Taking on tunnel vision

It’s easy to fall back on tunnel vision—to accept that the processes and protocols we see and use are the way to perform x, y or z.

A few of this week’s top stories challenge readers to rethink old habits.

The focused assessment with sonography in trauma (FAST) has been a mainstay of trauma imaging. Efficient and accurate, the ultrasound exam comprised of abdominal and cardiac components represents two billable studies, thus medical necessity must be established for each indication.

When researchers from the University of Texas at Houston Medical School conducted a retrospective chart review of blunt trauma patients, they found very low incidence of hemopericardium among these patients. The fraction of diagnosed cases all occurred in conjunction with major mechanism of injury, hypotension or emergent intubation.

The authors recommended a rethinking of the iconic FAST protocol in blunt trauma cases, with the cardiac portion of the exam reserved for patients presenting with a high acuity variable.

Structured reporting represents a different type of dilemma. Many physicians cling to personal reporting protocols. But the successful transition to structured reporting requires adoption of department templates rather than personal preferences.

David B. Larson, MD, and his colleagues at the radiology department at Cincinnati Children’s Hospital Medical Center, acknowledged the tremendous challenge of achieving consensus on reporting style in Radiology Jan 17. Larson et al detailed how the department achieved consensus and near universal adherence to standardized structured report formats, which translated into a successful deployment.

How are you challenging your department to see beyond tunnel vision? Please email and let us know.

Lisa Fratt, editor