Date of Award

9-20-2010

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Dr. Kevin Johnson

Second Advisor

Dr. Howard Forman

Abstract

Clinical management of misplaced endotracheal tubes provides a compelling model to study the communication of critical radiology results: abnormal findings are clearly defined, require a narrow range of actions, and can be followed in subsequent radiographs. In this study, we assessed rates of endotracheal tube correction following misplacement and correlated those rates with communication practices. A manual screen was done of radiology reports from 11/2008-6/2009 at Yale New Haven to identify patients with endotracheal tube misplacement. Patients were included in the study if misplacement was verified by image measurement, if there was evidence of endotracheal tube placement for more than 24 hours following misplacement, and if they had radiographic follow-up. An endotracheal tube was determined to be corrected by image measurement on subsequent chest x-rays within 30 hours. 21,277 chest x-ray reports were screened and 224 patients with endotracheal tube misplacement were identified. 119 patients had misplacement on initial intubation; 69 (58.0%) had evidence of correction within 30 hours. 105 patients had misplacements subsequently in the ICU; 59 (56.2%) had evidence of correction within 30 hours. Correction rates were not associated with explicit recommendations in the report text [OR=1.36, 95% CI=0.65-2.86, p=0.45 for initial misplacement, OR=1.36, 95% CI=0.63-2.94, p=0.55 for subsequent misplacement] or with additional radiologist-clinician communication [OR=1.36, 95% CI=0.65-2.86, p=0.45 for initial misplacement, OR=1.36, 95% CI=0.63-2.94, p=0.55 for subsequent misplacement]. We describe the rates of timely correction of misplaced endotracheal tubes at a large university hospital. Correction rates were not influenced by additional communication from the interpreting radiologist or by explicit recommendations in the report text.

Comments

This is an Open Access Thesis.

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