You've heard all about the need for quality and excellence in radiology, but the concept means different things to different people. The American College of Radiology (ACR) is hoping to clarify what quality means with its Diagnostic Imaging Centers of Excellence (DICOE) award, given for the first time earlier this month to two radiology facilities.
The ACR recognized Hackensack University Medical Center in Hackensack, NJ, and Mount Desert Island Hospital in Bar Harbor, ME, as its two inaugural winners. We spoke to the ACR and the two hospitals about the award.
What is it?
The DICOE award was established because radiology departments -- unlike many other services in a hospital -- haven't had a way to show when they've gone above and beyond regular accreditation criteria, according to Marion Boston, ACR's assistant director of validation site surveys.
"The award is a way for radiology departments to say, 'Hey, we're doing good work; we're here and we want to provide excellent patient care,'" Boston told AuntMinnie.com.
The award process includes a written application and a day-long site visit from an ACR team that consists of a radiologist, a physicist, and an ACR staff person. Several areas are assessed:
- Governance
- Personnel
- Facility organization and management
- Physical environment
- Equipment and IT infrastructure
- Radiation and general safety
- Quality management
- Policies and procedures
- Patient rights
- Medical records
"We get basic information from the applicant, but most of the award assessment process happens during the site visit," Boston said. "If everything is in order, the department could know by the end of the day if they've won the award."
The application for the DICOE award costs $2,000, which covers the cost of the site visit. However, during 2013 the ACR is waiving the survey team's expenses, according to Boston. The award status is for three years, and winners are automatically included in the ACR's quality registries.
"We really want the award winners to participate in our registries," Boston said. "Because they've demonstrated that they're the best of the best, these practices set a standard others across the country can strive for."
Hackensack University Medical Center
Hackensack University Medical Center (HUMC), a 775-bed teaching and research hospital, is the largest provider of inpatient and outpatient services in the state. It was the first hospital in New Jersey and is the "hometown hospital" for the New York Giants.
Over the years, HUMC has been ranked high on quality-of-care lists ranging from Thomson Reuters' "100 Top Hospitals" to Becker's Hospital Review and U.S. News and World Report. But until now, there hasn't been a way to specifically recognize the contributions of the radiology program, according to Jason Kreitner, administrator of clinical services.
"With the DICOE award, the ACR has provided a comprehensive guideline that we can benchmark against," Kreitner told AuntMinnie.com. "HUMC is committed to quality -- it's in our DNA -- and we want to prove this to our community."
HUMC Chairman Emeritus Dr. Harry Agress Jr.There are a number of ways HUMC's radiology department strives for excellence, including providing 24-hour coverage, participating in more than 20 subspecialty conferences per month, and employing a dedicated quality assurance manager, said chairman emeritus Dr. Harry Agress Jr.
"We have attending radiologists onsite 24/7," Agress told AuntMinnie.com. "CT, MRI, and ultrasound technologists are here all night long. We're reading things at all hours and are also available for consultation. We also do a lot of conferences and go over radiology findings with our colleagues. And we have a QA manager who works closely with nurses, technologists, and administration."
HUMC radiology's QA manager tracks test-result reporting, requiring all radiologists not only to communicate results as soon as possible to referring physicians, but also to document the findings in reports, according to Agress.
"Our obligation is to have 100% compliance in results reporting," he said.
In addition, HUMC radiology requires its technologists to receive advanced certification within one year of hire, Kreitner said.
"We have some pretty high expectations for our techs, but we want quality people," he said.
Not only is the DICOE award a good way for a radiology department to evaluate its own efforts, it's also a good way to demonstrate radiology's importance to the larger community, according to Agress.
"It's rare that a patient comes into the hospital and doesn't receive some kind of imaging," Agress said. "What we do and how we do it is extremely important and has a major effect on our clinicians' treatment decisions and, therefore, our patients."
Mount Desert Island Hospital
Big university hospitals aren't the only winners of the DICOE award; small community hospitals can also prove the excellence of their patient care. Mount Desert Island Hospital (MDIH) is a 25-bed, critical-access hospital that performs about 17,000 imaging studies annually. In addition, MDIH serves more than 100 cruise ships in a season, providing x-ray, MRI, and ultrasound.
Dr. John Benson of MDIH.The radiology department is a one-man operation run by Dr. John Benson. One CT/x-ray technologist handles the overnight shift, and emergency scans are read by a teleradiology firm, according to Jeff Murad, director of medical imaging and laboratory services.
"Dr. Benson is very much in tune with tracking quality," he told AuntMinnie.com. "He wants to make sure we're not only providing good care, but that we're doing the best we can."
MDIH radiology's accreditation process prepared the department well for applying for the DICOE award, Murad said.
"Since we went through a stringent accreditation process in all the modalities, we were already doing much of what the ACR is looking for for the DICOE award," he said. "Our policies are in place."
Even if MDIH hadn't won the award, Murad believes that just applying for it was a worthwhile process, and he recommends it for other imaging facilities.
"I'd definitely get the award criteria from the ACR, look through it, and ask myself what don't we do, what are we missing, what are we not doing as well as we could," he said. "If nothing else, applying for the award can improve your department processes."
