Learning from errors in radiology to improve patient safety

To determine the views and practices of trainees and consultant radiologists about error reporting. Cross-sectional survey. Radiology trainees and consultant radiologists in four tertiary care hospitals in Karachi approached in the second quarter of 2011. Participants were enquired as to their grade, sub-specialty interest, whether they kept a recod/log of their errors [defined as a mistake that has management implications for the patient], number of errors they made in the last 12 months and the predominant type of error. They were also asked about the details of their department error meeting. All duty completed questionnaires were included in the study while the ones with incomplete information were excluded. A total of 100 radiologists participated in the survey. Of them 34 were consultants and 66 were trainees. They had a wide range of sub-specialty interest like CT, Ultrasound, etc. Out of the 100 responders, 49 kept a personal record/log of their errors. In response to the recall of approximate errors they made in the last 12 months. 73 [73%] of participants recorded a varied response with 1 - 5 errors mentioned by majority i.e. 47 [64.5%]. Most of the radiologists [97%] claimed receiving information about their errors through multiple sources like morbidity/mortality meetings, patients' follow-up, through colleagues and consultants. Perceptual error 66 [66%] were the predominant error type reported. Regular occurrence of error meetings and attending three or more error meetings in the last 12 months was reported by 35% participants. Majority among these described the atmosphere of these error meetings as informative and comfortable [n = 22, 62.8%]. It is of outmost importance to develop a culture of learning from mistakes by conducting error meetings and improving the process of recording and addressing errors to enhance patient safety

Percutaneous cholecystostomy [PC] in the management of acute cholecystitis in high risk patients

To determine the role of ultrasound -guided percutaneous cholecystostomy [PC] regarding complications and outcome in the management of acute cholecystitis in patients high risk for surgery and anaesthesia and not responding to conservative management. Observational case series. The study was carried out at The Aga Khan University Hospital, Karachi, from January 2003 to December 2007. The study included patients admitted with acute cholecystitis considered unfit for immediate surgery but not responding to conservative management. Percutaneous cholecystostomy was conducted under ultrasound guidance. The studied variables included patients' demographics, co-morbid, ultrasound findings of biliary tree, indication for percutaneous cholecystostomy, its route, complication during or after procedure, patient's clinical outcome [upto 48 hours] and 30 days follow-up. Those with incomplete medical record and follow-up were excluded. Data were analyzed and results compiled using SPSS 16.0 version. Mean and standard deviation for quantitative variable like age was derived. Proportions were computed for complications and patient's clinical outcome. Forty one patients with complete medical record were studied including 15 [37%] males and 26 [63%] females. Mean age was 65 +/- 13.5 years. Indications for PC included calculus cholecystitis in 25, acalculous cholecystitis in 10, empyema in 04 and gallbladder perforation in 02 patients. No complication was seen during or after procedure in 31 [75%] patients. Complications occurred in 10 [25%] patients including vagal reaction, pain during procedure, tube blockage, catheter dislodgement and bile leakage. Favourable clinical response [improvement in clinical symptoms] was noted in 34 [83%] patients. Seven [17%] patients did not show any improvement in clinical condition after the procedure. On 30 days follow-up, 9 patients had undergone cholecystectomy, 5 [12%] patients expired due to underlying clinical conditions and the rest were settled without requiring an immediate cholecystectomy. There was no direct procedure-related mortality. Imaging guided PC is a safe and effective procedure for immediate management of non-resolving acute cholecystitis in patients high risk for surgery and anaesthesia and not responding to conservative management

Malignant phyllodes tumour as an intracystic growth with osteosarcomatous differentiation

Phyllodes tumour is an uncommon fibro epithelial tumour of breast that often presents clinically as a rapidly enlarging lump. On mammography it appears as a soft tissue density well circumscribed mass. Ultrasound shows it to be a solid hypoechoic mass with small cystic spaces. A case of malignant phyllodes tumour with an atypical appearance of intracystic tumour on sonography is reported with pertinent imaging features and histopathological diagnostic criteria. The tumour had undergone osteosarcomatous differentiation