From: "Christie, Margaret" <[EMAIL PROTECTED]> Just received a curly one this afternoon................"Periorbital swelling post hair perm. L sided preural rub." Exam required CXR. Cheers MITs at Kalgoorlie.
-----Original Message----- From: Gail Durbridge [mailto:gail.durbridge@;cmr.uq.edu.au] Sent: Friday, 15 November 2002 7:15 AM To: AIRNEWS Subject: Re: [AIRNEWS] Role extension? From: Gail Durbridge <[EMAIL PROTECTED]> Best one I ever had "...xeroradiograph of knee - subtraction technique please!!!!!!" Gail Dieter wrote: > From: Dieter <[EMAIL PROTECTED]> > > Some that I can remember form our dept (large teaching hospital in Syd) > > Paed - AXR supine and in suspension > > Adult - CXR with O2 > > Adult - CXR + inspiration > > Teenager - xray left leg, left knee, left tibia, left ankle > > Adult - xray left wrist and metacarpals > > The classic > > Adult - CXR - ap and lat chest pain > > Isn't a pa better ? > > Adult - AXR - supine and erect ? AAA > > Scary yes, what do we do, just laugh and add to our request of the > week list > > But most of this is more proof that we need to take a more active role > in the requesting of x-rays > > PS love that first one and had me stumped for days, see who can guess > what they meant > > > At 01:53 PM 14/11/2002 +1100, you wrote: > >> From: "Leo Klein" <[EMAIL PROTECTED]> >> >> Hello Izan, Some request forms that claim to be true.Not from nurses but >> from doctors. LJK >> Actual Medical Chart Notes >> >> >> 1.. Patient has two teenage children, but no other >> abnormalities. >> 2.. Patient has chest pain if she lies on her left side for >> over a >> year. >> 3.. On the second day, the knee was better, and then on the >> third >> day it disappeared. >> 4.. The patient is tearful and crying constantly. She also >> appears >> to be depressed. >> 5.. Discharge status: Alive, but without my permission. >> 6.. Healthy-appearing decrepit, 69-year-old male, mentally >> alert but >> forgetful. >> 7.. The patient refused autopsy. >> 8.. The patient has no previous history of suicides. >> 9.. Patient has left white blood cells at another hospital. >> 10.. Patient's medical history has been remarkably insignificant >> with only a 40-pound weight gain in the last three days. >> 11.. She is numb from her toes down. >> 12.. Occasional, constant, infrequent headaches. >> 13.. I saw your patient today, who is still under our car for >> physical therapy. >> 14.. Skin: somewhat pale but present. >> 15.. The patient has been depressed since she began seeing me in >> 1993. >> >> >> ----- Original Message ----- >> From: "Izan Gill" <[EMAIL PROTECTED]> >> To: <[EMAIL PROTECTED]> >> Sent: Thursday, November 14, 2002 1:26 PM >> Subject: Re: [AIRNEWS] Role extension? >> >> >> > From: "Izan Gill" <[EMAIL PROTECTED]> >> > >> > In RR areas there is a sort of generic NIXR procedure as very often >> the >> problem is not queues of people waiting but the fact that the sole >> hospital >> doctor is in OT, Maternity or, if part time, at the surgery. The OPD/ >> A&E >> nurse triages the patient if the Dr. is unable to attend and then takes >> direction from there over the phone. The examination requested will >> be along >> the llines "fall off ladder at work" and the verbal addition will be >> "whatever you think is best". Falls for NOF are included, very few >> CXRs, but >> not MVAs of course, paediatrics other than limbs or very young paeds. >> One of >> the advantages for the nurses is that in a small community, the >> patient is >> probably well known over the years. The nurses are normally very good at >> this (at this hospital anyway) as they tend not to move away once >> they reach >> the stage of being in charge of a Dept. even though the staff numbers >> are >> very small. Radiologists are an unknown breed out here - face to face at >> least. The team feeling and involvement is excellent and the >> Radiographer's >> opinion is sought and valued - at least by the hospital staffand some >> of the >> GPs. I never know whether to laugh or spit when GPs treat me as a number >> (not needing clinical details or previous films etc.) but follow on >> with "if >> you see anything let me know". So far laughter has triumphed. >> > >> > >> > Izan Gill >> > >> > >>> [EMAIL PROTECTED] 11/14/02 11:33am >>> >> > From: Alex Craven <[EMAIL PROTECTED]> >> > >> > Just thought I'd share an instance where NIXR seems to >> > work: >> > >> > This is a large hospital where NIXR has been in place >> > in the ED for some time, and seems to be working. >> > >> > The nurses can only request views distal to the knee >> > and elbow. Though some nurses are very good, generally >> > they seem to over-order and the incidence of ordering >> > the wrong body part is significantly higher than with >> > the Drs. Also, the clinical notes are often of very >> > poor standard (though that applies to a lot of DRs). >> > >> > However, it is generally assumed that the radiographer >> > will take responsibility for the examination >> > performed. The radiographer performs the >> > examination(s) she or he finds most appropriate then >> > notes and initials any alterations to the original >> > order on the request form. The radiologist is >> > consulted if it is deemed necessary, and it is well >> > with in the radiographers' rights to seek approval >> > from the radiologist to cancel the examination >> > completely (isn't often necessary, but it does >> > happen). >> > >> > The 'clinical examinations' we perform are only aimed >> > at localising pain/swelling/other symptoms, and is >> > really no different from what most radiographers do at >> > the start of a procedure anyway. As you know patients >> > often give a lot of information during the procedure >> > (previous injuries, underlying conditions etc) and >> > some of us have also started adding anything of >> > particular relevance that isn't in the clinical notes >> > (with initials so the radiologist knows it was us) or >> > putting arrows on films to show the location of >> > lacerations, tenderness etc. >> > >> > I'm not sure if all of this is the formal system >> > originally introduced for NIXR at this hospital, in >> > fact I doubt very much that this follows the procedure >> > exactly (it works too well!) >> > >> > >From a patient-care viewpoint this system is much >> > quicker than waiting for a DR, but seems to avoid the >> > disadvantages I've been hearing about at other >> > hospitals. Ie radiation safety and the appropriateness >> > of examinations are still given the attention they >> > deserve. >> > >> > Another advantagous change I see occuring is in the >> > relationship between radiographer and radiologist. The >> > little notes and consultations here and there seem to >> > remind both that the radiographer may have relevant >> > information that is not conveyed in the images >> > produced. I see radiologists stepping out of the >> > office to ask radiographers patients where clinical >> > notes are innadequate, more often than in any other >> > place I have worked, and not just for NIXR patients. >> > It's not as if every second case is discussed (may not >> > happen at all some days) but it is good for the >> > patient, allows the radiologist to do a better job, >> > acknowledges the radiographer as more than just a >> > pusher of buttons, and generally makes for a more >> > pleasant working environment. >> > >> > Sorry I couldn't be more succint, >> > >> > Alex >> > >> > PS - Please note that I cannot compare this to the >> > pre-NIXR system (only those at other hospitals I have >> > worked at), and these are my views (not necessarily >> > those of the people organisation I work for). >> > >> > >> > --- Dieter <[EMAIL PROTECTED]> wrote: >> > > From: Dieter <[EMAIL PROTECTED]> >> > > >> > > We have a similar situation going on at our >> > > institution at the moment. The >> > > NIXR is trying to be introduced but the ED got it >> > > wrong when they put in >> > > the nurse procedures the comment "if in doubt x-ray >> > > it" >> > > >> > > Needless to say the fan was on full blast...... >> > > >> > > I think if the radiographer profession is going to >> > > grow and not be swept up >> > > by other professions, we need to expand our role and >> > > take more >> > > responsibilty in our job. We have had it too easy >> > > too long, with not >> > > having to think that hard and then running to the >> > > radiologist for back up >> > > as soon as things get slightly out of the norm. >> > > >> > > If we as a profession really want to put a hold on >> > > the whole NIXR concept, >> > > (which many rads want to do) we will have to step up >> > > to the plate and start >> > > clinically assessing the patients to determine which >> > > x-rays we are going to >> > > take. It will have to become, >> > > clinician/nurse/patient thinks that the >> > > patient might need an x-ray and sends the patient to >> > > us, we then decide >> > > which and how the x-rays will be taken and then >> > > provide an interim >> > > report. Obviously there will need to be additional >> > > training needed by the >> > > current MRS's and more will ahve to be introduced >> > > into the universities' >> > > course work, but if it will guarantee the >> > > continuation and expansion of our >> > > profession, then it will have to be done. >> > > >> > > The biggest issue that will confront an expansion of >> > > roles such as this, is >> > > the treading on the toes of the radiologists. This >> > > will start to blur the >> > > lines between tech and Dr, and DR's don't tend to >> > > take too kindly to this. >> > > >> > > Are we up to it ? >> > > >> > > Interesting times ahead, but we will have to >> > > determine where we are going >> > > to go soon as NIXR's are well and truly getting >> > > their claws in. >> > > >> > > Dieter >> > > >> > > >> > > >> > > At 12:49 PM 13/11/2002 +0800, you wrote: >> > > > From: Rob Hart <[EMAIL PROTECTED]> >> > > > >> > > >The following is a small extract from a larger >> > > discussion on the ACEM list >> > > >in relation to nurse-initiated XR (NIXR). >> > > Interesting reading! My posting is >> > > >at the bottom, with the ED director of a large >> > > Eastern States hospital's >> > > >reply above. >> > > > >> > > > >> > > > >Brilliant >> > > > > >> > > > >In fact I did suggest at St Matyrs when NIXR >> > > came in & there were >> > > > >problems with a colleague encouraging them to ask >> > > for multiple areas in >> > > > >case they missed the wrong one & a lot of >> > > problems with suboptimal >> > > > >imaging (half of a Jones # on ankle xray, >> > > injured wrist right on the >> > > > >edge of a 30cm long film of forarm etc) that >> > > the nurses should stop >> > > > >at recognising probable need for xr and ask the >> > > radiographer to >> > > > >determine which xrays to take. >> > > > > >> > > > >It was the radiographers who refused. >> > > > > >> > > > >Similarly, when I managed (took a year!) to >> > > introduce provisional >> > > > >xray reports by the clinician so the radiologist >> > > would know when we'd >> > > > >screwed up & notify us early, I tried to >> > > persuade the radiographers >> > > > >into the "redspot" system. They were a really >> > > nice bunch of people, but >> > > > >chickened out - head radiographer says that's >> > > giving them clinical >> > > > >responsibility & they don't want it. We had at >> > > that stage a lot of >> > > > >shifts covered only by juniors; I think the >> > > system is useful there. >> > > > > >> > > > > >> > > > > >> > > > >>At 04:36 PM 12/11/2002 +0800, Rob Hart wrote: >> > > > >>Dear All >> > > > >> >> > > > >>Perhaps I can put in a spoke here for the >> > > radiology depts. I am hopeful >> > > > >>that all, with or without NIXR, rely on the >> > > professional opinion of >> > > > >>their medical imaging staff (radiographers as >> > > were) in determining the >> > > > >>relevant imaging to be performed. I know when I >> > > was at Royal Perth ED >> > > > >>for 5 years as a diagnostic radiographer, we >> > > considered ourselves part >> > > > >>of the decision-making process even though we >> > > are not entitled to >> > > > >>"order" (we prefer "request", but let's not get >> > > pedantic!) imaging exams >> > > > >>ourselves. In many cases we have seen many more >> > > of a particular #, >> > > > >>strain, sprain or other musculoskeketal injury >> > > than the refering intern >> > > > >>or RN/CN. This applies both to initial >> > > presentation, and to follow-up >> > > > >>zapping based on the results of the first series >> > > performed. Or is this >> > > > >>as polarised an issue (Dr initiated/NIXR) as it >> > > appears from the >> > > > >>outside? >> > > > >> >> > > > >>Regards to all >> > > > >> >> > > > >>Rob Hart >> > > > >> > > > >> > > > +=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+= >> > > > This message is being broadcast by AIRNEWS, >> > > > the Australian Institute of Radiography list >> > > Server >> > > > >> > > > Send messages to [EMAIL PROTECTED] >> > > > For assistance send mail to >> > > [EMAIL PROTECTED] >> > > > Commands should be sent to >> > > [EMAIL PROTECTED] >> > > > >> > > >Opinions expressed on this list are not necessarily >> > > those of the >> > > >moderator, his assistants or those of the A.I.R. >> > > >> > > >> > > >> > > >> > > +=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+= >> > > This message is being broadcast by AIRNEWS, >> > > the Australian Institute of Radiography list Server >> > > >> > > Send messages to [EMAIL PROTECTED] >> > > For assistance send mail to >> > > [EMAIL PROTECTED] >> > > Commands should be sent to >> > > [EMAIL PROTECTED] >> > > >> > > Opinions expressed on this list are not necessarily >> > > those of the >> > > moderator, his assistants or those of the A.I.R. >> > >> > >> > ===== >> > Alex Craven >> > Ph. 0407-685-319 >> > Email: [EMAIL PROTECTED] >> > >> > __________________________________________________ >> > Do you Yahoo!? >> > U2 on LAUNCH - Exclusive greatest hits videos >> > http://launch.yahoo.com/u2 >> > >> > >> > +=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+= >> > This message is being broadcast by AIRNEWS, >> > the Australian Institute of Radiography list Server >> > >> > Send messages to [EMAIL PROTECTED] >> > For assistance send mail to [EMAIL PROTECTED] >> > Commands should be sent to [EMAIL PROTECTED] >> > >> > Opinions expressed on this list are not necessarily those of the >> > moderator, his assistants or those of the A.I.R. >> > >> > >> > ********************************************************************** >> > This e-mail, including any attachments sent with it, is confidential >> > and for the sole use of the intended recipient(s). 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