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Fishbone (cause-and-effect) diagram shows root cause analysis of an error involving use of the wrong imaging test.  

Fishbone (cause-and-effect) diagram shows root cause analysis of an error involving use of the wrong imaging test.  

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Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement ef...

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... Joint Commission suggests 11 steps for performing root cause analysis for sentinel events, as follows: (a) organize a team, (b) define what happened, (c) identify and define processes related to the event, (d) identify proximate (closest to the error) causes, (e) design and implement any necessary "quick fix" interim changes, (f) identify root causes, (g) identify potential risk-reduction strategies, (h) formulate and evaluate proposed improvement actions and identify measures of suc- cess, (i) develop and implement an improvement action plan, (j) evaluate and fine-tune improve- ment efforts, and (k) communicate the results (23,26). A cause-and-effect (fishbone) diagram for root cause analysis of why an incorrect imaging test was performed is illustrated in Figure 2. ...

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... Quality improvement is a central component of a highperforming healthcare system and essential to improving performance standards and optimizing delivery of care [1]. Recent efforts to promote improved healthcare delivery are motivated by several Institute of Medicine (IOM) reports which highlight the magnitude and scope of medical errors and estimate the role of diagnostic errors as contributing to 10% of patient deaths [2,3]. ...
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Objective The purpose of this study was to transition from a traditional score-based peer-review system to an education-oriented peer-learning program in our academic abdominal radiology practice. Material and methods This retrospective study compared our experience with a score-based peer-review model used prior to September 2020 and a peer-learning model implemented and used exclusively beginning in October of 2020. In peer review, a web-based peer-review tool randomly generated a list of cases, which were blindly reviewed in consensus. Comparison of the consensus interpretation with the original report was used to categorize each reviewed case and to calculate the rates of significant and minor discrepancies. Only cases with a discrepancy were considered to represent a learning opportunity. In peer learning, faculty prospectively identified and submitted cases for review in several categories, including case interpretations with a discrepancy from subsequent opinion or result, interpretations considered to represent a great call, and interesting or challenging cases meriting further discussion. The peer-learning coordinator showed each case to the group in a manner which blinded the group to both submitting and interpreting radiologist and invited discussion during various stages of the case. Results During peer review, a total of 172 cases were reviewed over 16 sessions occurring between April 2016 and September 2020. Only 3 cases (1.8%) yielded significant discrepancies whereas 13 (7.6%) yielded minor discrepancies, representing a total of 16 learning opportunities (3.6 per year). In peer learning, 64 cases were submitted and 52 reviewed over 7 sessions occurring between October 2020 and October 2021. 29 (56%) were submitted as an interesting or challenging case meriting further discussion, 18 (35%) were submitted for a discrepancy, and 5 (10%) were submitted for a great call. All 52 presented cases represented learning opportunities (48 per year). Conclusion An education-focused peer-learning program provided a platform for continuous quality improvement and yielded substantially more learning opportunities compared to score-based peer review. Graphical abstract
... The next step is to apply the 5S (sort, simplify, sweep, standardize, and self -discipline). [21][22][23] Six Sigma and Lean have a complementary relationship with each other and can be combined as Lean Six Sigma. The synergetic adoption of these methods allows the creation of a continuous process flow that eliminates waste (Lean) and reduces process variation (Six Sigma), to achieve and maintain the best quality. ...
... IRL is about using the opportunities from reported actual or potential incidents and analyzing them to determine the systemic and human factors involved. [22,26,27] IRL is a reactive and retrospective look at a known error. ...
... Therefore, an evaluation of data transparency by radiologic technologist managers and error reporting by staff technologists might further explain why staff technologists' OPRS was lower in this study. Given that those closest to the problem often are most acutely aware of the issues at hand, managerial rounding, Gemba walks, 59 and active and open communication related to radiation safety challenges with staff technologists might support an improved understanding of radiation safety perception across radiologic technologists holding various roles. ...
Article
Purpose: The purpose of the study was to examine mean differences between intrapersonal and institutional variables and the overall perception of radiation safety (OPRS) among U.S. radiologic technologists. The study also sought to demonstrate the applicability of the socioecological model for radiation safety decision-making. Methods: A quantitative, cross-sectional design with the Radiation Actions and Dimensions of Radiation Safety survey instrument was used to collect data and guide hypotheses testing. The 425 research participants included radiologic technologists working in radiography, mammography, computed tomography, and radiology management. Categorical and descriptive data were calculated, and 1-way analysis of variance tests were used to analyze hypotheses. Results: Seven main effects demonstrated mean differences between groups for the OPRS, including age (F 5,419 = 2.55, P = .03), years of experience (F 5,419 = 4.27, P = .001), primary employed imaging modality (F 2,422 = 9.04, P < .001), primary role (F 2,422 = 4.58, P = .01), shift length (F 3,421 = 10.33, P < .001), primary practice facility (F 4,404 = 5.00, P = .001), and work shift (F 3,405 = 4.14, P = .007), with shift length having the largest effect. Level of education, employment status, number of imaging credentials, gender, patient population, and practice location were not significant at the level of P ≤ .05. Discussion: Radiation safety culture is a multidimensional topic that requires consideration of several intervening influences, making the socioecological model well aligned when considering radiation safety culture and radiation safety perception in medical imaging. Previous research on radiation safety perception among radiologic technologists demonstrated that leadership actions, teamwork across imaging stakeholders, organizational learning, and questioning behavior are drivers of OPRS. However, this study's findings demonstrate that radiologic technologist scheduling practices and primary employed imaging modalities also should be considered when seeking to improve OPRS. Conclusion: This study presents an extensive examination of intrapersonal and institutional variables on OPRS among U.S.-based radiologic technologists and provides findings to support radiation safety culture decision-making in medical imaging, particularly for shift length considerations.
... Quality improvement is currently highly prioritised by most health services and various reports refer to different approaches that could be followed in diagnostic medical imaging [39,40]. Table 1 proposes a tool that imaging teams could use to reflect on PCC in their practice and on ways to improve it. ...
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Background There is emerging interest in person-centred care within a short-lived yet complex medical imaging encounter. This study explored this event from the viewpoint of patients referred for an imaging examination, with a focus on the person and their person-al space. Methods We used convenience sampling to conduct semi-structured interviews with 21 patients in a private medical imaging practice in Australia. The first phase of data analysis was conducted deductively, using the six elements of the person-centred, patient-journey framework of the Australian Commission on Safety and Quality in Healthcare: transition in; engagement; decisions; well-being; experience; and transition out. This was followed by inductive content analysis to identify overarching themes that span a patient’s journey into, through and out of an imaging encounter. Results The transition-in phase began with an appointment and the first point of contact with the imaging department at reception. Engagement focused on patient-radiographer interactions and explanations to the patient on what was going to happen. Decisions related primarily to radiographers’ decisions on how to conduct a particular examination and how to get patient cooperation. Participants’ well-being related to their appreciation of gentle treatment; they also referred to past negative experiences that had made a lasting impression. Transitioning out of the imaging encounter included the sending of the results to the referring medical practitioner. Person-al vulnerabilities emerged as a cross-cutting theme. Patients’ vulnerability, for which they needed reassurance, pertained to uncertainties about the investigation and the possible results. Healthcare professionals were vulnerable because of patient expectations of a certain demeanour and of pressure to perform optimal quality investigations. Lastly, patients’ personal lives, concerns and pressures – their person-al ‘baggage’ – shaped their experience of the imaging encounter. Conclusion To add value to the quality of the service they deliver, radiography practitioners should endeavour to create a person-al space for clients. Creating these spaces is complex as patients are not in a position to judge the procedures required by technical imaging protocols and the quality control of equipment. A reflective tool is proposed for radiographers to use in discussions with their team and its leaders on improving person-centred care and the quality of services in their practice.
... Quality assurance with respect to the clinical processes associated with MRI can be measured and tracked to provide objective data. These data potentially include several parameters including appropriateness of imaging ordered, ready access to imaging and the scheduling process, wait times before scanning, timely study protocoling, patient safety in the scanner, image interpretation, timeliness of reporting, imaging repeat rates, communicating critical findings and measuring the outcomes both clinically and in terms of patient satisfaction surveys [7,14]. The authors present their experiences with institutional QA processes across a spectrum of pediatric radiology divisions in the next subsections. ...
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Quality in MR imaging is a comprehensive process that encompasses scanner performance, clinical processes for efficient scanning and reporting, as well as data-driven improvement involving measurement of key performance indicators. In this paper, the authors review this entire process. This article provides a framework for establishing a successful MR quality program. The collective experiences of the authors across a spectrum of pediatric hospitals is summarized here. © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
... We did not consider noncommercial applications that also provide solutions, which are commonly used in research. A radiologist with 10+ years of experience in neuroradiology (AO) performed the coding of the collected data by using codebooks to examine which tasks of radiology [15,16] are targeted by an application and what kind of impacts it can have on these tasks (i.e. 'supporting', 'extending', 'replacing'; Table 1). ...
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PurposeTo conduct a systematic review of the possibilities of artificial intelligence (AI) in neuroradiology by performing an objective, systematic assessment of available applications. To analyse the potential impacts of AI applications on the work of neuroradiologists.Methods We identified AI applications offered on the market during the period 2017–2019. We systematically collected and structured information in a relational database and coded for the characteristics of the applications, their functionalities for the radiology workflow and their potential impacts in terms of ‘supporting’, ‘extending’ and ‘replacing’ radiology tasks.ResultsWe identified 37 AI applications in the domain of neuroradiology from 27 vendors, together offering 111 functionalities. The majority of functionalities ‘support’ radiologists, especially for the detection and interpretation of image findings. The second-largest group of functionalities ‘extends’ the possibilities of radiologists by providing quantitative information about pathological findings. A small but noticeable portion of functionalities seek to ‘replace’ certain radiology tasks.Conclusion Artificial intelligence in neuroradiology is not only in the stage of development and testing but also available for clinical practice. The majority of functionalities support radiologists or extend their tasks. None of the applications can replace the entire radiology profession, but a few applications can do so for a limited set of tasks. Scientific validation of the AI products is more limited than the regulatory approval.
... However, it has to be considered that besides RADPEER, there are other well-established measures to improve the quality of radiological reports like daily clinical demonstrations and tumor boards that include as in the case of RADPEER a "second look" on radiological examinations, often by a different radiologist [32]. Morbidity & mortality conferences provide a systematic approach to analyze errors in radiology with the aim of reducing these in the future. ...
Article
Objective To estimate the human resources required for a retrospective quality review of different percentages of all routine diagnostic procedures in the Department of Radiology at Bern University Hospital, Switzerland. Materials and Methods Three board-certified radiologists retrospectively evaluated the quality of the radiological reports of a total of 150 examinations (5 different examination types: abdominal CT, chest CT, mammography, conventional X-ray images and abdominal MRI). Each report was assigned a RADPEER score of 1 to 3 (score 1: concur with previous interpretation; score 2: discrepancy in interpretation/not ordinarily expected to be made; score 3: discrepancy in interpretation/should be made most of the time). The time (in seconds, s) required for each review was documented and compared. A sensitivity analysis was conducted to calculate the total workload for reviewing different percentages of the total annual reporting volume of the clinic. Results Among the total of 450 reviews analyzed, 91.1 % (410/450) were assigned a score of 1 and 8.9 % (40/450) were assigned scores of 2 or 3. The average time (in seconds) required for a peer review was 60.4 s (min. 5 s, max. 245 s). The reviewer with the greatest clinical experience needed significantly less time for reviewing the reports than the two reviewers with less clinical expertise (p < 0.05). Average review times were longer for discrepant ratings with a score of 2 or 3 (p < 0.05). The total time requirement calculated for reviewing all 5 types of examination for one year would be more than 1200 working hours. Conclusion A retrospective peer review of reports of radiological examinations using the RADPEER system requires considerable human resources. However, to improve quality, it seems feasible to peer review at least a portion of the total yearly reporting volume. Key Points: Citation Format
... Systematic and organizational optimization for efficiency, quality, and patient safety are essential components of successful healthcare delivery. Many radiology departments have embarked upon efficiency initiatives in an effort to improve patient care [1][2][3]. Following "Lean" principles, an approach first introduced by the Toyota automobile company in 1988, we aimed to eliminate waste and optimize systematic and organizational efficiency within the musculoskeletal (MSK) division [4]. ...
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Within an everchanging healthcare system, continuous evaluation of standard operating procedures must be performed to ensure optimization of system level organization, communication, and efficiency. Using the Lean management approach, our institution introduced modifications to our musculoskeletal (MSK) radiology workflow in order to facilitate beneficial change that improved clinical workflow efficiency, reduced moonlighting costs, and improved radiologist satisfaction without sacrificing quality of care. The scope of our study included the MSK division of adult inpatient and outpatient populations at three hospitals in a single academic medical center. A root cause analysis was executed to determine the causative factors contributing to clinical inefficiency. Five main factors were identified, and appropriate countermeasures were introduced. Efficiency was measured via the turnaround time (TAT) for radiographic examinations, measured from exam completion to final report submission. Moonlighting expenses were monitored for the fiscal year in which the modifications were implemented. Surveys were administered to MSK radiologists before and after the countermeasures were introduced to determine subjective ratings of efficiency and satisfaction. The average TAT within our MSK division decreased from 40 h to 12 h after introducing changes to our workflow. During one fiscal year, moonlighting expenses decreased from $26,000 to $5000. Post-study survey results indicated increased efficiency of and satisfaction with our implemented modifications to the scheduling and clinical workflow. Optimization of our radiology department's workflow led to increased productivity, efficiency, and radiologist satisfaction, as well as a reduction in moonlighting costs. This project leveraged Lean management principles to combat clinical inefficiency, waste time, and high costs.
... Regarding programs targeting radiology departments, the quality audit compares local performance against published benchmarks 1 and may follow with ''Plan, Do, Study, Act'', or Deming, cycles until the desired target is met. 2 In other programs such as Lean management and Kaizen exercises, stakeholders define ''value'' and ''waste,'' identify a problem, implement an intervention, and assess whether ''value'' is increased and ''waste'' reduced. 2 Progress toward departmental goals can also be tracked with metrics called key performance indicators (KPIs), 3 although presumably KPIs could apply to users (ie, radiologists) as well. Peer review and peer learning are quality programs which aim to improve the performance of users; radiologists review image interpretations of other radiologists to identify discrepancies. ...
... Regarding programs targeting radiology departments, the quality audit compares local performance against published benchmarks 1 and may follow with ''Plan, Do, Study, Act'', or Deming, cycles until the desired target is met. 2 In other programs such as Lean management and Kaizen exercises, stakeholders define ''value'' and ''waste,'' identify a problem, implement an intervention, and assess whether ''value'' is increased and ''waste'' reduced. 2 Progress toward departmental goals can also be tracked with metrics called key performance indicators (KPIs), 3 although presumably KPIs could apply to users (ie, radiologists) as well. Peer review and peer learning are quality programs which aim to improve the performance of users; radiologists review image interpretations of other radiologists to identify discrepancies. ...
Article
Full-text available
Purpose The aim of this study was to determine the status of radiology quality improvement programs in a variety of selected nations worldwide. Methods A survey was developed by select members of the International Economics Committee of the American College of Radiology on quality programs and was distributed to committee members. Members responded on behalf of their country. The 51-question survey asked about 12 different quality initiatives which were grouped into 4 themes: departments, users, equipment, and outcomes. Respondents reported whether a designated type of quality initiative was used in their country and answered subsequent questions further characterizing it. Results The response rate was 100% and represented Australia, Canada, China, England, France, Germany, India, Israel, Japan, the Netherlands, Russia, and the United States. The most frequently reported quality initiatives were imaging appropriateness (91.7%) and disease registries (91.7%), followed by key performance indicators (83.3%) and morbidity and mortality rounds (83.3%). Peer review, equipment accreditation, radiation dose monitoring, and structured reporting were reported by 75.0% of respondents, followed by 58.3% of respondents for quality audits and critical incident reporting. The least frequently reported initiatives included Lean/Kaizen exercises and physician performance assessments, implemented by 25.0% of respondents. Conclusion There is considerable diversity in the quality programs used throughout the world, despite some influence by national and international organizations, from whom further guidance could increase uniformity and optimize patient care in radiology.
... 32,33 These approaches have demonstrated process improvement and cost reduction at all organizational levels and in a variety of industries including health care and radiology. 24,[34][35][36][37] A principle tenant of CQI is to focus on the customer as a means of identifying value and to remove components that do not add value (ie, waste). 38 In the context of the Donabedian model and value-based payments, waste includes any structure or step in a process that does not contribute positively to outcomes or cost reduction. ...
Article
Medical imaging in the United States is evolving because of increased emphasis on documenting performance to quantify quality and value in the field. However, this fundamental shift might not be apparent at the technologist level with the American Registry of Radiologic Technologists (ARRT) discontinuing issuance of the quality management (QM) credential. Although the QM technologist’s scope of practice has undergone significant changes, evidence suggests that the focus on quality continues to expand. The remainder of the manuscript address factors pertaining to quality improvement and the need to develop technologists with skills to contribute in this area.