Practical tips for MRGFUS treatment (Online Book)

Modern medical centers serve a large flow of a wide variety of patients. Employees work in these swarming anthills and often do not know each other. This situation creates a high probability of errors depending on people.

A long time ago, aviation resolved the same issue. Aviation accidents are rare but lead to a large number of victims. They are well-known and covered in the media. In medicine, everything is a little different. Mistakes are regular but noticeable at the level of one patient and, as a rule, are not advertised.

At 2000 J. Mercola wrote, that according to a study, more than 250,000 deaths in the United States every year occur because of medical malpractice and it is the third-largest cause of death [1]. ).

In aviation, fanatical adherence to checklists prevented many human errors such as “forgotten,” “mixed up,” and “cut a corner.” More recently, in 2009, WHO published guidelines for safe surgery [2], which proposed the introduction of checklists, briefings, and debriefings in surgery. This surgical checklist is available here.

Later in 2018, a systematic review was published, which showed that use checklists reduces postoperative mortality with an odds ratio of 0.75 (p<0.01) and complication rates with an odds ratio of 0.73 P<0.01. However, the authors note that the study is not randomized, and clinics using checklists are usually advanced hospitals where the risk may be lower simply because of the overall high level of medical care [3].

Walker et al. note that some centers made checklist modifications for certain types of surgery due to specialization features [4].

The MRgFUS teams are the pioneers of new medicine. We all remember films about space, where future doctors treat patients without touching them. Therefore, specialists in MRgFUS are not just aces pilots but astronauts conquering the faraway frontiers of medicine.

MRgFUS is a non-invasive operation. It does not lead to blood loss, infection, pain, and danger of general anesthesia. Therefore, the WHO checklist is not very suitable for this area. But there is still a possibility, for example, to operate on an underexamined patient or to mix up the side. Therefore, some kind of checklist is still vital.

The safety issues associated with minimally invasive MRGFUS are primarily related to the MRI room, where it is strictly forbidden to bring ferromagnetic objects. But a nurse in a critical situation helping an emergency patient may forget to bring the suction or oxygen enricher into the MRI room. The patient’s fixation is necessary to the table, and it takes a long time to get him out of the MRI room. Therefore, we fasten not the seatbelts as astronauts but tie all emergency devices with climbing slings to hooks before entering the MRI. The length of these slings allows you to carry to the distance available to the patient but not available.

In addition, the MRGFUS patient is a long lying position without anesthesia during the procedure. This situation requires a diaper and elastic knitwear. Imagine if you already bolted your patient to the helmet with a stereotaxic frame and suddenly remember that you forgot to give the medicine, put on a diaper or elastic knitwear.

As a result of two years of work, we have developed our checklist for the MRGFUS procedure. The checklist is shown in the figure and is available for download in pdf. But we ask you to indicate a link to our source in case of copying. There is nothing extra in this document, but we share two years of experience on one sheet of paper. Here you are.

References:

1. Mercola, J. (2000). Doctors Are The Third Leading Cause of Death in the US, Causing 250,000 Deaths Every Year. Journal American Medical Association, 284(4), 483-5.
2. World Health Organization. (2009). WHO guidelines for safe surgery, safe surgery saves lives. https://www.who.int/publications/i/item/9789241598552.
3. Abbott, T. E. F., Ahmad, T., Phull, M. K., Fowler, A. J., Hewson, R., Biccard, B. M., … & Kahn, D. (2018). The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis. British journal of anaesthesia, 120(1), 146-155.
4. Walker, I. A., Reshamwalla, S., & Wilson, I. H. (2012). Surgical safety checklists: do they improve outcomes?. British journal of anaesthesia, 109(1), 47-54.
5. Gordon, S., Mendenhall, P., & O’toole, B. B. (2012). Beyond the checklist. In Beyond the Checklist. Cornell University Press.