title: The Endovascular Preprocedural Run Through and Brief: A Simple Intervention to Reduce Radiation Dose and Contrast Load in Endovascular Aneurysm Repair.
abstract: OBJECTIVE
  To assess the impact of a quality assured planning and sizing process and the endovascular team briefing (preprocedure run through and brief - PRTB) on the delivery of endovascular aneurysm repair (EVAR), in Edinburgh.
  
  
  METHODS
  Prospective observational study, comparing parameters before and after the intervention.
  
  
  METHODS
  Prospectively collected database recording infrarenal aneurysms treated with EVAR performed from January 2007 to April 2014 at our institution. The total screening time, iodinated contrast volume used, radiation dose, endovascular training opportunities, and hospital length of stay were recorded.
  
  
  METHODS
  A comparison before (January 2007 to November 2011) and after (December 2011 to April 2014) the introduction of the PRTB was made for each of these variables. Multiple linear regression analysis was performed to account for the learning effect.
  
  
  RESULTS
  In this study, 61 EVAR cases were performed prior to and 44 EVAR cases after the introduction of the PRTB. Univariate Mann-Whitney tests suggested a significant difference between before PRTB introduction and after PRTB introduction on all outcome variables except procedure time. Multiple linear regression analysis results showed a statistically significant improvement in outcomes after the change point for all outcomes except for radiation dose. Endovascular training opportunities were realized in 12/61 (20%) before compared to 42/44 cases (95%) after PRTB introduction.
  
  
  CONCLUSIONS
  By introducing rigorous quality assurance and utilizing the principles of crew resource management to the EVAR process, it is possible to reduce screening times, contrast use, hospital length of stay, and improve endovascular training opportunities.
authors.affiliation: Department of Vascular & Endovascular Surgery, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom Present Address: David Grant Medical Center, 101 Boden Circle, Travis AFB, CA, USA. timstansfield@doctors.org.uk.
authors.forename: Tim
authors.initials: T
authors.lastname: Stansfield
authors.affiliation: Health Services Research Unit, University of Edinburgh, Centre for Population Health Sciences, Teviot Place, Edinburgh, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Parker
authors.affiliation: Department of Radiology, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Masson
authors.affiliation: Department of Vascular & Endovascular Surgery, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Lewis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000009:adverse effects; D057189:Checklist; D002983:Clinical Competence; D002985:Clinical Protocols; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects / Q000193:education; D005260:Female; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D010348:Patient Care Team / Q000458:organization & administration; D015397:Program Evaluation; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control*; D015641:Radiography, Interventional / Q000009:adverse effects; D012307:Risk Factors; D012606:Scotland; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: contrast media; endovascular procedures; patient care team; radiation