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Karami M, Hafizi N, Nickfarjam AM, Refahi S. Development of minimum data set and dashboard for monitoring adverse events in radiology departments. Heliyon 2024; 10:e30054. [PMID: 38707457 PMCID: PMC11068645 DOI: 10.1016/j.heliyon.2024.e30054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
Background To reduce the risk of errors, patient safety monitoring in the medical imaging department is crucial. Interventions are required and these can be provided as a framework for documenting, reporting, evaluating, and recognizing events that pose a threat to patient safety. The aim of this study was to develop minimum data set and dashboard for monitoring adverse events in radiology departments. Material and methods This developmental research was conducted in multiple phases, including content determination using the Delphi technique; database designing using SQL Server; user interface (UI) building using PHP; and dashboard evaluation in three aspects: the accuracy of calculating; UI requirements; and usability. Results This study identified 26 patient safety (PS) performance metrics and 110 PS-related significant data components organized into 14 major groupings as the system contents. The UI was built with three tabs: pre-procedure, intra-procedure, and post-procedure. The evaluation results proved the technical feasibility of the dashboard. Finally, the dashboard's usability was highly rated (76.3 out of 100). Conclusion The dashboard can be used to supplement datasets to obtain a more accurate picture of the PS condition and to draw attention to characteristics that professionals might otherwise overlook or undervalue.
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Affiliation(s)
- Mahtab Karami
- Clinical Research Development Center of Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Research Center for Health Technology Assessment and Medical Informatics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Health Information Technology and Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasrin Hafizi
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Ali-Mohammad Nickfarjam
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Technology and Management, School of Allied-Medical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Soheila Refahi
- Department of Medical Physics, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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2
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Donnelly LF, Guimaraes CV. Event-Based Learning and Improvement: Radiology's Move From Peer Review to Peer Learning. Semin Ultrasound CT MR 2024; 45:161-169. [PMID: 38373672 DOI: 10.1053/j.sult.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Over the past 15 years, the radiology community has made great progress moving from a system of score-based peer review to one of peer learning. Much has been learned along the way. In peer learning, cases in which learning opportunities are identified are reviewed solely for the purpose of fostering learning and improvement. This article defines peer learning and peer review and emphasizes the difference; looks back at the 20-year history of score-based peer review and transition to peer learning; outlines the problems with score-based peer review and the key elements of peer learning; discusses the current state of peer learning; and outlines future challenges and opportunities.
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Affiliation(s)
- Lane F Donnelly
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Carolina V Guimaraes
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
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3
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Donnelly LF, Podberesky DJ, Towbin AJ, Loh L, Basta KH, Platchek TS, Vossmeyer MT, Shook JE. The Joint Commission's Ongoing Professional Practice Evaluation Process: Costly, Ineffective, and Potentially Harmful to Safety Culture. J Am Coll Radiol 2024; 21:61-69. [PMID: 37683817 DOI: 10.1016/j.jacr.2023.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/14/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To evaluate the estimated labor costs and effectiveness of Ongoing Professional Practice Evaluation (OPPE) processes at identifying outlier performers in a large sample of providers across multiple health care systems and to extrapolate costs and effectiveness nationally. METHODS Six hospital systems partnered to evaluate their labor expenses related to conducting OPPE. Estimates for mean labor hours and wages were created for the following: data analysts, medical staff office professionals, department physician leaders, and administrative assistants. The total number of outlier performers who were identified by OPPE metrics alone and that resulted in lack of renewal, limitation, or revoking of hospital privileges during the past annual OPPE cycle (2022) was recorded. National costs of OPPE were extrapolated. Literature review of the effect of OPPE on safety culture in radiology was performed. RESULTS The evaluated systems had 12,854 privileged providers evaluated by OPPE. The total estimated annual recurring labor cost per provider was $50.20. Zero of 12,854 providers evaluated were identified as outlier performers solely through the OPPE process. The total estimated annual recurring cost of administering OPPE nationally was $78.54 million. In radiology over the past 15 years, the use of error rates based on score-based peer review as an OPPE metric has been perceived as punitive and had an adverse effect on safety culture. CONCLUSION OPPE is expensive to administer, inefficient at identifying outlier performers, diverts human resources away from potentially more effective improvement work, and has been associated with an adverse impact on safety culture in radiology.
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Affiliation(s)
- Lane F Donnelly
- Professor of Radiology and Pediatrics, Departments of Radiology and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Executive Medical Director, Pediatric Population Health and Quality, UNC Health; Director of Quality, UNC Children's Hospital; member, ACR Peer Learning Committee.
| | - Daniel J Podberesky
- Vice President and Chief Medical Officer, Nemours Children's Health, Orlando, Florida, and Professor of Radiology, University of Central Florida, College of Medicine, Orlando, Florida
| | - Alexander J Towbin
- Associate Chief, Associate Chief Medical Information Officer, and Neil D. Johnson Chair of Radiology Informatics, Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio; Professor of Radiology, Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio; ACR Roles: Informatics Commission, Councilor-at-Large (2023), Data Science Institute Non-Interpretive Panel Cochair, LI-RADS Steering Committee-Pediatric LI-RADS, Relevance and Impact Workgroup, Pediatric Measures Committee, ACR Annual Meeting Abstract Reviewers, Pediatric AI Workgroup
| | - Ling Loh
- Director, Analytics and Clinical Effectiveness, Center for Pediatric and Maternal Value, Stanford Medicine Children's Health, Palo Alto, California
| | - Kathryne H Basta
- Assistant Director, Quality and Patient Safety, Department of Quality and Safety, Texas Children's Hospital, Houston, Texas
| | - Terry S Platchek
- Vice President for Performance Improvement and Associate Chief Quality Officer, Center for Pediatric and Maternal Value, Stanford Medicine Children's Health, Palo Alto, California; Professor, Pediatrics and Internal Medicine, and Fellowship Director, Clinical Excellence Research Center, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Michael T Vossmeyer
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio; Associate Professor, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Chair, Utilization Review Committee; Chair, Focused Professional Practice Evaluation/OPPE Committee; member, Credentials Committee; member, Medical Executive Committee, Cincinnati Children's Hospital
| | - Joan E Shook
- Center for Pediatric and Maternal Value, Stanford Medicine Children's Health, Palo Alto, California; Professor of Pediatrics-Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Chief Safety Officer, Deputy Chief Quality Officer, Texas Children's Hospital
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Hannafin C, Ponce L, Dahiya N, Utecht C, DeYoung D, Flug J. DMAIC Quality Improvement Project to Reduce Specimen-Related Safety Events in Ultrasound. Curr Probl Diagn Radiol 2023; 52:469-473. [PMID: 37495482 DOI: 10.1067/j.cpradiol.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/12/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Cathy Hannafin
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ
| | - Lisa Ponce
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ
| | | | - Charles Utecht
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ
| | - Dyan DeYoung
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ
| | - Jonathan Flug
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ.
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Parrott EH, Saeedipour S, Walker CM, Best SR, Harn NR, Ash RM. Transition from Peer Review to Peer Learning: Lessons Learned. Curr Probl Diagn Radiol 2023; 52:223-229. [PMID: 37069021 DOI: 10.1067/j.cpradiol.2023.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
Landmark publications, such as To Err is Human, confronted the healthcare community with the egregious toll medical errors played in both patient safety and overall healthcare costs. This heralded a paradigm shift and a call for action by professional organizations to enact methods to ensure physician competency and quality assurance. The American College of Radiology similarly convened a task force to discuss these concerns and how best to address quality assurance in radiology practice, leading to the development of RADPEER, a score-based peer review system. However, critics were quick to point out the deficiencies of this model, highlighting it as punitive and a poor evaluator of physician performance. The recognized deficiencies in score-based peer review prompted the pursuit of an alternate model that would instead emphasize learning and improvement. Peer learning was proposed and highlighted the necessity of an inclusive and collaborative environment where colleagues could discuss case errors as learning opportunities without fear of punitive consequence. This paper explores peer learning, its benefits and challenges, as well as how to identify specific learning opportunities by utilizing case examples.
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Komarraju A, Maxwell C, Kung JW, Mhuircheartaigh JN, Kim W, Wu JS. Causes and diagnostic utility of musculoskeletal MRI recall examinations. Clin Radiol 2023; 78:e221-e226. [PMID: 36517267 DOI: 10.1016/j.crad.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/30/2022] [Accepted: 11/05/2022] [Indexed: 12/15/2022]
Abstract
AIM To determine the causes and diagnostic utility of musculoskeletal (MSK) magnetic resonance imaging (MRI) recall examinations. MATERIALS AND METHODS An institutional review board-approved retrospective review was conducted of all MSK MRI examinations performed at a single academic institution over 10 years where radiologists requested the patient return for additional imaging. The reason for the recall was documented. Recalls were reviewed in consensus by two MSK radiologists to determine whether additional sequences resulted in a change in the final report. Recall causes were divided into four categories: (1) radiologist-related: incorrect field of view (FOV) or incorrect protocol; (2) technologist-related: incorrect FOV or incorrect/incomplete protocol performed, or technically poor-quality images; (3) patient-related motion artefact; (4) unexpected lesion discovered. Fisher's exact test was used to assess for statistical significance. RESULTS The recall rate was 0.25% (156/62,930). Of the total 129 recalls returning for imaging, 42 (33%) were radiologist-related, 45 (35%) were technologist-related, six (5%) were patient-related, and 36 (28%) had an unexpected lesion requiring additional sequences. For clinical utility, 42% resulted in a change from the initial report. Recalls due to radiologist error, incorrect FOV, or unexpected lesion caused a significant change in the final report; however, recalls due to technologist error, patient motion artefact, or incorrect protocol did not. CONCLUSION MRI MSK recalls are uncommon, and the most common reasons are incorrect FOV, incorrect protocol, and unexpected lesion. Radiologist-related errors in protocols and FOV led to a significant change in the final report and should be targeted as areas for improvement to reduce recall examinations.
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Affiliation(s)
- A Komarraju
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - C Maxwell
- Scripps Clinic Medical Group, 10666 North Torrey Pines Rd, La Jolla, CA 92037, USA
| | - J W Kung
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - J N Mhuircheartaigh
- Department of Radiology, School of Medicine, University of Limerick, V94T9Pk, Ireland
| | - W Kim
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - J S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
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Results of a Virtual Multi-Institutional Program for Quality Improvement Training and Project Facilitation. J Am Coll Radiol 2023; 20:173-182. [PMID: 36272524 DOI: 10.1016/j.jacr.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this project was to describe the results of a multi-institutional quality improvement (QI) program conducted in a virtual format. METHODS Developed at Stanford in 2016, the Realizing Improvement Through Team Empowerment program uses a team-based, project-based improvement approach to QI. The program was planned to be replicated at two other institutions through respective on-site programs but was converted to a multi-institutional virtual format in 2020 in response to the COVID-19 pandemic. The virtual program began in July 2020 and ended in December 2020. The two institutions participated jointly in the cohort, with 10 2-hour training sessions every 2 weeks for a total of 18 weeks. Project progress was monitored using a predetermined project progress scale by the program manager, who provided more direct project support as needed. RESULTS The cohort consisted of six teams (37 participants) from two institutions. Each team completed a QI project in subjects including MRI, ultrasound, CT, diagnostic radiography, and ACR certification. All projects reached levels of between 3.0 (initial test cycles begun with evidence of modest improvement) and 4.0 (performance data meeting goal and statistical process control criteria for improvement) and met graduation criteria for program completion. DISCUSSION We found the structured problem-solving method, along with timely focused QI education materials via a virtual platform, to be effective in simultaneously facilitating improvement projects from multiple institutions. The combination of two institutions fostered encouragement and shared learning across institutions.
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Hetenyi S, Goelz L, Boehmcker A, Schorlemmer C. Quality Assurance of a Cross-Border and Sub-Specialized Teleradiology Service. Healthcare (Basel) 2022; 10:healthcare10061001. [PMID: 35742052 PMCID: PMC9223114 DOI: 10.3390/healthcare10061001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 02/06/2023] Open
Abstract
Background: The current literature discusses aspects of quality assurance (QA) and sub-specialization. However, the challenges of these topics in a teleradiology network have been less explored. In a project report, we aimed to review the development and enforcement of sub-specialized radiology at Telemedicine Clinic (TMC), one of the largest teleradiology providers in Europe, and to describe each step of its QA. Evaluation: The company-specific background was provided by the co-authors—current and former staff members of TMC. Detailed descriptions of the structures of sub-specialization and QA at TMC are provided. Exemplary quantitative evaluation of caseloads and disagreement rates of secondary reviews are illustrated. Description of Sub-specialization and Quality Assurance at TMC: Sub-specialization at TMC is divided into musculoskeletal radiology, neuroradiology, head and neck, a body, and an emergency section operating at local daytime in Europe and Australia. Quality assurance is based on a strict selection process of radiologists, specific reporting guidelines, feedback through the secondary reading of 100% of all radiology reports for new starters, and a minimum of 5% of radiology reports on a continuous basis for all other radiologists, knowledge sharing activities and ongoing training. The level of sub-specialization of each radiologist is monitored continuously on an individual basis in detail. After prospective secondary readings, the mean disagreement rate at TMC indicating at least possibly clinically relevant findings was 4% in 2021. Conclusion: With continuing and current developments in radiology in mind, the essential features of sub-specialization and innovative QA are relevant for further expansion of teleradiology services and for most radiology departments worldwide to respond to the increasing demand for value-based radiology.
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Affiliation(s)
- Szabolcs Hetenyi
- European Telemedicine Clinic SL, Torre Mapfre, C/Marina 16-18, 08005 Barcelona, Spain; (S.H.); (A.B.); (C.S.)
| | - Leonie Goelz
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
- Correspondence: ; Tel.: +49-30-56813829
| | - Alexander Boehmcker
- European Telemedicine Clinic SL, Torre Mapfre, C/Marina 16-18, 08005 Barcelona, Spain; (S.H.); (A.B.); (C.S.)
- AIDOC Medical, Aminadav St. 3, Tel Aviv-Yafo 6706703, Israel
| | - Carlos Schorlemmer
- European Telemedicine Clinic SL, Torre Mapfre, C/Marina 16-18, 08005 Barcelona, Spain; (S.H.); (A.B.); (C.S.)
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Akpan E, Kitundu J, Ekpo E. Public Health Radiography: A Scoping Review of Benefits, and Growth Opportunities for Radiographers. J Med Imaging Radiat Sci 2021; 52:615-625. [PMID: 34531164 DOI: 10.1016/j.jmir.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 06/17/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is growing adoption of radiographic techniques in public health to improve outcomes of chronic and communicable diseases. This review examines the applications, benefits, and implications of radiography in public health. It also examines the challenges and potential advanced practice roles for radiographers in public health radiography (PHR). METHODOLOGY Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping review extension (PRISMA- ScR) checklist was employed, and the search was conducted using PubMed, Medline, Web of Science, ScienceDirect, and Google Scholar to identify relevant articles that explored the concept of radiography in public health. Evidence was analysed using an inductive iterative approach. RESULTS Radiographic imaging modalities such as ultrasound, computed tomography, and plain X-ray had wide applicability in public health fields of preventive cardiology, preventive oncology, maternal health, infectious disease epidemiology, and radiographic informatics. PHR effectively reduced mortality, improved outcomes, informed lifestyle changes to mitigate the risk of impending disease. PHR also helped in monitoring disease progression and predicting treatment outcomes. However, evidence establishing a competency framework that supports PHR is scarce. CONCLUSION Radiography makes a significant contribution to public health in reducing mortality and morbidity. Therefore, developing a PHR competency framework can accentuate the contribution Radiographers make to solving public health issues.
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Affiliation(s)
- Eyo Akpan
- Grayscale International Ltd, Lagos, Nigeria.
| | - Jane Kitundu
- Vijibweni District Hospital, Kigamboni Municipal, Dar es Salaam, Tanzania
| | - Ernest Ekpo
- Image Optimisation and Perception Group, Discipline of Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Cumberland Campus C42
- 75 East Street, Lidcombe, NS, W
- 2141
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Mahnken AH, Boullosa Seoane E, Cannavale A, de Haan MW, Dezman R, Kloeckner R, O’Sullivan G, Ryan A, Tsoumakidou G. CIRSE Clinical Practice Manual. Cardiovasc Intervent Radiol 2021; 44:1323-1353. [PMID: 34231007 PMCID: PMC8382634 DOI: 10.1007/s00270-021-02904-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 12/19/2022]
Abstract
Background Interventional radiology (IR) has come a long way to a nowadays UEMS-CESMA endorsed clinical specialty. Over the last decades IR became an essential part of modern medicine, delivering minimally invasive patient-focused care. Purpose To provide principles for delivering high quality of care in IR. Methods Systematic description of clinical skills, principles of practice, organizational standards and infrastructure needed for the provision of professional IR services. Results There are IR procedures for almost all body parts and organs, covering a broad range of medical conditions. In many cases IR procedures are the mainstay of therapy, e.g. in the treatment of hepatocellular carcinoma. In parallel the specialty moved from the delivery of a procedure towards taking care for a patient’s condition with the interventional radiologists taking ultimate responsibility for the patient’s outcomes. Conclusions The evolution from a technical specialty to a clinical specialty goes along with changing demands on how clinical care in IR is provided. The CIRSE Clinical Practice Manual provides interventional radiologist with a starting point for developing his or her IR practice as a clinician.
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Affiliation(s)
- Andreas H. Mahnken
- Clinic of Diagnostic and Interventional Radiology, Marburg University Hospital, Baldingerstrasse, 35043 Marburg, Germany
| | - Esther Boullosa Seoane
- Department of Vascular and Interventional Radiology, University Hospital of Vigo, Vigo, Spain
| | - Allesandro Cannavale
- Department of Radiological Sciences, ‘Policlinico Umberto I’University Hospital, Rome, Italy
| | - Michiel W. de Haan
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rok Dezman
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center, 55131 Mainz, Germany
| | | | - Anthony Ryan
- University Hospital Waterford and Royal College of Surgeons in Ireland, Waterford, Ireland
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Bastawrous S, Wu L, Strzelecki B, Levin DB, Li JS, Coburn J, Ripley B. Establishing Quality and Safety in Hospital-based 3D Printing Programs: Patient-first Approach. Radiographics 2021; 41:1208-1229. [PMID: 34197247 DOI: 10.1148/rg.2021200175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The adoption of three-dimensional (3D) printing is rapidly spreading across hospitals, and the complexity of 3D-printed models and devices is growing. While exciting, the rapid growth and increasing complexity also put patients at increased risk for potential errors and decreased quality of the final product. More than ever, a strong quality management system (QMS) must be in place to identify potential errors, mitigate those errors, and continually enhance the quality of the product that is delivered to patients. The continuous repetition of the traditional processes of care, without insight into the positive or negative impact, is ultimately detrimental to the delivery of patient care. Repetitive tasks within a process can be measured, refined, and improved and translate into high levels of quality, and the same is true within the 3D printing process. The authors share their own experiences and growing pains in building a QMS into their 3D printing processes. They highlight errors encountered along the way, how they were addressed, and how they have strived to improve consistency, facilitate communication, and replicate successes. They also describe the vital intersection of health care providers, regulatory groups, and traditional manufacturers, who contribute essential elements to a common goal of providing quality and safety to patients. ©RSNA, 2021.
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Affiliation(s)
- Sarah Bastawrous
- From the Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, 1959 NE Pacific St, Seattle WA 98195; Department of Radiology, VA Puget Sound Health Care System, Seattle, Wash (S.B., L.W., B.R.); Department of Mechanical Engineering, University of Washington, Seattle, Wash (J.S.L.); Research and Development, Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Wash (B.S., J.S.L.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| | - Lei Wu
- From the Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, 1959 NE Pacific St, Seattle WA 98195; Department of Radiology, VA Puget Sound Health Care System, Seattle, Wash (S.B., L.W., B.R.); Department of Mechanical Engineering, University of Washington, Seattle, Wash (J.S.L.); Research and Development, Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Wash (B.S., J.S.L.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| | - Brian Strzelecki
- From the Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, 1959 NE Pacific St, Seattle WA 98195; Department of Radiology, VA Puget Sound Health Care System, Seattle, Wash (S.B., L.W., B.R.); Department of Mechanical Engineering, University of Washington, Seattle, Wash (J.S.L.); Research and Development, Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Wash (B.S., J.S.L.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| | - Dmitry B Levin
- From the Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, 1959 NE Pacific St, Seattle WA 98195; Department of Radiology, VA Puget Sound Health Care System, Seattle, Wash (S.B., L.W., B.R.); Department of Mechanical Engineering, University of Washington, Seattle, Wash (J.S.L.); Research and Development, Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Wash (B.S., J.S.L.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| | - Jing-Sheng Li
- From the Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, 1959 NE Pacific St, Seattle WA 98195; Department of Radiology, VA Puget Sound Health Care System, Seattle, Wash (S.B., L.W., B.R.); Department of Mechanical Engineering, University of Washington, Seattle, Wash (J.S.L.); Research and Development, Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Wash (B.S., J.S.L.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| | - James Coburn
- From the Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, 1959 NE Pacific St, Seattle WA 98195; Department of Radiology, VA Puget Sound Health Care System, Seattle, Wash (S.B., L.W., B.R.); Department of Mechanical Engineering, University of Washington, Seattle, Wash (J.S.L.); Research and Development, Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Wash (B.S., J.S.L.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| | - Beth Ripley
- From the Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, 1959 NE Pacific St, Seattle WA 98195; Department of Radiology, VA Puget Sound Health Care System, Seattle, Wash (S.B., L.W., B.R.); Department of Mechanical Engineering, University of Washington, Seattle, Wash (J.S.L.); Research and Development, Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Wash (B.S., J.S.L.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
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Burns J, Ciccarelli S, Mardakhaev E, Erdfarb A, Goldberg-Stein S, Bello JA. Handoffs in Radiology: Minimizing Communication Errors and Improving Care Transitions. J Am Coll Radiol 2021; 18:1297-1309. [PMID: 33989534 DOI: 10.1016/j.jacr.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/13/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
Handoffs are essential to achieving safe care transitions. In radiology practice, frequent transitions of care responsibility among clinicians, radiologists, and patients occur between moments of care such as determining protocol, imaging, interpreting, and consulting. Continuity of care is maintained across these transitions with handoffs, which are the process of communicating patient information and transferring decision-making responsibility. As a leading cause of medical error, handoffs are a major communication challenge that is exceedingly common in both diagnostic and interventional radiology practice. The frequency of handoffs in radiology underscores the importance of using evidence-based strategies to improve patient safety in the radiology department. In this article, reliability science principles and handoff improvement tools are adapted to provide radiology-focused strategies at individual, team, and organizational levels with the goal of minimizing handoff errors and improving care transitions.
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Affiliation(s)
- Judah Burns
- Chair, Montefiore Medical Center Peer Review Board; Program Director, Montefiore Medical Center Diagnostic Radiology Residency Program; Department of Radiology, Montefiore Medical Center, Bronx, New York.
| | | | | | - Amichai Erdfarb
- Director of Quality and Safety, Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Shlomit Goldberg-Stein
- Director of Operational Improvement, Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Jacqueline A Bello
- Vice Chair, Board of Chancellors, American College of Radiology; Section Chief of Neuroradiology, Montefiore Medical Center; Department of Radiology, Montefiore Medical Center, Bronx, New York
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Larson DB, Broder JC, Bhargavan-Chatfield M, Donnelly LF, Kadom N, Khorasani R, Sharpe RE, Pahade JK, Moriarity AK, Tan N, Siewert B, Kruskal JB. Transitioning From Peer Review to Peer Learning: Report of the 2020 Peer Learning Summit. J Am Coll Radiol 2020; 17:1499-1508. [DOI: 10.1016/j.jacr.2020.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/05/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
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Lee YH, Quek ST, Khong PL, Lee CS, Wu JS, Zhang L, Ng KH, Yang SO, Kudo K, Do KH, Kim SH, Chen DC, Cheng A, Leung JH, Chang YC, Hsu HH, Chan WP. Consensus survey on pre-procedural safety practices in radiological examinations: a multicenter study in seven Asian regions. Br J Radiol 2020; 93:20200082. [PMID: 32584595 DOI: 10.1259/bjr.20200082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To understand the status of pre-procedural safety practices in radiological examinations at radiology residency training institutions in various Asian regions. METHODS A questionnaire based on the Joint Commission International Accreditation Standards was electronically sent to 3 institutions each in 10 geographical regions across 9 Asian countries. Questions addressing 45 practices were divided into 3 categories. A five-tier scale with numerical scores was used to evaluate safety practices in each institution. Responses obtained from three institutions in the United States were used to validate the execution rate of each surveyed safety practice. RESULTS The institutional response rate was 70.0% (7 Asian regions, 21 institutions). 44 practices (all those surveyed except for the application of wrist tags for identifying patients with fall risks) were validated using the US participants. Overall, the Asian participants reached a consensus on 89% of the safety practices. Comparatively, most Asian participants did not routinely perform three pre-procedural practices in the examination appropriateness topic. CONCLUSION Based on the responses from 21 participating Asian institutions, most routinely perform standard practices during radiological examinations except when it comes to examination appropriateness. This study can provide direction for safety policymakers scrutinizing and improving regional standards of care. ADVANCES IN KNOWLEDGE This is the first multicenter survey study to elucidate pre-procedural safety practices in radiological examinations in seven Asian regions.
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Affiliation(s)
- Yuan-Hao Lee
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
| | - Pek-Lan Khong
- Department of Diagnostic Radiology, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Cindy S Lee
- Department of Radiology, NYU Langone Medical Center, Garden City, New York, USA
| | - Jim S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Lei Zhang
- Department of Radiology, Shanghai General Hospital (South Branch), Shanghai Jiaotong University, Shanghai, China
| | - Kwan-Hoong Ng
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia.,University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Seoung-Oh Yang
- Department of Radiology / Nuclear Medicine, Dongnam Institute of Radiological and Medical Sciences, Gijang-gun, Busan, Korea
| | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, SapporoHokkaido, Japan
| | - Kyung-Hyun Do
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Dillon C Chen
- Department of Radiology, University of California, Davis, Sacramento, California, USA
| | - Amy Cheng
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Joseph Hang Leung
- Department of Radiology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsian-He Hsu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Schwartz M, Osborn H, Palmieri J, Patel B, Flug JA. Reducing Errors in Radiology Specimen Labeling Through Use of a Two-person Check. Curr Probl Diagn Radiol 2020; 49:351-354. [PMID: 32113747 DOI: 10.1067/j.cpradiol.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 12/03/2019] [Accepted: 01/06/2020] [Indexed: 11/22/2022]
Abstract
Improper specimen labeling of biopsy samples can cause substantial harm to patients through diagnostic delays, administration of inappropriate treatments, and can result in a loss of trust in the healthcare system. Specimen labeling errors are considered a relevant safety metric in our department and tracked on a rolling basis. One imaging section was noted to have nearly completely eliminated these errors through implementation of a 2-person check prior to submission to pathology. The purpose of this intervention was to identify the causes of continued specimen labeling errors in radiology and to standardize the specimen labeling workflow across the department of radiology to include the best practice identified in breast imaging utilizing a 2-person check. Preintervention, 31 specimen labeling errors were reported by the procedural staff over a period of 149 weeks resulting in an error rate of 0.21 errors per week. Postintervention, 3 specimen labeling errors occurred in the next 46 weeks resulting in a rate of 0.07 errors per week, a 68.8% decrease in the specimen labeling error rate. This quality improvement project highlights the process flaws which contribute to medical errors and demonstrates a potential pathway to try and reduce these errors and patient harm without significant investment in capital or new technology.
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Affiliation(s)
| | - Howard Osborn
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ
| | | | - Bhavika Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ
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16
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Siewert B, Hochman M, Eisenberg RL, Swedeen S, Brook OR. Acing the Joint Commission Regulatory Visit: Running an Effective and Compliant Safety Program. Radiographics 2019; 38:1744-1760. [PMID: 30303792 DOI: 10.1148/rg.2018180134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ensuring the safety of patients and staff is a core effort of all health care organizations. Many regulatory agencies, from The Joint Commission to the Occupational Safety and Health Administration, provide policies and guidelines, with relevant metrics to be achieved. Data on safety can be obtained through a variety of mechanisms, including gemba walks, team discussion during safety huddles, audits, and individual employee entries in safety reporting systems. Data can be organized on a scorecard that provides an at-a-glance view of progress and early warning signs of practice drift. In this article, relevant policies are outlined, and instruction on how to achieve compliance with national patient safety goals and regulations that ensure staff safety and Joint Commission ever-readiness are described. Additional critical components of a safety program, such as department commitment, a just culture, and human factors engineering, are discussed. ©RSNA, 2018.
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Affiliation(s)
- Bettina Siewert
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115
| | - Mary Hochman
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115
| | - Ronald L Eisenberg
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115
| | - Suzanne Swedeen
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115
| | - Olga R Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115
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Vision to improve: quality improvement in ophthalmology. Can J Ophthalmol 2019; 55:107-115. [PMID: 31712012 DOI: 10.1016/j.jcjo.2019.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/27/2019] [Accepted: 07/21/2019] [Indexed: 12/25/2022]
Abstract
Improving quality of care and patient outcomes is a professional duty of all health care workers. Quality improvement is a part of health policy, an accreditation requirement of residency programs, and a recognized sub-specialty in academic medicine. Given the increasing need for ophthalmological services with our aging population, it is critical for ophthalmologists and their staff to develop the necessary skills in quality improvement to ensure access to care that is safe, patient-centered, effective, efficient, equitable, and timely. This narrative review outlines tools that are used in a recognized framework, including the creation of an aim statement, Ishikawa diagram, Pareto analysis, process maps, Plan-Do-Study-Act cycles, and run charts. We also discuss common challenges that occur when conducting quality initiatives. Two quality improvement projects conducted in the Department of Ophthalmology at University of Toronto are used as examples to illustrate these tools. The aim of the first project was to improve visual field test reliability and the aim of the second was to ensure secure email communication between residents and staff in caring for emergency patients. This primer provides the foundations ophthalmologists and their staff can use to support and guide their quality improvement efforts.
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Sorrentino K. Accreditation, Credentialing, and Quality Improvement in Diagnostic Medical Sonography: A Literature Review. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319838234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are few regulations regarding facility accreditation and individual credentialing in diagnostic medical sonography (DMS), although it is known that the quality of examinations in the field can vary based by the operator. This literature review summarizes the findings from 19 research studies on accreditation, credentialing, and quality improvement and includes illustrative quotes from 23 position papers and 42 editorials. The review uncovered large differences in facility accreditation status based on sonography specialty and geographical area. The findings included many examples of positive correlations between accreditation and improved quality and also a positive correlation between credentialing and improved image quality. The survey studies revealed overwhelming support for accreditation and credentialing. Many articles raised concerns about the unknown quality of sonograms performed in nonaccredited facilities or by uncredentialed sonographers. If facility accreditation and/or individual credentialing could be implemented nationwide in DMS, it may lead to increased quality within the field.
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Flug JA, Ponce LM, Osborn HH, Jokerst CE. Never Events in Radiology and Strategies to Reduce Preventable Serious Adverse Events. Radiographics 2018; 38:1823-1832. [DOI: 10.1148/rg.2018180036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Jonathan A. Flug
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Lisa M. Ponce
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Howard H. Osborn
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Clinton E. Jokerst
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054
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Mamede FMB, Gama ZADS, Saturno-Hernández PJ. Improving the quality of radiological examinations: effectiveness of an internal participatory approach. Int J Qual Health Care 2018; 29:420-426. [PMID: 28339950 DOI: 10.1093/intqhc/mzx026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/20/2017] [Indexed: 11/13/2022] Open
Abstract
Quality problem or issue To assess the quality of radiological examinations (REs) and to evaluate the effectiveness of a participatory continuous improvement approach to ensure best practices in a Portuguese hospital imaging department. Initial assessment At baseline, we found 232 (10.2%) non-compliances, mostly related to the criteria image centering and framing in chest radiography (CXR), proper use of radiological protection equipment in other conventional RE (CR) and X-ray beam collimation (CXR/CR). Choice of solution A baseline and three consecutive evaluations of the RE quality were conducted. Each assessment was followed by participatory focused interventions for improvement. Implementation For each evaluation, we selected a random sample (n = 60) of cases for four types of examination (total n = 240 for each assessment, and 960 for the whole project). Both the building of quality criteria and the design of interventions for improvement were participatory, involving the radiology technicians. Estimates of criteria compliance were calculated with 95% confidence intervals. The statistical significance of absolute and relative improvements was tested using one-tail z-tests. Evaluation After the intervention, non-compliances decreased to 48 (2.1%). Compliance estimates improved in 25 of 38 criteria assessed, with statistical significance for 5 criteria in CXR and 3 in CR and digestive examination. Lessons learned The internal participatory approach enabled the identification of existing quality problems and, by focusing on the more frequent quality defects, was effective in improving the quality of RE.
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Affiliation(s)
| | - Zenewton André da Silva Gama
- Departamento de Saúde Coletiva, Universidade Federal do Rio Grande do Norte, Avenida Salgado Filho, s/n, CEP 59078-970 Natal/ RN, Brazil
| | - Pedro Jesus Saturno-Hernández
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública Universidad, No. 655, Col. Santa María Ahuacatitlán, Cerrada los Pinos y Caminera, CP. 62100 Cuernavaca Morelos, México
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21
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Patel V, Sindhwani G, Gupta M, Arora S, Mishra A, Bhatt J, Arora M, Gehani A. A Comprehensive Approach Towards Quality and Safety in Diagnostic Imaging Services: Our Experience at a Rural Tertiary Health Care Center. J Clin Diagn Res 2017; 11:TC10-TC16. [PMID: 28969238 DOI: 10.7860/jcdr/2017/29545.10354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/12/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION An organization's transformation from imple-mentation of small, distinct Quality Improvement (QI) efforts to complete incorporation of Quality Improvement Program (QIP) into its culture occurs through a process of churning the foundational elements over time. AIM To develop a quality culture across the employees, identify measurable indicators and various tools to impart effective quality care and develop a learning culture for continuous quality improvement in the field of imaging services. MATERIALS AND METHODS To establish a QIP, the bare minimum requirement started with forming a quality committee. The committee identified the areas of improvement and ascertaining the core principle of Quality Management System (QMS) by having a Quality Manual, Standard Operating Procedures (SOP's), work-instructions, identification and monitoring of quality indicators and a training calendar. Appropriate tools like formatted daily registers, periodic check lists, run charts etc., were developed to collect the data followed by multiple PDSA cycles (Plan, Do, Study and Act) which helped identify the process bottlenecks, followed by implementing solutions and reanalysis. RESULTS A total of 17 measurable key performance indicators were identified from the four major quality tasks namely Safety, Process Improvement, Professional Outcome and Satisfaction, to assess the performance measures and targets of QIP. CONCLUSION Diagnostic services should evaluate how to choose the most appropriate method and develop a comprehensive QIP to meet the needs of the staff and the end users, thus, creating a working environment, where people constitutes the intrinsic value in attaining the ultimate quality and safety.
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Affiliation(s)
- Viral Patel
- Associate Professor, Department of Radiodiagnosis, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
| | - Geetika Sindhwani
- Assistant Professor, Department of Radiodiagnosis, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
| | - Monica Gupta
- Professor, Department of Pathology, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
| | - Sweta Arora
- Manager QIG, Department of QIG, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
| | - Arpita Mishra
- Executive QIG, Department of QIG, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
| | - Jayesh Bhatt
- Professor, Department of Radiodiagnosis, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
| | - Manali Arora
- Senior Resident, Department of Radiodiagnosis, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
| | - Anisha Gehani
- Resident, Department of Radiodiagnosis, Pramukhswami Medical College and Shree Krishna Hospital, Anand, Gujarat, India
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Implementation of a Point-of-Care Radiologist-Technologist Communication Tool in a Quality Assurance Program. AJR Am J Roentgenol 2017; 209:W18-W25. [PMID: 28402126 DOI: 10.2214/ajr.16.17517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We implemented an Image Quality Reporting and Tracking Solution (IQuaRTS), directly linked from the PACS, to improve communication between radiologists and technologists. MATERIALS AND METHODS IQuaRTS launched in May 2015. We compared MRI issues filed in the period before IQuaRTS implementation (May-September 2014) using a manual system with MRI issues filed in the IQuaRTS period (May-September 2015). The unpaired t test was used for analysis. For assessment of overall results in the IQuaRTS period alone, all issues filed across all modalities were included. Summary statistics and charts were generated using Excel and Tableau. RESULTS For MRI issues, the number of issues filed during the IQuaRTS period was 498 (2.5% of overall MRI examination volume) compared with 78 issues filed during the period before IQuaRTS implementation (0.4% of total examination volume) (p = 0.0001), representing a 625% relative increase. Tickets that documented excellent work were 8%. Other issues included images not pushed to PACS (20%), film library issues (19%), and documentation or labeling (8%). Of the issues filed, 55% were MRI-related and 25% were CT-related. The issues were stratified across six sites within our institution. Staff requiring additional training could be readily identified, and 80% of the issues were resolved within 72 hours. CONCLUSION IQuaRTS is a cost-effective online issue reporting tool that enables robust data collection and analytics to be incorporated into quality improvement programs. One limitation of the system is that it must be implemented in an environment where staff are receptive to quality improvement.
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Lee MH, Schemmel AJ, Pooler BD, Hanley T, Kennedy T, Field A, Wiegmann D, Yu JPJ. Radiology Workflow Dynamics: How Workflow Patterns Impact Radiologist Perceptions of Workplace Satisfaction. Acad Radiol 2017; 24:483-487. [PMID: 27769823 DOI: 10.1016/j.acra.2016.08.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES The study aimed to assess perceptions of reading room workflow and the impact separating image-interpretive and nonimage-interpretive task workflows can have on radiologist perceptions of workplace disruptions, workload, and overall satisfaction. MATERIALS AND METHODS A 14-question survey instrument was developed to measure radiologist perceptions of workplace interruptions, satisfaction, and workload prior to and following implementation of separate image-interpretive and nonimage-interpretive reading room workflows. The results were collected over 2 weeks preceding the intervention and 2 weeks following the end of the intervention. The results were anonymized and analyzed using univariate analysis. RESULTS A total of 18 people responded to the preintervention survey: 6 neuroradiology fellows and 12 attending neuroradiologists. Fifteen people who were then present for the 1-month intervention period responded to the postintervention survey. Perceptions of workplace disruptions, image interpretation, quality of trainee education, ability to perform nonimage-interpretive tasks, and quality of consultations (P < 0.0001) all improved following the intervention. Mental effort and workload also improved across all assessment domains, as did satisfaction with quality of image interpretation and consultative work. CONCLUSION Implementation of parallel dedicated image-interpretive and nonimage-interpretive workflows may improve markers of radiologist perceptions of workplace satisfaction.
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Affiliation(s)
- Matthew H Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, M/C 3252, Madison, WI 53792-3252
| | - Andrew J Schemmel
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, M/C 3252, Madison, WI 53792-3252
| | - B Dustin Pooler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, M/C 3252, Madison, WI 53792-3252
| | - Taylor Hanley
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin, Madison, Wisconsin
| | - Tabassum Kennedy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, M/C 3252, Madison, WI 53792-3252
| | - Aaron Field
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, M/C 3252, Madison, WI 53792-3252; Department of Biomedical Engineering, College of Engineering, University of Wisconsin, Madison, Wisconsin
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, Madison, Wisconsin
| | - John-Paul J Yu
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, M/C 3252, Madison, WI 53792-3252; Department of Biomedical Engineering, College of Engineering, University of Wisconsin, Madison, Wisconsin; Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Wisconsin Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin.
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Radiology Research in Quality and Safety: Current Trends and Future Needs. Acad Radiol 2017; 24:263-272. [PMID: 28193376 DOI: 10.1016/j.acra.2016.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/19/2016] [Accepted: 07/19/2016] [Indexed: 01/29/2023]
Abstract
Promoting quality and safety research is now essential for radiology as reimbursement is increasingly tied to measures of quality, patient safety, efficiency, and appropriateness of imaging. This article provides an overview of key features necessary to promote successful quality improvement efforts in radiology. Emphasis is given to current trends and future opportunities for directing research. Establishing and maintaining a culture of safety is paramount to organizations wishing to improve patient care. The correct culture must be in place to support quality initiatives and create accountability for patient care. Focused educational curricula are necessary to teach quality and safety-related skills and behaviors to trainees, staff members, and physicians. The increasingly complex healthcare landscape requires that organizations build effective data infrastructures to support quality and safety research. Incident reporting systems designed specifically for medical imaging will benefit quality improvement initiatives by identifying and learning from system errors, enhancing knowledge about safety, and creating safer systems through the implementation of standardized practices and standards. Finally, validated performance measures must be developed to accurately reflect the value of the care we provide for our patients and referring providers. Common metrics used in radiology are reviewed with focus on current and future opportunities for investigation.
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Gerrie S, Sim J, Winstone T, Milne D, Modahl L, Bagnall C, Curin R, Metcalfe J, O'Carroll N. Auckland district health board radiology service improvement: An after hours ultrasound service pilot study. SONOGRAPHY 2017. [DOI: 10.1002/sono.12094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Samantha Gerrie
- Radiology Department; Auckland City Hospital; Auckland New Zealand
| | - Jenny Sim
- Department of Anatomy and Medical Imaging, School of Medical Sciences, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Tim Winstone
- Auckland DHB Performance and Improvement Team; Auckland City Hospital; Auckland New Zealand
| | - David Milne
- Radiology Department; Auckland City Hospital; Auckland New Zealand
| | - Lucy Modahl
- Radiology Department; Auckland City Hospital; Auckland New Zealand
| | - Carol Bagnall
- Radiology Department; Auckland City Hospital; Auckland New Zealand
| | - Raewyn Curin
- Radiology Department; Auckland City Hospital; Auckland New Zealand
| | - Julia Metcalfe
- Radiology Department; Auckland City Hospital; Auckland New Zealand
| | - Nicola O'Carroll
- Radiology Department; Auckland City Hospital; Auckland New Zealand
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Donnelly LF, Cherian SS, Chua KB, Thankachan S, Millecker LA, Koroll AG, Bisset GS. The Daily Readiness Huddle: a process to rapidly identify issues and foster improvement through problem-solving accountability. Pediatr Radiol 2017; 47:22-30. [PMID: 27771747 DOI: 10.1007/s00247-016-3712-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/06/2016] [Accepted: 09/13/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Because of the increasing complexities of providing imaging for pediatric health care services, a more reliable process to manage the daily delivery of care is necessary. Objective We describe our Daily Readiness Huddle and the effects of the process on problem identification and improvement. MATERIALS AND METHODS Our Daily Readiness Huddle has four elements: metrics review, clinical volume review, daily readiness assessment, and problem accountability. It is attended by radiologists, directors, managers, front-line staff with concerns, representatives from support services (information technology [IT] and biomedical engineering [biomed]), and representatives who join the meeting in a virtual format from off-site locations. Data are visually displayed on erasable whiteboards. The daily readiness assessment uses queues to determine whether anyone has concerns or outlier data in regard to S-MESA (Safety, Methods, Equipment, Supplies or Associates). Through this assessment, problems are identified and categorized as quick hits (will be resolved in 24-48 h, not requiring project management) and complex issues. Complex issues are assigned an owner, quality coach and report-back date. Additionally, projects are defined as improvements that are often strategic, are anticipated to take more than 60 days, and do not necessarily arise out of identified issues during the Daily Readiness Huddle. We tracked and calculated the mean, median and range of days to resolution and completion for complex issues and for projects during the first full year of implementing this process. RESULTS During the first 12 months, 91 complex issues were identified and resolved, 11 projects were in progress and 33 completed, with 23 other projects active or in planning. Time to resolution of complex issues (in days) was mean 37.5, median 34.0, and range 1-105. For projects, time to completion (in days) was mean 86.0, median 84.0, and range 5-280. CONCLUSION The Daily Readiness Huddle process has given us a framework to rapidly identify issues, bring accountability to problem-solving, and foster improvement. It has also had a positive effect on team-building and coordination.
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Affiliation(s)
- Lane F Donnelly
- Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA.
| | - Shirley S Cherian
- Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Kimberly B Chua
- Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Sam Thankachan
- Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Laura A Millecker
- Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Alex G Koroll
- Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - George S Bisset
- Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
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Larson DB, Mickelsen LJ, Garcia K. Realizing Improvement through Team Empowerment (RITE): A Team-based, Project-based Multidisciplinary Improvement Program. Radiographics 2016; 36:2170-2183. [DOI: 10.1148/rg.2016160136] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lee YH, Chen CCC, Lee SK, Chen CY, Wan YL, Guo WY, Cheng A, Chan WP. Patient safety during radiological examinations: a nationwide survey of residency training hospitals in Taiwan. BMJ Open 2016; 6:e010756. [PMID: 27650758 PMCID: PMC5051322 DOI: 10.1136/bmjopen-2015-010756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 06/21/2016] [Accepted: 09/02/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Variations in radiological examination procedures and patient load lead to variations in standards of care related to patient safety and healthcare quality. To understand the status of safety measures to protect patients undergoing radiological examinations at residency training hospitals in Taiwan, a follow-up survey evaluating the full spectrum of diagnostic radiology procedures was conducted. DESIGN Questionnaires covering 12 patient safety-related themes throughout the examination procedures were mailed to the departments of diagnostic radiology with residency training programmes in 19 medical centres (with >500 beds) and 17 smaller local institutions in Taiwan. After receiving the responses, all themes in 2014 were compared between medical centres and local institutions by using χ(2) or 2-sample t-tests. PARTICIPANTS Radiology Directors or Technology Chiefs of medical centres and local institutions in Taiwan participated in this survey by completing and returning the questionnaires. RESULTS The response rates of medical centres and local institutions were 95% and 100%, respectively. As indicated, large medical centres carried out more frequent clinically ordered, radiologist-guided patient education to prepare patients for specific examinations (CT, 28% vs 6%; special procedures, 78% vs 44%) and incident review and analysis (89% vs 47%); however, they required significantly longer access time for MRI examinations (7.00±29.50 vs 3.50±3.50 days), had more yearly incidents of large-volume contrast-medium extravasation (2.75±1.00 vs 1.00±0.75 cases) and blank radiographs (41% vs 8%), lower monthly rates of suboptimal (but interpretable) radiographs (0.00±0.01% vs 0.64±1.84%) and high-risk reminder reporting (0.01±0.16% vs 1.00±1.75%) than local institutions. CONCLUSIONS Our study elucidates the status of patient safety in diagnostic radiology in Taiwan, thereby providing helpful information to improve patient safety guidelines needed for medical imaging in the future.
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Affiliation(s)
- Yuan-Hao Lee
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | | | - San-Kan Lee
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Yu Chen
- Department of Radiology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yung-Liang Wan
- Institute for Radiological Research, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Wan-Yuo Guo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Amy Cheng
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Amaratunga T, Dobranowski J. Systematic Review of the Application of Lean and Six Sigma Quality Improvement Methodologies in Radiology. J Am Coll Radiol 2016; 13:1088-1095.e7. [DOI: 10.1016/j.jacr.2016.02.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/24/2016] [Accepted: 02/26/2016] [Indexed: 11/30/2022]
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Rubenstein J, Zettel JC, Lee E, Cote M, Aziza A, Connolly BL. Pediatric interventional radiology clinic - how are we doing? Pediatr Radiol 2016; 46:1165-72. [PMID: 27053279 DOI: 10.1007/s00247-016-3593-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 12/06/2015] [Accepted: 02/19/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Development of a pediatric interventional radiology clinic is a necessary component of providing a pediatric interventional radiology service. Patient satisfaction is important when providing efficient, high-quality care. OBJECTIVE To analyze the care provided by a pediatric interventional radiology clinic from the perspective of efficiency and parent satisfaction, so as to identify areas for improvement. MATERIALS AND METHODS The prospective study was both quantitative and qualitative. The quantitative component measured clinic efficiency (waiting times, duration of clinic visit, nurse/physician time allocation and assessments performed; n = 91). The qualitative component assessed parental satisfaction with their experience with the pediatric interventional radiology clinic, using a questionnaire (5-point Likert scale) and optional free text section for feedback (n = 80). Questions explored the family's perception of relevance of information provided, consent process and overall satisfaction with their pediatric interventional radiology clinic experience. RESULTS Families waited a mean of 11 and 10 min to meet the physician and nurse, respectively. Nurses and physicians spent a mean of 28 and 21 min with the families, respectively. The average duration of the pediatric interventional radiology clinic consultation was 56 min. Of 80 survey participants, 83% were satisfied with their experience and 94% said they believed providing consent before the day of the procedure was helpful. Only 5% of respondents were not satisfied with the time-efficiency of the interventional radiology clinic. CONCLUSION Results show the majority of patients/parents are very satisfied with the pediatric interventional radiology clinic visit. The efficiency of the pediatric interventional radiology clinic is satisfactory; however, adherence to stricter scheduling can be improved.
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Affiliation(s)
- Jonathan Rubenstein
- Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children & University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,York University, Toronto, ON, Canada
| | - Julie C Zettel
- Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children & University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Eric Lee
- Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children & University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Michelle Cote
- Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children & University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Albert Aziza
- Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children & University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Bairbre L Connolly
- Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children & University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
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Harvey HB, Hassanzadeh E, Aran S, Rosenthal DI, Thrall JH, Abujudeh HH. Key Performance Indicators in Radiology: You Can’t Manage What You Can’t Measure. Curr Probl Diagn Radiol 2016; 45:115-21. [DOI: 10.1067/j.cpradiol.2015.07.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/21/2015] [Accepted: 07/28/2015] [Indexed: 11/22/2022]
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O'Keeffe MM, Davis TM, Siminoski K. Performance results for a workstation-integrated radiology peer review quality assurance program. Int J Qual Health Care 2016; 28:294-8. [PMID: 26892609 DOI: 10.1093/intqhc/mzw017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess review completion rates, RADPEER score distribution, and sources of disagreement when using a workstation-integrated radiology peer review program, and to evaluate radiologist perceptions of the program. DESIGN Retrospective review of prospectively collected data. SETTING Large private outpatient radiology practice. PARTICIPANTS Radiologists (n = 66) with a mean of 16.0 (standard deviation, 9.2) years of experience. INTERVENTIONS Prior studies and reports of cases being actively reported were randomly selected for peer review using the RADPEER scoring system (a 4-point scale, with a score of 1 indicating agreement and scores of 2-4 indicating increasing levels of disagreement). MAIN OUTCOME MEASURES Assigned peer review completion rates, review scores, sources of disagreement and radiologist survey responses. RESULTS Of 31 293 assigned cases, 29 044 (92.8%; 95% CI 92.5-93.1%) were reviewed. Discrepant scores (score = 2, 3 or 4) were given in 0.69% (95% CI 0.60-0.79%) of cases and clinically significant discrepancy (score = 3 or 4) was assigned in 0.42% (95% CI 0.35-0.50%). The most common cause of disagreement was missed diagnosis (75.2%; 95% CI 66.8-82.1%). By anonymous survey, 94% of radiologists felt that peer review was worthwhile, 90% reported that the scores they received were appropriate and 78% felt that the received feedback was valuable. CONCLUSION Workstation-based peer review can increase completion rates and levels of radiologist acceptance while producing RADPEER scores similar to those previously reported. This approach may be one way to increase radiologist engagement in peer review quality assurance.
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Affiliation(s)
- Margaret M O'Keeffe
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada Medical Imaging Consultants, 11010-101 Street, Edmonton, Alberta, Canada T5H 4B9
| | - Todd M Davis
- Intelerad, Montreal, Quebec, Canada Present address: 295 Midpark Way SE, Suite 380, Calgary, Alberta, Canada T2X 2A8
| | - Kerry Siminoski
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada Medical Imaging Consultants, 11010-101 Street, Edmonton, Alberta, Canada T5H 4B9
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Hsu W, Han SX, Arnold CW, Bui AA, Enzmann DR. A data-driven approach for quality assessment of radiologic interpretations. J Am Med Inform Assoc 2015; 23:e152-6. [PMID: 26606938 DOI: 10.1093/jamia/ocv161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/23/2015] [Indexed: 11/12/2022] Open
Abstract
Given the increasing emphasis on delivering high-quality, cost-efficient healthcare, improved methodologies are needed to measure the accuracy and utility of ordered diagnostic examinations in achieving the appropriate diagnosis. Here, we present a data-driven approach for performing automated quality assessment of radiologic interpretations using other clinical information (e.g., pathology) as a reference standard for individual radiologists, subspecialty sections, imaging modalities, and entire departments. Downstream diagnostic conclusions from the electronic medical record are utilized as "truth" to which upstream diagnoses generated by radiology are compared. The described system automatically extracts and compares patient medical data to characterize concordance between clinical sources. Initial results are presented in the context of breast imaging, matching 18 101 radiologic interpretations with 301 pathology diagnoses and achieving a precision and recall of 84% and 92%, respectively. The presented data-driven method highlights the challenges of integrating multiple data sources and the application of information extraction tools to facilitate healthcare quality improvement.
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Affiliation(s)
- William Hsu
- Department of Radiological Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Simon X Han
- Department of Radiological Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Corey W Arnold
- Department of Radiological Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Alex At Bui
- Department of Radiological Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Dieter R Enzmann
- Department of Radiological Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Quality Measurements in Radiology: A Systematic Review of the Literature and Survey of Radiology Benefit Management Groups. J Am Coll Radiol 2015; 12:1173-81.e23. [DOI: 10.1016/j.jacr.2015.06.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 11/22/2022]
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Tekin C, van der Schaar M. Active Learning in Context-Driven Stream Mining With an Application to Image Mining. IEEE TRANSACTIONS ON IMAGE PROCESSING : A PUBLICATION OF THE IEEE SIGNAL PROCESSING SOCIETY 2015; 24:3666-3679. [PMID: 26087490 DOI: 10.1109/tip.2015.2446936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We propose an image stream mining method in which images arrive with contexts (metadata) and need to be processed in real time by the image mining system (IMS), which needs to make predictions and derive actionable intelligence from these streams. After extracting the features of the image by preprocessing, IMS determines online the classifier to use on the extracted features to make a prediction using the context of the image. A key challenge associated with stream mining is that the prediction accuracy of the classifiers is unknown, since the image source is unknown; thus, these accuracies need to be learned online. Another key challenge of stream mining is that learning can only be done by observing the true label, but this is costly to obtain. To address these challenges, we model the image stream mining problem as an active, online contextual experts problem, where the context of the image is used to guide the classifier selection decision. We develop an active learning algorithm and show that it achieves regret sublinear in the number of images that have been observed so far. To further illustrate and assess the performance of our proposed methods, we apply them to diagnose breast cancer from the images of cellular samples obtained from the fine needle aspirate of breast mass. Our findings show that very high diagnosis accuracy can be achieved by actively obtaining only a small fraction of true labels through surgical biopsies. Other applications include video surveillance and video traffic monitoring.
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Herold CJ, Lewin JS, Wibmer AG, Thrall JH, Krestin GP, Dixon AK, Schoenberg SO, Geckle RJ, Muellner A, Hricak H. Imaging in the Age of Precision Medicine: Summary of the Proceedings of the 10th Biannual Symposium of the International Society for Strategic Studies in Radiology. Radiology 2015; 279:226-38. [PMID: 26465058 DOI: 10.1148/radiol.2015150709] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
During the past decade, with its breakthroughs in systems biology, precision medicine (PM) has emerged as a novel health-care paradigm. Challenging reductionism and broad-based approaches in medicine, PM is an approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle. It involves integrating information from multiple sources in a holistic manner to achieve a definitive diagnosis, focused treatment, and adequate response assessment. Biomedical imaging and imaging-guided interventions, which provide multiparametric morphologic and functional information and enable focused, minimally invasive treatments, are key elements in the infrastructure needed for PM. The emerging discipline of radiogenomics, which links genotypic information to phenotypic disease manifestations at imaging, should also greatly contribute to patient-tailored care. Because of the growing volume and complexity of imaging data, decision-support algorithms will be required to help physicians apply the most essential patient data for optimal management. These innovations will challenge traditional concepts of health care and business models. Reimbursement policies and quality assurance measures will have to be reconsidered and adapted. In their 10th biannual symposium, which was held in August 2013, the members of the International Society for Strategic Studies in Radiology discussed the opportunities and challenges arising for the imaging community with the transition to PM. This article summarizes the discussions and central messages of the symposium.
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Affiliation(s)
- Christian J Herold
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Jonathan S Lewin
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Andreas G Wibmer
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - James H Thrall
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Gabriel P Krestin
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Adrian K Dixon
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Stefan O Schoenberg
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Rena J Geckle
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Ada Muellner
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
| | - Hedvig Hricak
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (C.J.H., A.G.W.); Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (J.S.L., R.J.G.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands (G.P.K.); Department of Radiology, University of Cambridge, Cambridge, England (A.K.D.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (S.O.S.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065 (A.M., H.H.)
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Kelly AM, Cronin P. Practical Approaches to Quality Improvement for Radiologists. Radiographics 2015; 35:1630-42. [DOI: 10.1148/rg.2015150057] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tran L, Wadhwa A, Mann E. Implementation of Structured Radiology Reports. J Am Coll Radiol 2015; 13:296-9. [PMID: 26410349 DOI: 10.1016/j.jacr.2015.06.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 06/28/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Leanne Tran
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anupma Wadhwa
- Division of Infectious Diseases, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Erika Mann
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Lacson R, O'Connor SD, Sahni VA, Roy C, Dalal A, Desai S, Khorasani R. Impact of an electronic alert notification system embedded in radiologists' workflow on closed-loop communication of critical results: a time series analysis. BMJ Qual Saf 2015; 25:518-24. [PMID: 26374896 DOI: 10.1136/bmjqs-2015-004276] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 08/31/2015] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Optimal critical test result communication is a Joint Commission national patient safety goal and requires documentation of closed-loop communication among care providers in the medical record. Electronic alert notification systems can facilitate an auditable process for creating alerts for transmission and acknowledgement of critical test results. We evaluated the impact of a patient safety initiative with an alert notification system on reducing critical results lacking documented communication, and assessed potential overuse of the alerting system for communicating results. METHODS We implemented an alert notification system-Alert Notification of Critical Results (ANCR)-in January 2010. We reviewed radiology reports finalised in 2009-2014 which lacked documented communication between the radiologist and another care provider, and assessed the impact of ANCR on the proportion of such reports with critical findings, using trend analysis over 10 semiannual time periods. To evaluate potential overuse of ANCR, we assessed the proportion of reports with non-critical results among provider-communicated reports. RESULTS The proportion of reports with critical results among reports without documented communication decreased significantly over 4 years (2009-2014) from 0.19 to 0.05 (p<0.0001, Cochran-Armitage trend test). The proportion of provider-communicated reports with non-critical results remained unchanged over time before and after ANCR implementation (0.20 to 0.15, p=0.45, Cochran-Armitage trend test). CONCLUSIONS A patient safety initiative with an alert notification system reduced the proportion of critical results among reports lacking documented communication between care providers. We observed no change in documented communication of non-critical results, suggesting the system did not promote overuse. Future studies are needed to evaluate whether such systems prevent subsequent patient harm.
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Affiliation(s)
- Ronilda Lacson
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
| | - Stacy D O'Connor
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
| | - V Anik Sahni
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher Roy
- Harvard Medical School, Boston, Massachusetts, USA Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anuj Dalal
- Harvard Medical School, Boston, Massachusetts, USA Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sonali Desai
- Harvard Medical School, Boston, Massachusetts, USA Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ramin Khorasani
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
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Stanescu AL, Parisi MT, Weinberger E, Ferguson MR, Otto RK, Iyer RS. Peer Review: Lessons Learned in A Pediatric Radiology Department. Curr Probl Diagn Radiol 2015; 45:139-48. [PMID: 26489791 DOI: 10.1067/j.cpradiol.2015.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/05/2015] [Indexed: 12/21/2022]
Abstract
The purpose of this article is to illustrate types of diagnostic errors and feedback given to radiologists, using cases to support and clarify these categories. A comment-enhanced peer review system may be leveraged to generate a comprehensive feedback categorization scheme. These include errors of observation, errors of interpretation, inadequate patient data gathering, errors of communication, interobserver variability, informational feedback, and compliments. Much of this feedback is captured through comments associated with interpretative agreements.
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Affiliation(s)
- A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA.
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Edward Weinberger
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Mark R Ferguson
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Randolph K Otto
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA
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Levin DC. The 2014 RSNA Annual Oration in Diagnostic Radiology: Transitioning from Volume-based to Value-based Practice—A Meaningful Goal for All Radiologists or a Meaningless Platitude? Radiology 2015; 275:314-20. [DOI: 10.1148/radiol.15142861] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Four-year impact of an alert notification system on closed-loop communication of critical test results. AJR Am J Roentgenol 2015; 203:933-8. [PMID: 25341129 DOI: 10.2214/ajr.14.13064] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE One of the patient safety goals proposed by the Joint Commission urges hospitals to develop a policy for communicating critical test results and to measure adherence to that policy. We evaluated the impact of an alert notification system on policy adherence for communicating critical imaging test results to referring providers and assessed system adoption over the first 4 years after implementation. MATERIALS AND METHODS This study was performed in a 753-bed academic medical center. The intervention, an automated alert notification system for critical results, was implemented in January 2010. The primary outcome was adherence to institutional policy for timely closed-loop communication of critical imaging results, and the secondary outcome was system adoption. Policy adherence was determined through manual review of a random sample of radiology reports from the first 4 years after the intervention (n = 37,604) compared with baseline outcomes 1 year before the intervention (n = 9430). Adoption was evaluated by quantifying the use of the system overall and the proportion of alerts that used noninterruptive communication as a percentage of all reports generated by 320 radiologists (n = 1,538,059). A statistical analysis of the trend at 6-month intervals over 4 years was performed using a chi-square trend test. RESULTS Adherence to the policy increased from 91.3% before the intervention to 95.0% after the intervention (p < 0.0001). There was a ninefold increase in the critical results communicated via the system (chi-square trend test, p < 0.0001). During the first 4 years after the intervention, 41,445 alerts (41% of the total number of alerts) used the system's noninterruptive process for communicating less urgent critical results, which was substantially unchanged over the 4 years postintervention, thus reducing unnecessary paging interruptions. CONCLUSION An automated alert notification system for communicating critical imaging results was successfully adopted and was associated with increased adherence to institutional policy for communicating critical test results and with reduced workflow interruptions.
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Sharpe RE, Mehta TS, Eisenberg RL, Kruskal JB. Strategic Planning and Radiology Practice Management in the New Health Care Environment. Radiographics 2015; 35:239-53. [DOI: 10.1148/rg.351140064] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Journal club: Renal masses detected at abdominal CT: radiologists' adherence to guidelines regarding management recommendations and communication of critical results. AJR Am J Roentgenol 2014; 203:828-34. [PMID: 25247948 DOI: 10.2214/ajr.13.11497] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study was to assess radiologists' adherence to published guidelines for managing renal masses detected at abdominal CT at one institution and to a critical results communication policy. MATERIALS AND METHODS A validated natural language processing tool supplemented by manual review was used to randomly assemble a cohort of 97 radiology reports from all abdominal CT reports (n = 11,952) generated from July 2010 to June 2011. Critical renal mass findings warranted consideration for surgery, intervention, or imaging follow-up and required direct, separate, and timely communication to the referrer in addition to the radiology report. Primary outcomes were adherence to guidelines and institutional policy for communicating critical results. Sample size allowed a 95% CI ± 5% for primary outcome. Pearson chi-square test was performed to assess whether radiology subspecialization was predictive of the primary outcome. RESULTS Of all abdominal CT reports, 35.6% contained at least one renal mass finding (4.3% critical). Guideline adherence was lower for patients with critical than for those with noncritical findings (48/57 [84.2%] vs 40/40 [100%]; p = 0.01). Adherence to critical result communication policy was 73.7% (42/57). For critical findings, abdominal radiologists had higher guideline adherence (40/43 [93.0%] vs 8/14 [57.1%]; p = 0.001) and critical result communication policy adherence (36/43 [83.7%] vs 6/14 [42.9%]; p = 0.002) than nonabdominal radiologists. CONCLUSION In reporting renal masses detected at abdominal CT, radiologists largely adhered to management guidelines but did not adhere to the critical results communication policy in one of four reports. Subspecialization improved adherence to both management guidelines and the institution's critical result communication policy.
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Norbash A, Bluth E, Lee CI, Francavilla M, Donner M, Dutton SC, Heilbrun M, McGinty G. Radiologist Manpower Considerations and Imaging 3.0: Effort Planning for Value-Based Imaging. J Am Coll Radiol 2014; 11:953-8. [DOI: 10.1016/j.jacr.2014.05.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 05/28/2014] [Indexed: 11/25/2022]
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Reiner BI. Innovation opportunities in critical results communication: theoretical concepts. J Digit Imaging 2014; 26:605-9. [PMID: 23775334 DOI: 10.1007/s10278-013-9609-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Bruce I Reiner
- Department of Radiology, Veterans Affairs Maryland Healthcare System, 10 North Greene Street, Baltimore, MD 21201, USA.
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Patient Safety in Radiology. PATIENT SAFETY 2014. [DOI: 10.1007/978-1-4614-7419-7_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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