A digits audit of emergency upper gastrointestinal fluoroscopy workflow in children with bilious vomiting

Background: Bilious vomiting in children requires an urgent evaluation with upper gastrointestinal (UCI) fluoroscopy as it may herald life-threatening midgut malrotation with volvulus (MMWV). There are no published data available on the duration of time-critical UCI workflow steps. Objectives: A digital audit of workflow in emergency UCI contrast studies performed on children with bile-stained vomiting at a large South African teaching hospital. Method: A retrospective study was conducted from 01 May 2012 - 31 May 2019. A customised search of the institutional radiology information system (RIS) defined all children with bilious vomiting who underwent emergency UCI fluoroscopy. Extracted RIS timestamps were used to calculate the median duration of the 'approval', 'waiting', 'study' and 'reporting' times. One-way analysis of variance and Chi-squared tests assessed the association between key parameters and the duration of workflow steps, with 5% significance (p < 0.05). Results: Thirty-seven patients (n = 37) with median age 0.8 months were included, of whom 20 (54%) had an abnormal C-loop. The median 'total time' from physician request to report distribution was 107 min (interquartile range [IQR1: 67-173). The median 'approval' (6 min; IQR: 1-15) and 'reporting' (38 min; IQR: 17-91) times were the shortest and longest workflow steps, respectively. Abnormal C-loops (p = 0.04) and consultant referrals (p = 0.03) were associated with shorter 'approval' times. The neonatal 'waiting' time was significantly longer than that for older patients (p = 0.02). Conclusion: The modern RIS is an excellent tool for time-critical workflow analyses, which can inform interventions for improved service delivery.