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. 2022 Mar 30;26(1):2300.
doi: 10.4102/sajr.v26i1.2300. eCollection 2022.

A digital audit of emergency upper gastrointestinal fluoroscopy workflow in children with bilious vomiting

Bradley C Messiahs  1 , Richard D Pitcher  1
Affiliations

A digital audit of emergency upper gastrointestinal fluoroscopy workflow in children with bilious vomiting

Bradley C Messiahs et al. SA J Radiol. .

Abstract

Background: Bilious vomiting in children requires an urgent evaluation with upper gastrointestinal (UGI) fluoroscopy as it may herald life-threatening midgut malrotation with volvulus (MMWV). There are no published data available on the duration of time-critical UGI workflow steps.

Objectives: A digital audit of workflow in emergency UGI contrast studies performed on children with bile-stained vomiting at a large South African teaching hospital.

Method: A retrospective study was conducted from 01 May 2012 - 31 May 2019. A customised search of the institutional radiology information system (RIS) defined all children with bilious vomiting who underwent emergency UGI fluoroscopy. Extracted RIS timestamps were used to calculate the median duration of the 'approval', 'waiting', 'study' and 'reporting' times. One-way analysis of variance and Chi-squared tests assessed the association between key parameters and the duration of workflow steps, with 5% significance (p < 0.05).

Results: Thirty-seven patients (n = 37) with median age 0.8 months were included, of whom 20 (54%) had an abnormal C-loop. The median 'total time' from physician request to report distribution was 107 min (interquartile range [IQR]: 67-173). The median 'approval' (6 min; IQR: 1-15) and 'reporting' (38 min; IQR: 17-91) times were the shortest and longest workflow steps, respectively. Abnormal C-loops (p = 0.04) and consultant referrals (p = 0.03) were associated with shorter 'approval' times. The neonatal 'waiting' time was significantly longer than that for older patients (p = 0.02).

Conclusion: The modern RIS is an excellent tool for time-critical workflow analyses, which can inform interventions for improved service delivery.

Keywords: bilious; malrotation; midgut volvulus; paediatric; upper gastrointestinal series; vomiting.

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Conflict of interest statement

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Figures

FIGURE 1
FIGURE 1
Normal upper gastrointestinal series in an infant with vomiting. Fluoroscopic frontal view shows the duodenojejunal junction (arrow) to the left of a vertebral body pedicle and at the level of the duodenal bulb.
See this image and copyright information in PMC

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