Dynamic Duo: Combining quality improvement systems yields better results

Combining a mandatory peer-review (PR) database with a quality assurance (QA) system that collects voluntary incident reports creates a strong quality improvement (QI) program, according to a study published this month in Radiology.

The researchers, including lead author Olga R. Brook, MD, of Beth Israel Deaconess Medical Center in Boston, contend that developing QI programs is an important part of providing optimum patient care, and that PR processes are required for accreditation by numerous organizations, including the American College of Radiology. These PR databases require radiologists to perform a certain number of peer reviews on image reports delivered in the past year.

The purpose of QA systems, on the other hand, are to collect voluntary reports of important errors that have occurred.

“The purpose of our study was to assess the complementary nature of two types of QI databases, a PR-mandated system that mandates physician review and reporting of discrepancies and a separate voluntary QA system that tracks anecdotal reporting of less common but potentially more clinically important errors, by using our obstetric and gynecologic QI databases,” Brook and colleagues wrote.

The retrospective study examined submissions to the voluntary QA and mandatory PR databases and graded them. The errors were categorized as perceptional, interpretive, communication related or procedural and the effects of the errors were assessed in terms of follow up required.

The total number of cases in the study were 185 and 64 in the QA and PR databases, respectively. The researchers found that procedure-related entries were entered almost exclusively through the QA database (97 percent) and that perceptional and interpretative errors occurred most frequently in the QA and PR systems.

The majority of events in both databases were considered minor (56 percent in QA and 76 percent in PR) and the two databases had similar numbers of moderate events (15 percent in QA and 14 percent in PR).

The researchers concluded that QA and PR databases are complimentary to one another in their roles in a QI system. They found the QA system yielded more clinically important errors and encompassed all imaging modalities while the PR database focused mostly on ultrasound.

“When we focus on quality metrics and evaluate submissions to a database such as our PR database, we conform to institutional guidelines regarding participation in a QI process. This allows for reporting from all physicians and by its nature should allow for a spectrum of types of imaging studies,” the authors concluded.  “However, this type of reporting, based on a proportion of imaging studies interpreted, will by nature lead to important quality issues being missed. Thus, each type of reporting serves separate but overlapping purposes.”