In the ever-evolving healthcare delivery environment, the discussion is centering on the need to shift from volume to quality. But what does the word "quality" actually mean in the context of radiology? It's imperative that radiologists work to define it, according to a talk at the recent International Symposium on Multidetector-Row CT (MDCT) in San Francisco.
"Everyone has a different understanding of what quality is, and in radiology we don't have a national short list of quality and performance metrics that everyone agrees on," said presenter Dr. Kimberly Applegate of Emory University. "That puts our profession at risk. We need to establish a set of metrics."
In 2006, Applegate was part of the Sun Valley Group, an informal association of radiologists interested in promoting quality improvement in radiology. The group met that year and offered a definition of quality in imaging (Journal of the American College of Radiology, August 2006, Vol. 3:7, pp. 544-549).
"The definition that came out of that group is that quality is 'the right exam for the right patient, at the right time, and for the right reason,' " Applegate said.
Improving quality means understanding that errors will occur, according to Applegate.
"Medicine has gotten increasingly complex, and there are many, many opportunities for errors," she said.
Creating a culture of quality and safety
One of the key factors to creating a culture of quality and safety is making sure that staff members can speak freely when they're worried about a protocol or a patient care situation.
"An environment of teamwork is very important," Applegate said.
Numerous resources and materials are available as well. Applegate listed quite a few that radiology departments can access to improve the quality of their service. For example, the American College of Radiology (ACR) offers the following:
- Its accreditation program
- The Image Wisely initiative (developed in collaboration with RSNA, the American Society of Radiologic Technologists, and the American Association of Physicists in Medicine)
- Practice parameters and technical standards
- Appropriateness criteria
- Data registries for quality assessment and improvement
- Radiation safety tools
- Imaging 3.0 modules
- Its General Radiology Improvement Database, which collects information about imaging facilities and aggregates it to establish benchmarks for quality improvement
- RadiologyInfo.org, which offers patients information on radiation dose and how imaging tests are performed and why, along with a glossary of terms and a cache of images and videos -- in both English and Spanish
There is also the Agency for Healthcare Research and Quality's Quality Indicators and the Alliance for Radiation Safety in Pediatric Imaging's Image Gently campaign. Finally, there are ideas for defining quality from the 2006 Intersociety Conference report, which included 49 metrics such as report turnaround time, patient adverse events, radiation dose tracking, incomplete or wrong studies, and the accuracy of interpretation (JACR, March 2007, Vol. 4:3, pp. 156-161), Applegate said.
Be your own case study
Finally, Applegate encouraged MDCT 2015 attendees to look to their own practices for quality improvement material.
Emory's radiology department has focused on four main goals: fostering a culture of quality and safety, enhancing patient satisfaction, standardizing work processes, and improving clinical quality and safety outcomes. To measure progress toward these goals, the department has used report turnaround time and critical results reporting time assessments, the RadPeer quality assurance program, quarterly morbidity and mortality conferences, one practice quality improvement project per year, and maintenance of certification (MOC) program participation.
Sometimes the real-life events are the ones that are most instructive, she noted.
"When we're willing to look at our 'near misses' and our 'real misses,' patient care gets better," she concluded.
