This is a report of incidental diagnosis of a persistent left superior vena cava (PLSVC) based on an abnormal positioning of central venous catheter seen on chest radiograph and an abnormal pressure waveform. Non-invasive bedside tests included venography with simultaneous chest radiograph and a transthoracic echocardiography with an agitated saline microbubble contrast. These tests led to the diagnosis of PLSVC. Although PLSVC is the most common venous thoracic anomaly that produces a diagnostic dilemma, not many anaesthetists and intensivists are familiar with its appearance, diagnosis and implications. The clinical significance of PLSVC and diagnostic options are discussed.
Introduction:The purpose of this study was to determine the types of incidents that occurred in the iMRI OT over a nineteen-month period in our institution. We aim to prevent any future avoidable incidents from happening in this potentially hazardous environment.Methods: This is a single centre prospective non-anonymous observational study conducted from February 2009 to September 2010 on surgeries performed in the iMRI OT. Safety incidents specific to the iMRI OT such as violation of safety protocols and equipment failures were reported as well as any other safety incidents resulting in potential or actual adverse safety outcomes. The outcomes of the incidents were included and the data analysed at the end of the study period.Results: Of 271 cases that were operated in the iMRI OT, 43 incidents were reported by the staff involved in the care of the patient. Of the 43 incidents, 14 incidents (32.6%) were classified as staff/personnel error and were preventable. Incidents resulted in either delayed surgery or cancellation of the surgery. There were no major adverse incidents that led to patient harm.
Conclusion:Many of the incidents were preventable and measures have been instituted to prevent the recurrence of such incidents. Staff training, safety protocols and stringent maintenance of equipment are paramount to safe and efficient use of the iMRI operating theatre.
Background:In the Singapore General Hospital, intraoperative MRI (iMRI) neurosurgery is a multi-disciplinary process that involves staff from multiple departments. However, a baseline analysis showed that only 10.5% of iMRI neurosurgeries start on time, resulting in unnecessary waste of resources. The project aimed to improve the percentage of on-time start iMRI neurosurgeries to 100% within nine months.Materials and Methods:Clinical Practice Improvement methodology was used. The project involves four phases: Diagnostic, in which a baseline analysis is conducted; Intervention, in which problem areas are identified; Implementation, in which potential solutions are implemented; and sustaining, in which strategies to sustain gains are discussed.Results:The percentage of on-time start cases gradually increased to 100% in eight months, and was sustained above 85% in the following five months.Conclusion:This project serves as a successful demonstration of how quality improvement can be effected in a complex, multidisciplinary workflow, which is the norm for many hospital procedures.
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