Piera C Robson1, David O'Connor2, Perri Pardini3, Terrah F Akard4, Mary S Dietrich5, Alan Kotin6, Alexandra Solomon7, Mohit Chawla8, Matthew Kennedy7, Stephen B Solomon9. 1. Memorial Sloan Kettering Cancer Center Department of Nursing and, Vanderbilt University School of Nursing, 1275 York Avenue, S121, New York, NY 10065. 2. Memorial Sloan Kettering Cancer Center Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-613D, New York, NY 10065. 3. Memorial Sloan Kettering Cancer Center Department of Nursing, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, M2 D-desk, New York, NY 10065. 4. Vanderbilt University School of Nursing, 461 21 Ave South, 514 Godchaux Hall, Nashville, TN 37240. 5. Vanderbilt University School of Nursing and School of Medicine (Biostatistics, VICC, Psychiatry), 461 21 Ave South, 410 Godchaux Hall, Nashville, TN 37240. 6. Memorial Sloan Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, 1275 York Avenue, C330A, New York, NY. 7. Memorial Sloan Kettering Cancer Center, Department of Nursing, 1275 York Avenue, New York, NY. 8. Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue, New York, NY. 9. Memorial Sloan Kettering Cancer Center, Department of Radiology, Memorial Sloan Kettering Cancer Center, H118, 1275 York Avenue, New York, NY 10065.
Abstract
BACKGROUND: A percutaneous transthoracic needle biopsy (PTNB) is performed to obtain tissue for a pathologic diagnosis. A PTNB is necessary prior to the initiation of many cancer treatments. There is a risk of hemoptysis, the expectoration of blood, with the possibility for adverse, life-threatening outcomes. A critical event checklist is a cognitive aid used in an emergency to ensure critical steps are followed. To date, there are no known checklists published for management of PTNB-related, life-threatening hemoptysis. The purpose of this report is to describe the development and implementation of a critical event checklist and the adoption of the checklist into hemoptysis management. METHODS: In March 2017, a process improvement team convened to evaluate the hemoptysis response using the Plan-Do-Study-Act (PDSA) methodology. The checklist was evaluated and updated through September 2019. The team educated Interventional Radiology (IR) clinicians on the new checklist and conducted simulations on its use. A retrospective chart review was performed on hemoptysis events between the ten-year period of October 1, 2008 and September 30, 2018 to evaluate the adoption of the checklist into practice. RESULTS: There were 231 hemoptysis events occurring in 229 patients (2 with repeat biopsies). Prior to implementing the protocol and checklist, there were 166 (71.9%) hemoptysis events. After implementation there were 65 (28.1%) events. The median amount of documented blood expectorated with hemoptysis was 100 mL (IQR 20.0-300.0). Twenty-six patients were admitted after PTNB for reasons related to the hemoptysis event (11.3%). During the procedure, four (1.7%) patients with hemoptysis suffered a cardiac arrest. Prior to implementation of the protocol and critical events checklist, nurses positioned patients in the lateral decubitus (LD) position in 40 out of 162 (24.7%) cases. After implementation of the critical events checklist, nurses positioned patients in the LD position 42 out of 65 cases (64.6%) (OR=5.57(95% CI 2.99-10.367), p<0.001). DISCUSSION: Interventional Radiology nurses successfully adopted the checklist into management of hemoptysis events. The reported incidence of hemoptysis suggests a need for IR teams to prepare for and simulate hemoptysis events. Future research is needed to evaluate the change in patient outcomes before and after critical events checklist implementation.
BACKGROUND: A percutaneous transthoracic needle biopsy (PTNB) is performed to obtain tissue for a pathologic diagnosis. A PTNB is necessary prior to the initiation of many cancer treatments. There is a risk of hemoptysis, the expectoration of blood, with the possibility for adverse, life-threatening outcomes. A critical event checklist is a cognitive aid used in an emergency to ensure critical steps are followed. To date, there are no known checklists published for management of PTNB-related, life-threatening hemoptysis. The purpose of this report is to describe the development and implementation of a critical event checklist and the adoption of the checklist into hemoptysis management. METHODS: In March 2017, a process improvement team convened to evaluate the hemoptysis response using the Plan-Do-Study-Act (PDSA) methodology. The checklist was evaluated and updated through September 2019. The team educated Interventional Radiology (IR) clinicians on the new checklist and conducted simulations on its use. A retrospective chart review was performed on hemoptysis events between the ten-year period of October 1, 2008 and September 30, 2018 to evaluate the adoption of the checklist into practice. RESULTS: There were 231 hemoptysis events occurring in 229 patients (2 with repeat biopsies). Prior to implementing the protocol and checklist, there were 166 (71.9%) hemoptysis events. After implementation there were 65 (28.1%) events. The median amount of documented blood expectorated with hemoptysis was 100 mL (IQR 20.0-300.0). Twenty-six patients were admitted after PTNB for reasons related to the hemoptysis event (11.3%). During the procedure, four (1.7%) patients with hemoptysis suffered a cardiac arrest. Prior to implementation of the protocol and critical events checklist, nurses positioned patients in the lateral decubitus (LD) position in 40 out of 162 (24.7%) cases. After implementation of the critical events checklist, nurses positioned patients in the LD position 42 out of 65 cases (64.6%) (OR=5.57(95% CI 2.99-10.367), p<0.001). DISCUSSION: Interventional Radiology nurses successfully adopted the checklist into management of hemoptysis events. The reported incidence of hemoptysis suggests a need for IR teams to prepare for and simulate hemoptysis events. Future research is needed to evaluate the change in patient outcomes before and after critical events checklist implementation.
Authors: Andrew J Lautz; Kelly C Martin; Akira Nishisaki; Christopher P Bonafide; Roberta L Hales; Elizabeth A Hunt; Vinay M Nadkarni; Robert M Sutton; Donald L Boyer Journal: Hosp Pediatr Date: 2018-03-07
Authors: David R Janz; Matthew W Semler; Aaron M Joffe; Jonathan D Casey; Robert J Lentz; Bennett P deBoisblanc; Yasin A Khan; Jairo I Santanilla; Itay Bentov; Todd W Rice Journal: Chest Date: 2017-09-14 Impact factor: 9.410
Authors: Yong Sub Song; Chang Min Park; Kyung Woo Park; Kwang Gi Kim; Hyun-Ju Lee; Mi-Suk Shim; Jin Mo Goo Journal: AJR Am J Roentgenol Date: 2013-05 Impact factor: 3.959
Authors: Theodora A Potretzke; Tina M Gunderson; David Aamodt; Adam J Weisbrod; Gina K Hesley; Timothy J Welch; Thomas D Atwell Journal: Abdom Radiol (NY) Date: 2016-04
Authors: Hashim Q Zaidi; Sarah S Dhake; Danielle T Miller; Priyanka Sista; Matthew J Pirotte; Abra L Fant; David H Salzman Journal: AEM Educ Train Date: 2019-09-12
Authors: Michael J Taylor; Chris McNicholas; Chris Nicolay; Ara Darzi; Derek Bell; Julie E Reed Journal: BMJ Qual Saf Date: 2013-09-11 Impact factor: 7.035
Authors: A J R De Bie; S Nan; L R E Vermeulen; P M E Van Gorp; R A Bouwman; A J G H Bindels; H H M Korsten Journal: Br J Anaesth Date: 2017-08-01 Impact factor: 9.166
Authors: Heekyung Kim; Dohee Kwon; Soon Ho Yoon; Hyungjin Kim; Chang Min Park; Jin Mo Goo; Yoon Kyung Jeon; Su Yeon Ahn Journal: PLoS One Date: 2018-09-21 Impact factor: 3.240