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Reporting Turnaround Time for NGT-coded Chest Radiographs at King
EP29254
Poster Title: Reporting Turnaround Time for NGT-coded Chest Radiographs at King's College Hospital
Submitted on 01 Nov 2018
Author(s): Daniel Maruszewski, Tina Cheng
Affiliations: King's College Hospital
This poster was presented at BIR Annual Congress 2018
Poster Views: 297
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Poster Information
Abstract: Introduction: Use of misplaced NG tubes is a 'never event'. Between September 2011 and March 2016 there were 95 incidents reported nationally where medications or food was administered into patient’s respiratory tract or pleural cavity. At least 45 of those were associated with inaccurate CXR interpretation by junior medical staff. NPSA and NHS England issued another alert in 2016 urging hospitals to take action. At King’s College Hospital in London a separate NGT request code for chest X-rays was developed and the radiology department has committed to reporting all NGT-coded radiographs within 2 hours. Initial audit looking at reporting turnaround time over a 2-month period was undertaken in 2017. Results were presented locally. A second audit has now been done in early 2018.

Methods: Data for February-April 2018 was collected from the hospital database and all NGT-coded chest X rays were included in the study. Times when radiographs were taken and when the formal report was issued for each film were compared.

Results: 426 CXRs were included in this audit loop. The two-hour target was achieved in 72% of all studied radiographs (previously 69%). Median time taken to issue a report was 67 minutes. For CXRs done between 9am and 5pm Monday-Friday, the performance was 73% (median time was 58 minutes). 71% of radiographs done out-of-hours were reported within 2 hours (median time was 72 minutes). 80% of all CXRs were reported within 4 hours.

Conclusion: Performance has improved after the initial audit loop results from 2017 were presented locally. However, further action needs to be undertaken in order to increase the 2-hour target achievement rate. In addition to regular audits and staff education, the use of skills-mix and implementation of IT-based solutions such as pop-up reminders for radiologists could be possible solutions.
Summary: In response to the NPSA’s alerts King’s College Hospital introduced a separate code for radiographs requested for confirmation of the position of the feeding tubes (“NGT CXR”). Hospital’s radiology department has committed to reporting all such X rays within 2 hours. Its performance was first audited in 2016 over a 2-month period and results were presented locally. We have repeated the audit in 2018 and results are presented below. References: [1] NHSI (2016) Patient Safety Alert Nasogastric tube misplacement: continuing risk of death and severe harm. Alert reference number: NHS/PSA/RE/2016/006. Available at: https://www.nlg.nhs.uk/ [Last accessed 14th Sept 2018]

[2] Reducing the risk of feeding through a misplaced nasogastric tube: How to analyse check X-rays accurately to detect correct tube placement (PowerPoint Presentation). Available at: www.wales.nhs.uk/bcupinnacle/opendoc/259201 [Last accessed 14th Sept 2018]
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