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BACKGROUND: Assessing and improving quality of care should be of paramount importance to health care systems and providers. This study aimed to evaluate the quality of surgical records at the Jordan University Hospital. METHODS: We used the previously validated Surgical Tool for Auditing Records (STAR) to retrospectively evaluate the quality of surgical records of patients who underwent surgery in the general surgery department from 2016 to 2021. Total STAR and section-specific STAR scores were compared using the two independent sample Student's ttest on SPSS Statistics, version 23 (IBM Corp, Armonk, NY). RESULTS: A total of 488 records were selected and evaluated using the STAR. The total STAR scores significantly improved steadily throughout the years compared to the baseline in 2016, reaching the highest in 2021. All domains had improved compared to the baseline except for anesthesia records that did not change from an already high baseline. The highest improvements between STAR domains were observed in Initial Clerking and Consent domains. CONCLUSION: Our study demonstrates that significant improvements in the quality of surgical records can be achieved by simply using an electronic record entry system, personnel education, and systematic auditing.
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This is a 51-year-old male who presented with abdominal pain, bilateral proximal upper and lower extremities pain and weakness, and decreased urine output with abnormal kidney function test; Urea and creatinine levels were elevated at 231.5 mg/dl and 11.05 mg/dl, respectively. Initial bone scan showed increased uptake within several muscles suspicious for polymyositis, this was confirmed by biopsy of the right triceps, identified by bone scan as the best superficial biopsy site. Pelvis and thigh MRI demonstrated diffuse hyperintense signal on fluid sensitive sequences involving several muscles. Renal biopsy showed acute tubular injury. He was treated with steroids resulting in significant improvement. A repeat bone scan showed near complete resolution of the muscular uptake seen at presentation. This case nicely illustrates the role of bone scanning in the initial recognition and determination of the extent of polymyositis with identification of a suitable biopsy site as well as assessment of response to treatment.
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OBJECTIVES: The 2015 American Thyroid Association (ATA) guidelines called for significantly more selective 131I therapy in patients with low-risk differentiated thyroid cancer (DTC). We hypothesized that application of these guidelines would significantly reduce the 131I activity utilized by an academic tertiary hospital in Jordan. METHODS: All DTC patients managed at Jordan University Hospital (JUH) between 1/2009 and 6/2019 were classified according to the 2015 ATA risk category and 131I activity was assigned accordingly. The actual 131I activity administered was compared with that recommended by the 2015 ATA guidelines. RESULTS: In total, 135/182 DTC patients (74.2%) managed at JUH underwent 131I therapy. Of those, 58 (43%) had ATA low-, 58 (43%) intermediate-, and 19 (14%) high-risk disease. The low-, intermediate-, and high-risk DTC patients received an average (±SD) initial 131I activity of 3.53 ± 0.95, 4.40 ± 1.49, and 5.06 ± 2.52 GBq, respectively. Withholding 131I therapy altogether in the 2015 ATA low-risk patients would result in decreasing the 131I activity in the overall patient population by 37%. Withholding 131I therapy only in low-risk papillary thyroid microcarcinomas while administering 1.11 GBq of 131I to other low-risk patients would result in 28% reduction of 131I. CONCLUSION: This study demonstrates a significant reduction in 131I therapeutic activity that would be given to DTC patients in an academic tertiary setting in Jordan, following acceptance of the 2015 ATA recommendations. Institutions that adopted the 2015 ATA guidance should measure outcomes in comparison to their historical controls and report those findings, while long-term results of randomized controlled trials are forthcoming.
