In vascular ultrasound labs, it's critical not to focus singularly on the job of scanning patients. It's also important to please those patients, according to a New York City hospital that has changed its focus from getting patients scanned to making patients happy.
Montefiore Medical Center in New York City launched an initiative several years ago to improve its customer service, and along the way discovered that many of the truisms it had assumed about customer service weren't true at all, according to George Berdejo, director of vascular ultrasound services at Montefiore.

"What we have figured out is that 'done' and 'happy' are not the same things," he said. "You may be getting the job done, but you may not necessarily be making the patient happy."

Berdejo discussed the need to ensure customer satisfaction during a talk at the Leading Edge in Diagnostic Ultrasound conference, held in May.

Several years ago, Montefiore decided it needed new ways of thinking about the service it was providing and new ways of providing service, he said. So the hospital adopted a strategy of service excellence, which is a commitment by staff to try to consistently meet and exceed expectations from patients and other customers, Berdejo said.
Customer satisfaction is a business term that's used to measure how satisfied an enterprise's customers are with the organization's efforts in a marketplace.

"When you have a bad experience in the business world, you're likely to tell not just one person, but 10, 15, 20 people," he said. "We see that in all areas of business, and we see it in healthcare, too."

Organizations need to worry about customer satisfaction, as they are interested in retaining existing customers and increasing the number of new customers, Berdejo said. "When you don't meet customer expectations, service failure occurs," he said.
When customer complaints arise, it presents an opportunity for service recovery, which involves taking a specific, meaningful action that will lead disappointed customers back to a state of satisfaction, he said. Patients who are "recovered" in this manner can become more loyal customers than those who may have never had a problem, Berdejo said.

Knowing the right way to apologize is important in the service recovery process, Berdejo said. “I'm sorry it happened to you' and 'I'm sorry you experienced' are some of the key phrases we use during service recovery," he said. "Saying I'm sorry doesn't mean that you did something wrong, it just means that you're feeling for the patient because they're experiencing a negative situation. All you have to do is say, 'I'm here to fix whatever broke down.' "

Part of the process, therefore, is to fix the person, rather than the problem, Berdejo said.

Service fundamentals

Montefiore uses an acronym called AIDET -- Acknowledge and apologize; Introduce yourself and intervene; Do what it takes to make it right; Explain with empathy and exceed patients' expectations; and Thank the patient, according to Berdejo.
The worst possible scenario is for a patient to experience a service failure and have no one acknowledge the perceived failure, Berdejo said.

"Apologize to the patient, and then accept accountability," he said. "You don't have to accept blame, but somebody has to accept accountability to get that patient back to a state of satisfaction. It doesn't matter who's at fault or what the issue is. Patients want someone to acknowledge that a problem occurred and to show concern for their disappointment."

It's also important to thank the customer for the opportunity to help him or her, Berdejo said. A token gift may also be indicated, commensurate with the level of the act that caused the service failure.

Good service yields a number of positive effects, including the ability to prevent escalation or litigation, building of trust, and empowerment and satisfaction of associates, he said.

"The bottom line is that it increases patient satisfaction," he said. "Service recovery is taking action immediately after a problem is identified, it's performing thoughtful and positive direct actions, it's making right what went wrong, it's apologizing and meaning it, it's healing a customer's feelings, it's getting a customer back to a state where expectations can be met again."

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Article written by staff at auntminnie.com and adapted for the purposes of this newsletter.

 

A revolutionary new approach to neurosurgery avoids both radiation and a scalpel.

A new ultrasound device, used in conjunction with magnetic resonance imaging (MRI), allows neurosurgeons to precisely burn out small pieces of malfunctioning brain tissue without cutting the skin or opening the skull. A preliminary study from Switzerland involving nine patients with chronic pain shows that the technology can be used safely in humans. The researchers now aim to test it in patients with other disorders, such as Parkinson's disease.

"The groundbreaking finding here is that you can make lesions deep in the brain--through the intact skull and skin--with extreme precision and accuracy and safety," said Neal Kassell, a neurosurgeon at the University of Virginia. Kassell, who was not directly involved in the study, is chairman of the Focused Ultrasound Surgery Foundation, a nonprofit based in Charlottesville, VA, that was founded to develop new applications for focused ultrasound.

High-intensity focused ultrasound (HIFU) is different from the ultrasound used for diagnostic purposes, such as prenatal screening. Using a specialized device, high-intensity ultrasound beams are focused onto a small piece of diseased tissue, heating it up and destroying it. The technology is currently used to ablate uterine fibroids--small benign tumors in the uterus--and it's in clinical testing for removing tumors from breast and other cancers. Now InSightec, an ultrasound technology company headquartered in Israel, has developed an experimental HIFU device designed to target the brain.

The major challenge in using ultrasound in the brain is figuring out how to focus the beams through the skull, which absorbs energy from the sound waves and distorts their path. The InSightec device consists of an array of more than 1,000 ultrasound transducers, each of which can be individually focused. "You take a CT scan of the patient's head and tailor the acoustic beam to focus through the skull," said Eyal Zadicario, head of InSightec's neurology program. The device also has a built-in cooling system to prevent the skull from overheating.

The ultrasound beams are focused on a specific point in the brain--the exact location depends on the condition being treated--that absorbs the energy and converts it to heat. This raises the temperature to about 130 degrees Fahrenheit and kills the cells in a region approximately 10 cubic millimeters in volume. The entire system is integrated with a magnetic resonance scanner, which allows neurosurgeons to make sure they target the correct piece of brain tissue. "Thermal images acquired in real time during the treatment allow the surgeon to see where and to what extent the rise in temperature is achieved," said Zadicario.

The Swiss study, published this month in the Annals of Neurology, tested the technology on nine patients with chronic debilitating pain that did not respond to medication. The traditional treatment for these patients is to use one of two methods to destroy a small part of the thalamus, a structure that relays messages between different brain areas. Surgeons either use radio frequency ablation, in which an electrode is inserted into the brain through a hole in the skull, or they use focused radiosurgery, a noninvasive procedure in which a focused beam of ionizing radiation is delivered to the target tissue. Zadicario said HIFU has advantages over radiosurgery because the effects of killing tissue with radiation can take weeks to months, whereas the thermal approach is immediate. Added Kassell, "The precision and accuracy [are] considerably greater with ultrasound, and it should be in principle safer in the long run."

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Article written by staff at technologyreview.com and adapted for the purposes of this newsletter.

 

One patient in four with superficial vein clots had concomitant deep-vein thrombosis (DVT), most of which were asymptomatic, data from a small clinical study showed.

Although superficial vein thrombosis is not life threatening, the risk of concomitant DVT should not be ignored, Barbara Binder, MD, of the Medical University of Graz in Austria, and colleagues said in the July issue of Archives of Dermatology.
Patients with superficial vein thrombosis should undergo color-coded duplex sonography to rule out DVT, they said.

"We recommend also evaluation of the contralateral leg in cases of superficial vein thrombosis with a substantially elevated D-dimer level and any symptoms of DVT to insure the best medical care and thus hopefully prevent pulmonary embolism or postthrombotic syndrome," they concluded.

Superficial vein thrombosis develops slowly and usually has a benign course. Although sharing risk factors with more serious forms of venous thromboembolism, superficial vein thrombosis had attracted little research attention until recently, the authors said.
Studies have shown that as many as two-thirds of patients with superficial vein thrombosis have concomitant DVT and as many as a third also have pulmonary emboli, they reported.

Previous studies had focused primarily on DVT in the affected leg. Dr. Binder and colleagues extended the investigation to both lower extremities of patients with superficial vein thrombosis.

The study involved 46 patients with confirmed superficial vein thrombosis. All patients underwent color-coded duplex sonography of both lower extremities. The principal objective was to describe risk factors associated with superficial vein thrombosis and concomitant DVT.

Superficial vein thrombosis was in the great saphenous vein in 10 patients, small saphenous vein in five, and branches in 19. In seven patients the area of involvement extended into the junction with the deep venous system.

The left leg was the affected limb in 54% of cases, the right leg in 44%, and one patient had superficial vein thrombosis in both legs.
Thrombophilic disorders identified in the patients consisted of elevated D-dimer levels (>200 µg/L) in 37 of 46 patients and a heterozygous mutation of factor V Leiden.

Sonography revealed concomitant DVT in 11 patients -- eight in the same leg as the superficial vein thrombosis, two in both lower extremities, and one in the contralateral extremity.

Median age of patients with concomitant DVT was 73 compared with 65 in patients who had only superficial vein thrombosis, a difference that did not reach statistical significance. Seven of the 11 patients had no history of thromboembolism.

In all patients with DVT, the superficial vein thrombosis was in the lower leg. In contrast, a third of patients who did not have DVT had superficial vein thrombosis in the thigh.

All patients with DVT had elevated D-dimer levels. The nine patients with normal D-dimer values had superficial vein thrombosis alone.

The investigators found no association between DVT and body mass index, Braden scale, oral contraceptive use, or history of thrombophilic disorders.

"Our study confirms the findings of previous studies and demonstrates that the risk of a concomitant DVT should not be underestimated in patients with SVT," the authors concluded.

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Article written by staff at medpagetoday.com and adapted for the purposes of this newsletter.