Use of a Checklist for the Postanesthesia Care Unit Patient Handoff.

PURPOSE: This quality improvement project aimed to evaluate the benefits of implementing a checklist in the postanesthesia care unit (PACU) setting to decrease the omission of health information during the handoff from anesthesia to PACU nurses. DESIGN: Patient handoffs from anesthesia providers were anonymously assessed by PACU nurses before and after the implementation of a handoff checklist with the Situation, Background, Assessment, Recommendation format. METHODS: PACU nurses recorded use of the handoff checklist and if five items of health information were included in the handoff during the preintervention and postintervention phase. FINDINGS: Checklist use increased from 0% to 73% with omitted information decreasing with checklist use: procedure from 19% to 2%, allergies 23% to 4%, input and output 16% to 0%, antiemetic used 21% to 4%, and lines 19% to 11%. Completed handoffs increased from 13% to 82% whereas checklist use remained high, at over 79%, for the 12 weeks after implementation. CONCLUSIONS: The project was successful in implementing a standardized checklist and echoed the success of the articles reviewed. The use of a PACU handoff checklist can improve transfer of care by ensuring the provider receives more pertinent medical information during these transfers.

Emerging evidence in infection control: effecting change regarding use of disposable laryngoscope blades.

The purpose of this evidence-based project was to determine the perceptions of anesthesia providers regarding the use of disposable laryngoscope blades. Frequency of use, ease of use, and complications encountered when using the disposable blade were evaluated before and after an in-service program designed to increase the use of disposable blades. Participants completed an anonymous questionnaire about their knowledge and practice regarding disposable laryngoscope blades. Then they received an investigator-developed article to read about the best and most recent practices regarding disposable laryngoscope blades. The same anonymous questionnaire was completed 3 months later. Inventory of the disposable laryngoscope blades was collected before the project and 1 and 3 months later. After the intervention, 25% of anesthesia providers described performance as their reason for not using the disposable laryngoscope blade, which was down from 60% at the project's start. Inventory showed a 23% increase in use of disposable laryngoscope blades after the intervention, which a single-proportion Z test showed was statistically significant (Z = 2.046, P = .041). This evidence-based project shows that a change in practice was evident after dissemination of the best and most recent clinical evidence regarding laryngoscope blades, which should translate to improved patient outcomes.

Exclusion of unstable cervical spine injury in obtunded patients with blunt trauma: is MR imaging needed when multi-detector row CT findings are normal?

PURPOSE: To retrospectively determine what information, if any, magnetic resonance (MR) imaging of the cervical spine in obtunded and/or "unreliable" patients with blunt trauma adds to multi-detector row computed tomography (CT) of the entire cervical spine (including routine multiplanar sagittal and coronal reformations) when the CT findings are normal. MATERIALS AND METHODS: The study was HIPAA compliant and institutional review board approved. Informed consent was not required. From April 2001 to November 2003, 1400 trauma patients underwent MR imaging of the cervical spine to evaluate potential cervical spine injuries. Multi-detector row CT of the cervical spine was performed with a four- or 16-detector row scanner. MR imaging of the cervical spine was performed with transverse gradient-echo, sagittal intermediate-weighted, sagittal short inversion time inversion-recovery, and sagittal T1- and T2-weighted fast spin-echo sequences. Many MR examinations were performed to exclude soft-tissue injuries in the cervical spine of obtunded patients with blunt trauma in whom cervical spine injury could not be excluded with physical examination. Complete cervical spine MR studies were obtained to evaluate soft-tissue injuries in 366 obtunded patients with blunt trauma (281 male and 85 female patients; age range, 13-92 years; mean age, 42.1 years). The patients had previously undergone total cervical spine multi-detector row CT with normal findings. The results obtained with these two modalities were compared. RESULTS: MR images were negative for acute injury in 354 of the 366 patients and negative for cervical spine ligamentous injury in 362. Seven of the 366 patients had cervical cord contusions, four patients had ligamentous injuries, three patients had intervertebral disk edema, and one patient had a cord contusion, a ligamentous injury, and an intervertebral disk injury. Four patients had ligamentous injuries; however, all of these patients had ligament injuries limited to only one of the three columns of cervical spine ligament support. Multi-detector row CT had negative predictive values of 98.9% (362 of 366 patients) for ligament injury and 100% (366 of 366 patients) for unstable cervical spine injury. CONCLUSION: A normal multi-detector row CT scan of the total cervical spine in obtunded and/or "unreliable" patients with blunt trauma enabled the authors to exclude unstable injuries on the basis of findings at follow-up cervical spine MR imaging.

Mesenteric ischemia.

MI remains a highly lethal entity. Improving survival requires an aggressive, multidisciplinary approach. High-risk patients with severe abdominal pain and a paucity of physical findings should be undergo emergent imaging in a search for this disease. Improvements in laboratory tests and advances in imaging techniques may improve the ability to diagnose MI earlier in its course, before irreversible damage has occurred. Many treatment modalities are available and should be tailored to each individual case. By recognizing and preventing ischemia-reperfusion injury,the cycle of protracted complications may be broken. A decrease in the mortality from MI finally is occurring. Early recognition and aggressive treatment finally may allow clinicians to have a marked impact on patient survival.