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Vicente-Guijarro J, Valencia-Martín JL, Moreno-Nunez P, Ruiz-López P, Mira-Solves JJ, Aranaz-Andrés JM. Estimation of the Overuse of Preoperative Chest X-rays According to "Choosing Wisely", "No Hacer", and "Essencial" Initiatives: Are They Equally Applicable and Comparable? Int J Environ Res Public Health 2020; 17:ijerph17238783. [PMID: 33256032 PMCID: PMC7730586 DOI: 10.3390/ijerph17238783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Overuse reduces the efficiency of healthcare systems and compromises patient safety. Different institutions have issued recommendations on the indication of preoperative chest X-rays, but the degree of compliance with these recommendations is unknown. This study investigates the frequency and characteristics of the inappropriateness of this practice. METHODS This is a descriptive observational study with analytical components, performed in a tertiary hospital in the Community of Madrid (Spain) between July 2018 and June 2019. The inappropriateness of preoperative chest X-ray tests was analyzed according to "Choosing Wisely", "No Hacer" and "Essencial" initiatives and the cost associated with this practice was estimated in Relative Value and Monetary Units. RESULTS A total of 3449 preoperative chest X-ray tests were performed during the period of study. In total, 5.4% of them were unjustified according to the "No Hacer" recommendation and 73.3% according to "Choosing Wisely" and "Essencial" criteria, which would be equivalent to 5.6% and 11.8% of the interventions in which this test was unnecessary, respectively. One or more preoperative chest X-ray(s) were indicated in more than 20% of the interventions in which another chest X-ray had already been performed in the previous 3 months. A higher inappropriateness score was also recorded for interventions with an American Society of Anesthesiologists (ASA) grade ≥ III (16.5%). The Anesthesiology service obtained a lower inappropriateness score than other Petitioning Surgical Services (57.5% according to "Choosing Wisely" and "Essencial"; 4.1% according to "No Hacer"). Inappropriate indication of chest X-rays represents an annual cost of EUR 52,122.69 (170.1 Relative Value Units) according to "No Hacer" and EUR 3895.29 (2276.1 Relative Value Units) according to "Choosing Wisely" or "Essencial" criteria. CONCLUSIONS There was wide variability between the recommendations that directly affected the degree of inappropriateness found, with the main reasons for inappropriateness being duplication of preoperative chest X-rays and the lack of consideration of the particularities of thoracic interventions. This inappropriateness implies a significant expense according to the applicable recommendations and therefore a high opportunity cost.
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Affiliation(s)
- Jorge Vicente-Guijarro
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (P.M.-N.); (J.M.A.-A.)
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, 28801 Acalá de Henares, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, 28034 Madrid, Spain;
- Correspondence: ; Tel.: +34-913-368-372
| | - José Lorenzo Valencia-Martín
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, 28034 Madrid, Spain;
- Servicio de Medicina Preventiva y Salud Pública, Unidad de Gestión Clínica de Prevención, Promoción y Vigilancia de la Salud, Hospital La Merced, Área de Gestión Sanitaria de Osuna, 41640 Osuna, Sevilla, Spain
- Facultad de Ciencias de la Salud, Universidad Internacional de la Rioja, 26006 Logroño, La Rioja, Spain;
| | - Paloma Moreno-Nunez
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (P.M.-N.); (J.M.A.-A.)
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, 28034 Madrid, Spain;
| | - Pedro Ruiz-López
- Facultad de Ciencias de la Salud, Universidad Internacional de la Rioja, 26006 Logroño, La Rioja, Spain;
- Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - José Joaquín Mira-Solves
- Health Psychology Department, Miguel Hernández University, 03202 Elche, Spain;
- Alicante-Sant Joan Health District, Ministry of Health, 03550 Alicante, Spain
- REDISSEC, Health Services Network Oriented to Chronic Diseases, Spain
| | - Jesús María Aranaz-Andrés
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (P.M.-N.); (J.M.A.-A.)
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, 28034 Madrid, Spain;
- Facultad de Ciencias de la Salud, Universidad Internacional de la Rioja, 26006 Logroño, La Rioja, Spain;
- CIBER Epidemiología y Salud Pública (CIBERESP), 28034 Madrid, Spain
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Romare C, Skär L. Smart Glasses for Caring Situations in Complex Care Environments: Scoping Review. JMIR Mhealth Uhealth 2020; 8:e16055. [PMID: 32310144 PMCID: PMC7199139 DOI: 10.2196/16055] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/27/2019] [Accepted: 02/06/2020] [Indexed: 11/13/2022] Open
Abstract
Background Anesthesia departments and intensive care units represent two advanced, high-tech, and complex care environments. Health care in those environments involves different types of technology to provide safe, high-quality care. Smart glasses have previously been used in different health care settings and have been suggested to assist health care professionals in numerous areas. However, smart glasses in the complex contexts of anesthesia care and intensive care are new and innovative. An overview of existing research related to these contexts is needed before implementing smart glasses into complex care environments. Objective The aim of this study was to highlight potential benefits and limitations with health care professionals' use of smart glasses in situations occurring in complex care environments. Methods A scoping review with six steps was conducted to fulfill the objective. Database searches were conducted in PubMed and Scopus; original articles about health care professionals’ use of smart glasses in complex care environments and/or situations occurring in those environments were included. The searches yielded a total of 20 articles that were included in the review. Results Three categories were created during the qualitative content analysis: (1) smart glasses as a versatile tool that offers opportunities and challenges, (2) smart glasses entail positive and negative impacts on health care professionals, and (3) smart glasses' quality of use provides facilities and leaves room for improvement. Smart glasses were found to be both a helpful tool and a hindrance in caring situations that might occur in complex care environments. This review provides an increased understanding about different situations where smart glasses might be used by health care professionals in clinical practice in anesthesia care and intensive care; however, research about smart glasses in clinical complex care environments is limited. Conclusions Thoughtful implementation and improved hardware are needed to meet health care professionals’ needs. New technology brings challenges; more research is required to elucidate how smart glasses affect patient safety, health care professionals, and quality of care in complex care environments.
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Affiliation(s)
- Charlotte Romare
- Region Blekinge, Karlskrona, Sweden.,Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Lisa Skär
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
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Paul M, Cariou A. [Cardiac arrest]. Rev Prat 2019; 69:e117-e125. [PMID: 31626509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Marine Paul
- Service de médecine intensive et réanimation, hôpital Cochin, Hôpitaux universitaires Paris Centre -AP-HP-, 75679 Paris Cedex 14, France
| | - Alain Cariou
- Centre d'expertise mort subite -CEMS-, Paris-Cardiovascular Research Centre -PARCC-, Inserm U970 -équipe 4-, Paris, France
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