Interventional Radiology Peer Learning Platform and Adverse Event Reporting (IR-PEER): Initial Experience Implementing a Team-based Novel Peer Learning System in Interventional Radiology

Although the transition from peer review to peer learning has had favorable outcomes in diagnostic radiology, experience with implementing a team-based peer review system in interventional radiology (IR) remains limited. Peer learning systems benefit diverse IR teams composed of multiple clinical roles and could contribute value in archiving events that have potential educational value. With multiple stakeholder input from clinical roles within the IR division at our institution (ie, radiologic technologists, nurses, advanced practice providers, residents, fellows, and attending physicians), we launched a HIPAA-compliant secure IR complication and learning opportunity reporting platform in April 2022. Case submissions were monitored over the subsequent 24 weeks, with monthly dashboard reports provided to departmental leadership. Preintervention and postintervention surveys were used to assess the impact of the peer learning platform and adverse event reporting in IR (IR-PEER) on perceptions of complication reporting in the IR division across clinical roles. Ninety-two peer learning submissions were collected for a weekly average ± standard error of 3.8 ± 0.6 submissions per week, and an additional 26 submissions were collected as part of the division's ongoing monthly complication review conference, for a total of 98 unique total case references. A total of 64.1% of submissions (59 of 92) involved a complication and/or adverse event, and 35.9% of submissions (33 of 92) identified a learning opportunity (no complication or adverse event). Nurses reported that IR-PEER made the complication-reporting process easier (P = .01), and all clinical roles reported that IR-PEER improved the overall process of complication reporting. Peer learning frameworks such as IR-PEER provide a more equitable communication platform for multidisciplinary teams to capture and archive learning opportunities that support quality and safety improvement efforts.

Increasing Engagement of Imaging Professionals in Quality Improvement Using an Encounter-specific Quality-reporting Tool

The involvement of pediatric imaging professionals in quality improvement (QI) in our department was low, with few available informatics tools to report issues or suggest improvement opportunities in a timely and efficient manner. We aimed to increase QI engagement in radiology by creating a real-time, encounter-specific reporting tool embedded into the clinical imaging workflow.

Methods

A multidisciplinary team outlined requirements for a new electronic quality-reporting tool, including point-of-care access during imaging workflow and simultaneous automatic capture of encounter-specific clinical information from the hospital information system. Information system experts created a user-friendly interface for categories based on stages of imaging workflow (Planning, Acquisition, Processing, Interpretation, Communication, and Data Collection). Team members trained all department staff. Quality coordinators sorted entries and monitored personnel engagement for two 36-week periods: immediately after launch and 3 years later. Descriptive statistics were used to analyze proposed and completed QI projects during these periods.

Results

There were 1,498 entries during the first 36 weeks. Ninety-three percent of radiologists and 56% of technologists participated. Three years later, there were 1,251 entries in 36 weeks. Data collection entries for established QI projects increased from 380 (25%) to 487(39%). The engagement continued among radiologists but decreased among technologists over time. Submissions for QI projects increased from baseline. The project completion rate increased.

Conclusion

We created a QI reporting tool embedded into the clinical imaging workflow, which improved the participation of our imaging professionals and increased the number of completed QI projects.

Flexibility in a Crisis: How Strong Relational Coordination and Lean Literacy Helped Us Weather the COVID Storm

Our city was significantly impacted by the initial COVID-19 outbreak in the United States. We describe how members of our Quality and Safety team were able to leverage skills in relational coordination and process improvement to respond to rapidly changing needs in a flexible and effective way.

Detection of unusual scores of individual students for immediate remedy according to daily assessment data

Purpose

The availability of daily assessment data in a centralized monitoring system at school provides the opportunity to detect unusual scores soon after the assessment is carried out. This paper introduces a model for the detection of unusual scores of individual students to immediately improve performances that deviate from a normal state.

Design/methodology/approach

A student's ability, a subject's difficulty level, a student's specific ability in a subject, and the difficulty level of an assessment in a subject are selected as factor effects of a linear ANOVA model. Through analysis of variance, a case study is conducted based on 330 data points of assessment scores of primary grade students retrieved from an international school in Japan.

Findings

The actual score is below the lower control limit, which is recognized as an unusual score, and the score can be detected immediately after sitting for an assessment and is beneficial for students to take immediate remedies based on daily assessment. This is demonstrated through a case study.

Originality/value

The detection of unusual scores based on a linear model of individual students soon after each assessment benefits from immediate remedy aligns with a daily management concept. The daily assessment data in a school system enable detection based on individual students, subject-wise and assessment-wise to improve student performances in the same academic year.

Creating a Process for the Implementation of Tiered Huddles in a Veterans Affairs Medical Center

Introduction

In 2019, the Veteran’s Health Administration began its journey in pursuit of becoming an enterprise-wide High Reliability Organization (HRO). Improving the delivery of safe, high quality patient care is a central focus of HROs. Requisite to meeting this goal is the timely identification and resolution of problems. This is best achieved by empowering and engaging both clinical and non-clinical staff across the healthcare organization through the promotion of robust collaboration and communication between various disciplines. Improved care coordination and increased accountability are two important subsequent outcomes. One method for accomplishing this is through the implementation of tiered huddles.

Materials and Methods

An extensive review of the current literature from 2013 until June 2021 was conducted for evidence highlighting the experiences of other healthcare organizations during implementation of huddles. Following the review, a tiered huddle proposal was developed and presented to the executive leadership team of a healthcare system for approval. Pilot testing of the tiered huddle implementation plan began in October 2021 over a 12-week period with three services. On average, the pilot services had between three to four tiers from frontline staff to the executive level of leadership.

Results

Over the 12-week period, out of the possible 120 tiered huddles that could have been conducted, 68% (n = 81) were completed. Of the tiered huddles conducted, 99% (n = 80) started and ended on time. During the pilot test, seven issues were identified by frontline staff: coordination of pre-procedural coronavirus testing, equipment/computer issues, rooms out of service, staffing levels, and lack of responsiveness from other departments. Issues related to staffing, unresponsiveness from other departments, and equipment concerns required elevation to a higher-level tier with no issues remaining open. Delays in patient care, or prolongation of shift hours for staff because of tiered huddles, was low at 2.5% (n = 2). For the duration of the pilot test, a total of 75 minutes accounted for shifts being extended among five staff members.

Conclusions

The success of this initiative demonstrates the importance of thoughtfully creating a robust process when planning for the implementation of tiered huddles. The findings from this initiative will be of immense value with the implementation of tiered huddles across our healthcare system. We believe that this approach can be used by other healthcare institutions along their journey to improving patient safety and quality.

Program for Supporting Frontline Improvement Projects in an Academic Radiology Department

OBJECTIVE. The purpose of this study was to describe the results of an ongoing program implemented in an academic radiology department to support the execution of small- to medium-size improvement projects led by frontline staff and leaders. MATERIALS AND METHODS. Staff members were assigned a coach, were instructed in improvement methods, were given time to work on the project, and presented progress to department leaders in weekly 30-minute reports. Estimated costs and outcomes were calculated for each project and aggregated. An anonymous survey was administered to participants at the end of the first year. RESULTS. A total of 73 participants completed 102 projects in the first 2 years of the program. The project type mix included 25 quality improvement projects, 22 patient satisfaction projects, 14 staff engagement projects, 27 efficiency improvement projects, and 14 regulatory compliance and readiness projects. Estimated annualized outcomes included approximately 4500 labor hours saved, $315K in supply cost savings, $42.2M in potential increased revenues, 8- and 2-point increase in top-box patient experience scores at two clinics, and a 60-incident reduction in near-miss safety events. Participant time equated to approximately 0.35 full-time equivalent positions per year. Approximately 0.4 full-time equivalent was required to support the program. Survey results indicated that the participants generally viewed the program favorably. CONCLUSION. The program was successful in providing a platform for simultaneously solving a large number of organizational problems while also providing a positive experience to frontline personnel.

Modeling Pathology Workload and Complexity to Manage Risks and Improve Patient Quality and Safety

Anatomic pathology (AP) laboratories provide critical diagnostic information that help determine patient treatments and outcomes, but the risks of AP operations and their impact on patient safety and quality of care remain poorly recognized and undermanaged. Hospital-based laboratories face an operational and risk management challenge because clinical work of unknown quantity and complexity arrives with little advance notice, which results in fluctuations in workload that can push operations beyond planned capacity, leading to diagnostic delays and potential errors. Modeling the dynamics of workload and complexity in AP offers the opportunity to better use available information to manage risks. We developed a stock-and-flow model of a typical AP laboratory operation and identified key exogenous inputs that drive AP work. To test the model, we generated training and validations data sets by combining data from the electronic medical records and laboratory information systems over multiple years. We demonstrate the implementation of 10-day AP work forecast generated on a daily basis, and show its performance in comparison with actual work. Although the model somewhat underpredicts work as currently implemented, it provides a framework for prospective management of resources to ensure quality during workload surges. Although full implementation requires additional model development, we show that AP workload largely depends on few and accessible clinical inputs. Recognizing that level loading of work in a hospital is not practical, predictive modeling of work can empower laboratories to triage, schedule, or mobilize resources more effectively and better manage risks that reduce the quality or timeliness of diagnostic information.

Before-after evaluation of patient length of stay in a rehabilitation context following implementation of an electronic patient journey board

PURPOSE

To investigate whether the installation of electronic patient journey boards in an inpatient adult rehabilitation centre in Victoria, Australia, is associated with shorter lengths of stay for admitted adult rehabilitation patients.

METHODS

A retrospective before-after analysis of 3 259 adult inpatient rehabilitation episodes from 2013 to 2018 was performed, analysing case-mix adjusted lengths of stay.

RESULTS

A reduction in case-mix adjusted length of stay of 4.1 days per episode (95 % confidence interval: 2.0-6.4 days) was found. The corresponding reduction in hospital costs was estimated to be $3 738 per episode (95 % confidence interval $2 398-$4 983).

CONCLUSIONS

Installation of electronic patient journey boards was associated with shorter lengths of stay in an inpatient adult rehabilitation centre. Additional research is needed to 1) provide further evidence of the causal effect of the boards on length of stay, and 2) investigate the mechanisms by which they reduce lengths of stay (e.g., increased currency of information, changes to procedures, remote viewing) in rehabilitation settings.

Acing the Joint Commission Regulatory Visit: Running an Effective and Compliant Safety Program

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.

Radiology Reading Room Huddles: Our Initial Experience

OBJECTIVE. The objective of our study was to adapt the safety, methods, equipment, supplies, and associates, termed "S-MESA," communication tool from daily management huddles and implement it in radiology reading rooms to address the complexities of daily communications. We collected data on huddle logistics and perceived value from radiologists at an academic institution. MATERIALS AND METHODS. We constructed a 16-item survey composed of multiple-choice questions (single answer and multiple answers), statements requiring Likert scale ratings (from 1 [strongly disagree] to 5 [strongly agree]), and items requiring free text responses. The survey was distributed to 244 radiologists. Answers were collected over a 6-week period. RESULTS. The response rate was 41% (101/244). The majority of huddles were performed sometimes (59%) or daily or nearly daily (25%), and most lasted 5 minutes or less (83%), which was perceived as "just right" (87.5%). The components discussed more frequently in the huddle were availability (33.5%) and time goals (27%). Task review (19%) and miscellaneous (14%) were not as common. Huddles were valued for facilitating communication and better organizing the workday. CONCLUSION. Reading room huddles are feasible and perceived as useful. Moving forward, we are planning to integrate reading room huddles with multitier system huddles and include items that are of specific interest to radiology trainees.

Increasing Referrals to a Community Paramedicine Fall Prevention Program Through Implementation of a Daily Management System

This quality improvement project was undertaken to improve trauma service referral compliance to an existing home-based elderly fall prevention program through the implementation of a daily management system (DMS). Operational excellence, a hospital-wide initiative, provided the foundation for improvement efforts. This initiative went through a series of 5 plan, do, study, and act (PDSA) cycles and demonstrated significant improvement in referrals from 0% to 100%. Compliance with referrals after the retirement of the key performance indicator remained high at 95.5%. Results from this project provided support for the framework set forth in DMS and PDSA improvement methodologies as a feasible option to implement quality and process improvement projects. Further study in this area is warranted.

Improving Patient Flow: Analysis of an Initiative to Improve Early Discharge

BACKGROUND

Discharge delays adversely affect hospital bed availability and thus patient flow.

OBJECTIVE

We aimed to increase the percentage of early discharges (EDCs; before 11 am). We hypothesized that obtaining at least 25% EDCs would decrease emergency department (ED) and postanesthesia care unit (PACU) hospital bed wait times.

DESIGN

This study used a pre/postintervention retrospective analysis.

SETTING

All acute care units in a quaternary care academic children's hospital were included in this study.

PATIENTS

The patient sample included all discharges from the acute care units and all hospital admissions from the ED and PACU from January 1, 2014, to December 31, 2016.

INTERVENTION

A multidisciplinary team identified EDC barriers, including poor identification of EDC candidates, accountability issues, and lack of team incentives. A total of three successive interventions were implemented using Plan-Do-Check-Act (PDCA) cycles over 10 months between 2015 and 2016 addressing these barriers. Interventions included EDC identification and communication, early rounding on EDCs, and modest incentives.

MEASUREMENTS

Calendar month EDC percentage, ED (from time bed requested to the time patient left ED) and PACU (from time patient ready to leave to time patient left PACU) wait times were measured.

RESULTS

EDCs increased from an average 8.8% before the start of interventions (May 2015) to 15.8% after interventions (February 2016). Using an interrupted time series, both the jump and the slope increase were significant (3.9%, P = .02 and 0.48%, P < .01, respectively). Wait times decreased from a median of 221 to 133 minutes (P < .001) for ED and from 56 to 36 minutes per patient (P = .002) for PACU.

CONCLUSION

A multimodal intervention was associated with more EDCs and decreased PACU and ED bed wait times.

How much of Toyota's philosophy is embedded in health care at the organisational level? A review

AIMS

Identify which of Toyota's principles are reported in health care institutions at the organisational level and to identify the type of reported outcomes related to the effectiveness of lean production reported in these studies.

BACKGROUND

No scientific research has been conducted to determine which of Toyota's principles are embedded in health care systems. This knowledge is needed to perform targeted adjustments in health care.

EVALUATION

Sixty studies were identified for the final analysis.

KEY ISSUE(S)

Some Toyota Way principles appear more deeply embedded in health care institutions than others are.

CONCLUSION

Not all principles of Toyota's philosophy and production system were embedded in the studies in this review. The type of reported outcomes at the organisational level was diverse.

IMPLICATIONS FOR NURSING MANAGEMENT

This literature review increases our knowledge about how many (and which) of the Toyota Way principles are embedded in health care. This knowledge may support reflection by nursing managers about how the full range of lean management principles could be embedded at the managerial and/or operational level.

Practical Suggestions on How to Move From Peer Review to Peer Learning

OBJECTIVE

The purpose of this article is to outline practical steps that a department can take to transition to a peer learning model.

CONCLUSION

The 2015 Institute of Medicine report on improving diagnosis emphasized that organizations and industries that embrace error as an opportunity to learn tend to outperform those that do not. To meet this charge, radiology must transition from a peer review to a peer learning approach.

Aspirational characteristics for effective leadership of improvement teams

Working on quality improvement has become an innate part of managing a pediatric radiology service. To help radiologists effectively lead improvement teams, eight aspirational characteristics are discussed. These are: 1) Be a good listener, 2) Effectively communicate around an accountability cycle, 3) Stress simplicity: Prioritization and pace, 4) Expend energy to optimize people development, 5) Lead with optimism, 6) Create a culture of wellness and sustainability, 7) Have a progressive attitude toward failure and 8) Project humility over arrogance.