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Clinical practice: Use of medical imaging for diagnosing appendicitis in pediatric patients
Outlines work-up of suspected cases of appendicitis in patients under 18 years of age including clinical exam, surgical consult, and if advanced imaging is indicated, to utilized ultrasound first (if available). Then if the ultrasound is equivocal or negative (or not available) and there is a reasonable index fo suspicion, a CT scan with IV and without oral contrast is recommended.
- Clinical practice: Use of medical imaging for diagnosing appendicitis in pediatric patients (loaded 02/12)
Clinical Practice: Screening pregnant women for suspected appendicitis
It is an expected clinical practice that all pregnant patients presenting to the hospital who are suspected of having appendicitis will be screened using ultrasonography. If further testing is needed, MRI will be used if resources are available. This clinical practice has been defined but not yet fully implemented.
Reduce variation of medical imaging in pneumonia
As part of the Reduce Variation in Pneumonia care practices and resource utilization strategic initiative and to improve length of stay, provide the safest care by reducing unecessary imaging, and reduce unnecessary delays in care of hospitalized pneumonia patients, Banner has set a goal to deduce the percent of pneumonia patients that receive a Chest CT as part of the routine work-up (Chest CT to be ordered only for underlying disease or if complications are present)
- Reducing variation in pneumonia care fact sheet (loaded 10/11)
Reduce variation in ED Brain CT scan for atraumatic headaches
The purpose of this initiative is to reduce the variation in ordering of Brain CT scans in the Emergency Department for patients presenting with a Atraumatic Headache by establishing guidelines for ordering Brain CT scans in these situations including documentation guidelines for the medical indication(s) for these scans.
Clinical practice: Appropriate use of CT imaging in pediatric head injury
This expected clinical practice states that all pediatric patients presenting with acute closed head injury will be evaluated to determine the need for head CT in order to avoid unnecessary imaging. This clinical practice outlines guidelines for performing head CT for children under two years old and those children over two years old based on Glasgow Coma Scale, presenting signs and symptoms and mechanism of injury.
Clinical practice: Use of emergent MRI - adult
The use of emergent MRI without requiring direct contact and subsequent authorization from a radiologist for adult patients presenting to Banner will be reserved for those patients where there is clinical indication of new or rapidly progressive neurological deficits suspected to be related to cord compression OR dural venous thrombosis with indeterminate CTV results and for pregnant patients. For other conditions where emergent MRI is deemed critical for patient care, there is to be direct contact with and subsequent authorization from a radiologist.
- Clinical practice: Use of emergent MRI - adult (loaded 03/13)
Clinical Practice: Diagnosis of spinal cord compression – adult
It is an expected clinical practice that all patients presenting with suspected spinal cord compression will be emergently assessed and undergo a whole-spine screening MRI utilizing an established medical imaging protocol which is ordered by choosing a designated order. This clinical practice has been defined but not yet fully implemented.
Clinical practice: Appropriate use of inpatient PET scan - pediatric and adult
All patients requiring Positive Emission Tomography (PET) scans will be seen as outpatients rather than inpatients except in rare clinical circumstances, including patients with new diagnoses of lymphoma with symptoms or oncology patients too sick to leave the hospital, both needing staging for urgent inpatient treatment. Inpatient PET scanning should be used in rare clinical circumstances. Outpatient PET scan is appropriate for most patient scenarios.
Clinical Practice: Positron Emission Tomography (PET) Scans in the surveillance of Asymptomatic Patients with Lymphoma
It is an expected clinical practice that All adult patients with aggressive lymphoma who have achieved a complete response will not receive routine surveillance positron emission tomography (PET) scans unless clinically indicated, due to the risk for false positives.
- Clinical Practice: Positron Emission Tomography (PET) Scans in the surveillance of Asymptomatic Patients with Lymphoma (loaded 10/14)
Clinical practice: Administration of intravascular iodinated contrast media - adult
All adult patients (inpatient and ambulatory care) at Banner facilities receiving intravenous iodinated contrast will have contrast administered following a process that identifies risk for complications and ensures safety measures.
Additions for interventional radiologists
Correct patient, correct procedure and correct procedural site/side policy
All surgical sites involving laterality, level, and.or multiples will be marked by the surgeon by placing his or her initials on the operative site such that the mark is visible after the patient is prepped and drapped so that it can be reverified during the Surgical Time Out process. If it is not possible to mark the surgical site then the surgeon will mark the site on an anatomical diagram and anesthesia providers who are performing a procedure that involves laterality will mark the appropriate site with a “A” that is circled.
- Provider role in safe surgery process (loaded 10/11)
- Correct patient, correct procedure and correct procedural site/side policy #12705 (loaded 07/12)
Clinical policy: Safe procedure policy – medical imaging and endoscopy
The purpose of this policy is to standardize safe practices to ensure correct patient, correct procedure, and the correct procedure site for procedures performed in Medical Imaging and Endoscopy including the process for conducting an interactive procedure time out just prior to the onset of procedure. This policy is consistent with Safe Surgery policy and Counts policy utilized in Surgery and Labor and Delivery areas.
Clinical Practice: Central Line Management and Prevention of Vascular Catheter Associated Infections (VCAI)
Establishes protocols for insertion and needs assessment for central lines including central line infection outcome (infection rate), insertion protocols (central line bundle compliance rate), timeliness of central line necessity check (daily check rate), and formalized process for event investigation and documentation. Central line insertion bundle includes hand hygiene, maximal barrier precautions upone insertion (gloves, hat, mask, gown, draps), chlorhexidine skin antisepsis, optimal catheter site selection (avoidance of femoral vein for access), and daily review of line necessity.
- Clinical Practice: Central Line Management and Prevention of Vascular Catheter Associated Infections (VCAI) (loaded 02/12)
Clinical practice: Anesthesia administration
This clinical practice applies to all inpatients and outpatients in any setting for any purpose, by any route that receive anesthesia (including the use of short acting anesthetic agents for procedural sedation) in Banner Health facilities. All inpatients and outpatients within the Banner Health facilities receiving anesthesia will be administered anesthesia by appropriately credentialed providers based on evidenced based practice, or in its absence will practice within consensus guidelines to best serve the safety of Banner Health patients.
- Clinical practice: Anesthesia administration (loaded 02/12)
Clinical Policy: Procedural sedation for therapeutic/diagnostic procedure
This clinical policy applies to both Adult and Pediatric Patients and defines the circumstances under which procedural sedation may be administered and define responsibilities and parameters for the management of the patient requiring procedural sedation for pre-intra-post, short-term diagnostic, or therapeutic procedures including monitoring requirements. This clinical policy has been defined but not yet fully implemented.
Clinical practice: Quantitative and qualitative exhaled carbon dioxide measurements during procedural sedation pediatric and adult patients
It is an expected clinical practice that all inpatients and outpatients of any age and clinical setting receiving anesthesia (moderate, deep, general and regional ((with sedation)) will, in addition to standard monitors, have the ventilation evaluated by continual observation of qualitative clinical signs and monitoring for the presence of exhaled carbon dioxide. This clinical practice has been defined but not yet fully implemented.
- Clinical practice: Quantitative and qualitative exhaled carbon dioxide measurements during procedural sedation pediatric and adult patients (loaded 10/13)
Clinical practice: Surgical approaches using vertebroplasty to treat painful vertebral compression fractures - adult
Patients with painful compression fractures (pain level >7 on a Visual Analog Scale (VAS) 1-10) refractory to non-invasive pain intervention(s) applied for reasonable time periods and that interferes with basic activities of daily life (ADLS) may be considered for surgical treatment (Vertebroplasty and Kyphoplasty procedures) in an outpatient setting. Identification of the medical necessity for the procedure based on Medicare Guidelines, signature, date, and time will be established prior to procedure and documented on a “Medical Necessity Checklist” that is initiated prior to scheduling.