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To report a case of varix of the retromandibular vein within the parotid gland.
Case report, and discussion of the appropriate selection and use of radiological investigation techniques.
A 64-year-old lady who presented with unilateral tinnitus underwent a magnetic resonance imaging scan to exclude a vestibular schwannoma. The magnetic resonance scout images revealed an incidental finding of a hyper-echoic mass within the parotid gland. The mass was most consistent with a pleomorphic adenoma. Ultrasound-guided fine needle aspiration cytology was arranged; the ultrasound identified the mass as a varix of the retromandibular vein and fine needle aspiration cytology was not performed.
A varix of the retromandibular vein is a very rare cause of a parotid mass. Appropriate radiological investigations can prevent unnecessary invasive investigations or procedures.
The World Health Organization ‘Surgical Safety Checklist’ has been adopted by UK surgical units following National Patient Safety Agency guidance. Our aim was to assess compliance with our local version of this Checklist.
Otolaryngology trainee doctors prospectively assessed compliance with the local Checklist over a six-week period. A staff educational intervention was implemented and the audit was repeated 12 months later.
A total of 72 cases were assessed. The initial audit found that: 44 per cent of procedures were undocumented at ‘Sign in’; ‘Time out’ was inappropriately interrupted in 39 per cent of cases; the procedure started before Checklist completion in 33 per cent of cases; and the ‘Sign out’ was not read out in 94 per cent of cases and was not fully documented in 42 per cent of cases. Following education, re-audit indicated that overall compliance had improved from 63.7 per cent (±8.9 per cent standard error of the mean) to 90.4 per cent (±2.7 per cent standard error of the mean).
Our completed audit cycle demonstrated a significant improvement in Checklist compliance following educational intervention. We discuss barriers to compliance, as well as strategies for quality improvement, and we call for other surgeons to similarly publish their Checklist experience and assess its impact on surgical outcomes.
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