title: Enhancing patient safety: the effect of process improvement on bedside fluoroscopy time related to nasoduodenal feeding tube placement in pediatric burn patients.
abstract: Nutrition support is essential in the care of burn patients. Early in the course of treatment, postpyloric feeding tube placement permits initiation of enteral nutrition, minimizes risk of aspiration, and may also attenuate hypermetabolism. Fluoroscopy aids in postpyloric feeding tube placement, yet concerns remain about safety. The purpose of this study was to measure fluoroscopy-associated radiation exposure during bedside feeding tube placement in pediatric burn patients and to take appropriate action to improve hospital protocols that minimize radiation exposure. During a 19-year period, radiation doses were measured before and after performance improvement of radiation safety initiatives. This plan included mandatory training for surgical house officers, measurement of maximum midline dosage for each procedure, limitation of radiation exposure to 5 minutes, and development of standardized policies and protocols for feeding tube placement. Phase 1 of the study retrospectively determined fluoroscopy time required for enteral tube placement. Phase 2 used thermoluminescent chips to measure the amount of radiation during fluoroscopy to establish an acceptable midline radiation dose. Phase 3 evaluated fluoroscopy times following implementation of improved safety processes. There were 357 procedures in phase 1 and mean fluoroscopy time was 4.1 minutes. Of the 10 procedures in phase 2, mean fluoroscopy time decreased to 2.7 minutes. There were 1804 procedures in phase 3, and mean fluoroscopy time was 2.3 minutes. Mean radiation exposure was significantly reduced following implementation of standardized policies and the development of a clinical protocol for bedside fluoroscopy (P<.0001). With proper processes, fluoroscopy procedures result in minimal radiation exposure for patients and staff.
authors.affiliation: Department of Imaging Services, Shriners Hospitals for Children, and Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio 45229, USA.
authors.forename: Lois C
authors.initials: LC
authors.lastname: Cone
authors.forename: Mary F
authors.initials: MF
authors.lastname: Gilligan
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Kagan
authors.forename: Theresa
authors.initials: T
authors.lastname: Mayes
authors.forename: Michele M
authors.initials: MM
authors.lastname: Gottschlich
mesh_terms: D002056:Burns / Q000534:rehabilitation*; D016009:Chi-Square Distribution; D002648:Child; D004750:Enteral Nutrition / Q000295:instrumentation*; D004869:Equipment Safety; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D019095:Point-of-Care Systems; D017064:Process Assessment, Health Care; D011829:Radiation Dosage; D015641:Radiography, Interventional; D013819:Thermoluminescent Dosimetry; D013997:Time Factors