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Pathmaraj K, Welch J, Ng W, Lee D, Lee ST, Brink A, Dondi M, Paez D, Scott AM. A patient journey audit tool (PJAT) to assess quality indicators in a nuclear medicine service. Eur J Nucl Med Mol Imaging 2024; 51:1816-1825. [PMID: 38340206 PMCID: PMC11139729 DOI: 10.1007/s00259-024-06627-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To develop a nuclear medicine specific patient journey audit tool (PJAT) to survey and audit patient journeys in a nuclear medicine department such as staff interaction with patients, equipment, quality of imaging and laboratory procedures, patient protection, infection control and radiation safety, with a view to optimising patient care and providing a high-quality nuclear medicine service. METHODS The PJAT was developed specifically for use in nuclear medicine practices. Thirty-two questions were formulated in the PJAT to test the department's compliance to the Australian National Safety and Quality Health Service Standards, namely clinical governance, partnering with consumers, preventing and controlling health care infection, medication safety, comprehensive care, communicating for safety, blood management and recognising and responding to acute deterioration. The PJAT was also designed to test our department's adherence to diagnostic reference levels (DRL). A total of 60 patient journey audits were completed for patients presenting for nuclear medicine, positron emission tomography and bone mineral density procedures during a consecutive 4-week period to audit the range of procedures performed. A further 120 audits were captured for common procedures in nuclear medicine and positron emission tomography during the same period. Thus, a total of 180 audits were completed. A subset of 12 patients who presented for blood labelling procedures were audited to solely assess the blood management standard. RESULTS The audits demonstrated over 85% compliance for the Australian national health standards. One hundred percent compliance was noted for critical aspects such as correct patient identification for the correct procedure prior to radiopharmaceutical administration, adherence to prescribed dose limits and distribution of the report within 24 h of completion of the imaging procedure. CONCLUSION This PJAT can be applied in nuclear medicine departments to enhance quality programmes and patient care. Austin Health has collaborated with the IAEA to formulate the IAEA PJAT, which is now available globally for nuclear medicine departments to survey patient journeys.
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Affiliation(s)
- Kunthi Pathmaraj
- Department of Molecular Imaging and Therapy, Austin Health, Level 1, Harold Stokes Building, Studley Road, Melbourne, Victoria, 3084, Australia.
- Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia.
- School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia.
- School of Health and Biomedical Science, RMIT University, Melbourne, VIC, Australia.
| | - Jessica Welch
- Department of Molecular Imaging and Therapy, Austin Health, Level 1, Harold Stokes Building, Studley Road, Melbourne, Victoria, 3084, Australia
| | - Wesley Ng
- Department of Molecular Imaging and Therapy, Austin Health, Level 1, Harold Stokes Building, Studley Road, Melbourne, Victoria, 3084, Australia
| | - Danny Lee
- Department of Molecular Imaging and Therapy, Austin Health, Level 1, Harold Stokes Building, Studley Road, Melbourne, Victoria, 3084, Australia
| | - Sze Ting Lee
- Department of Molecular Imaging and Therapy, Austin Health, Level 1, Harold Stokes Building, Studley Road, Melbourne, Victoria, 3084, Australia
- Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Anita Brink
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Maurizio Dondi
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Level 1, Harold Stokes Building, Studley Road, Melbourne, Victoria, 3084, Australia
- Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
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Giammarile F, Knoll P, Kunikowska J, Paez D, Estrada Lobato E, Mikhail-Lette M, Wahl R, Holmberg O, Abdel-Wahab M, Scott AM, Delgado Bolton RC. Guardians of precision: advancing radiation protection, safety, and quality systems in nuclear medicine. Eur J Nucl Med Mol Imaging 2024; 51:1498-1505. [PMID: 38319322 PMCID: PMC11043166 DOI: 10.1007/s00259-024-06633-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND In the rapidly evolving field of nuclear medicine, the paramount importance of radiation protection, safety, and quality systems cannot be overstated. This document provides a comprehensive analysis of the intricate regulatory frameworks and guidelines, meticulously crafted and updated by national and international regulatory bodies to ensure the utmost safety and efficiency in the practice of nuclear medicine. METHODS We explore the dynamic nature of these regulations, emphasizing their adaptability in accommodating technological advancements and the integration of nuclear medicine with other medical and scientific disciplines. RESULTS Audits, both internal and external, are spotlighted for their pivotal role in assessing and ensuring compliance with established standards, promoting a culture of continuous improvement and excellence. We delve into the significant contributions of entities like the International Atomic Energy Agency (IAEA) and relevant professional societies in offering universally applicable guidelines that amalgamate the latest in scientific research, ethical considerations, and practical applicability. CONCLUSIONS The document underscores the essence of international collaborations in pooling expertise, resources, and insights, fostering a global community of practice where knowledge and innovations are shared. Readers will gain an in-depth understanding of the practical applications, challenges, and opportunities presented by these regulatory frameworks and audit processes. The ultimate goal is to inspire and inform ongoing efforts to enhance safety, quality, and effectiveness in nuclear medicine globally.
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Affiliation(s)
- Francesco Giammarile
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria.
| | - Peter Knoll
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Diana Paez
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Enrique Estrada Lobato
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Miriam Mikhail-Lette
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Richard Wahl
- Washington University in St Louis School of Medicine, St. Louis, USA
- The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ola Holmberg
- Department of Nuclear Safety and Security, Radiation Safety and Monitoring Section, International Atomic Energy Agency, Vienna, Austria
| | - May Abdel-Wahab
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia
- Olivia Newton-John Cancer Research Institute, Melbourne, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), La Rioja, Logroño, Spain
- Servicio Cántabro de Salud, Santander, Spain
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Jornet N, Strojan P, Howlett DC, Brady AP, Hierath M, Clark J, Wadsak W, Giammarile F, Coffey M. The QuADRANT study: Current status and recommendations for improving uptake and implementation of clinical audit of medical radiological procedures in Europe. The radiotherapy perspective. Radiother Oncol 2023; 186:109772. [PMID: 37385381 DOI: 10.1016/j.radonc.2023.109772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND QuADRANT was a research project funded by the European Commission to evaluate clinical audit uptake and implementation across Europe, with an emphasis on clinical audit as mandated within the BSSD (Basic Safety Standards Directive). AIM Focusing on the QuADRANT objectives - to obtain an overview of European clinical audit activity; identify good practices, resources, barriers and challenges; provide guidance and recommendations going forwards; identify the potential for European Union action on quality and safety focusing on the field of radiotherapy. RESULTS A pan-European survey, expert interviews and a literature review conducted within the framework of the QuADRANT project indicated that developments in national clinical audit infrastructure are required. While in radiotherapy, there is a strong tradition and high level of experience of dosimetry audits and well-established practice through the IAEA's QUATRO audits, few countries have a well-established comprehensive clinical audit programme or international/national initiatives on tumour specific clinical audits. Even if sparse, the experience from countries with established system of quality audits can be used as role-models for national professional societies to promote clinical audit implementation. However, resource allocation and national prioritisation of clinical audit are needed in many countries. National and international societies should take the initiative to promote and facilitate training and resources (guidelines, experts, courses) for clinical audits. Enablers used to enhance clinical audit participation are not widely employed. Development of hospital accreditation programmes can facilitate clinical audit uptake. An active and formalised role for patients in clinical audit practice and policy development is recommended. Because there is a persisting variation in European awareness of BSSD clinical audit requirements, work is needed to improve dissemination of information on the legislative requirements relating to clinical audit in the BSSD and in relation to inspection processes. The aim is to ensure these include clinical audit and that they encompass all clinics and specialties involved in medical applications using ionising radiation. CONCLUSION QuADRANT provided an overarching view of clinical audit practice in Europe, with all its related aspects. Unfortunately, it showed that the awareness of the BSSD requirements for clinical audit are highly variable. Therefore, there is an urgent need to dedicate efforts towards ensuring that regulatory inspections also incorporate an assessment of clinical audit program(s), affecting all aspects of clinical work and specialties involved in patient exposure to ionising radiation.
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Affiliation(s)
- Núria Jornet
- Servei de Radiofísica i Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; European Society for Radiotherapy and Oncology, Brussels, Belgium.
| | - Primoz Strojan
- Dept. of Radiation Oncology, Institute of Oncology Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia; European Society for Radiotherapy and Oncology, Brussels, Belgium
| | - David C Howlett
- Radiology Department, East Sussex Healthcare NHS Trust, Brighton and Sussex Medical School, UK; European Society of Radiology (ESR), Vienna, Austria
| | - Adrian P Brady
- Radiology Department, Mercy University Hospital, Cork, Ireland; Radiology Department, University College Cork, Ireland; European Society of Radiology (ESR), Vienna, Austria
| | | | | | - Wolfgang Wadsak
- European Association of Nuclear Medicine, Vienna, Austria; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Francesco Giammarile
- European Association of Nuclear Medicine, Vienna, Austria; Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency (IAEA), Vienna, Austria
| | - Mary Coffey
- Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Ireland; European Society for Radiotherapy and Oncology, Brussels, Belgium
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