activity. Problems were identified and changes were implemented over a 1-week period. The changes included measures to reduce time taken for collation of critical bed-state information and improving patient and staffing data quality collected in the electronic patient management system (EPMS) and electronic staffing record (ESR). Impact was monitored for 30 days pre-implementation and post-implementation.Following intervention, the time taken by the bed manager to gather live bed-state information decreased from 50 to 9 min; the EPMS storing correct bed-state data was improved from 71% to 0% defect; the ESR was improved from 100% to 4% defects; critical care patient step-downs occurring at night (after 20:00) improved from 80% to 20%; and the number of cancelled elective cases over a 30-day period reduced from nine to one.Implementing these organisational efficiencies can significantly improve critical care patient flow and elective case throughput.
Ever-developing changes to the working hours of junior doctors by the European Working Time Directive, the junior doctor contract of 2019 and most recently the COVID-19 pandemic have impacted the professional identity of doctors. There has been little investigation into its influence on the multifaceted aspects of postgraduate medical training, which feeds into how trainees consider themselves professionally and the concept of professional identity or ‘being a doctor’. A review of the medical, socio-political and educational literature reveals that the impact on the professional identity development of trainees is influenced by several perspectives from the trainee, trainer and the public. Gross reduction in working hours has no doubt decreased the raw volume of clinical experiences. However, to counteract this, smarter learning processes have evolved, including narrative reflection, supervised learning events, and a greater awareness of coaching and training among trainers.
Background: Cervical neural foraminal stenosis is a common and debilitating condition affecting people 40-60 years old. Although it is established that MRI is the best method of scanning the neural foramen, the question remains whether there is a role for three-dimensional MRIs and subsequently if it is possible to develop a computer aided automated grading system to establish the degree of clinically relevant cervical foraminal stenosis. Objective: The aim of the study is to review the literature for current or emerging automated grading systems of the cervical neural foramen, also including volumetric assessments of the neural foramen using MRI. Methods: A systematic search of Cochrane Library, Cochrane Clinical Trials, Ovid MEDLINE, EMBASE, CINAHL, ACM Digital Library and Institute of Electrical and Electronics Engineers (IEEE) and Web of Science was performed for reports examining automated systems and volumetric scanning foraminal stenosis published before 31.07.2021. Results: 3971 articles were identified with 8 included. The automated grading systems of the neural foramen focus largely of the lumbar spine with elements that may be applicable to the cervical spine. Although there are established studies for the automated grading of the lumbar spine, it is uncertain whether any of these are reproducible in the cervical spine. Visual grading systems for the cervical spine demonstrate good inter-reader reliability between radiologists and clinicians. Conclusion: The Park visual grading system although has limited data on the correlation with neurological symptoms or surgical outcome does demonstrate good inter-reader reliability between radiologists and clinicians. There is scope for further development of an automated grading system for cervical foraminal stenosis to improve the speed and consistency of image interpretation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.