Our patients often walk or are carried several hours to receive care, and in evaluating such patients, our providers often order an x-ray. Our providers are highly skilled in x-ray diagnosis, but, unlike most doctors in the United States and other resource-rich areas, they do not have the benefit of having all of their x-rays reviewed and read by radiologists. Our Health Assistants in particular have tremendous experience after years of seeing upwards of forty patients a day. Yet much of the quality data over the last decade has shown that, in the absence of implementing systematic practices, even the most experienced providers will make mistakes. Making morning rounds with the medical team, long-time Nyaya leader Dr. Bijay Acharya and our Medical Director Dr. Sizan Thapa expressed their frustration with trying to read patient x-rays at the bedside without a viewbox, and sometimes with the wrong x-ray in the patient’s bed space. We also had no way of providing immediate feedback to our X-Ray Technician, Dhan Bahadur Bogati. So, we had a trial day of radiology morning rounds, where we reviewed cases with Dhan Bahadur and the whole Health Assistant team. Over the course of the initial session, Bijay outlined a systematic approach to reading chest x-rays, which are the most common form of x-ray used in evaluating heart failure, pneumonia, emphysema, pneumothorax, tuberculosis, and several other conditions. After that teaching, he started asking the Health Assistants if they could read the x-rays on their own, using this approach. It went so well that we decided to institutionalize morning x-ray rounds and his approach with the following very basic protocol:
The first days of trialing have been tremendously successful. In a hospital where there are so many challenges and problems with delivering the excellent care that our patients deserve, it is a beautiful moment when we can identify a tangible way to improve the professionalism, quality, and safety of our services. For us here at Bayalpata Hospital, this was one of those moments.
Duncan Maru, MD, PhD is the co-founder of Nyaya Health. He is currently a resident in the Internal Medicine – Pediatrics program and fellow in Global Health Equity at Brigham and Women’s Hospital and Children’s Hospital of Boston.