Delivering care in a way that improves the quality of patient services as well as organizational efficiency requires a paradigm shift in leadership and organizational structure. Attention to quality, patient care and efficiency can bolster the bottom line. The Best Practices in Radiology Quality and Economics Awards were conceived out of a desire to recognize radiology practices, groups or departments for their work in using imaging in a meaningful way to improve quality of care and patient outcomes, increase efficiency across the department or facility, reduce costs and drive lasting economic benefits. Given this year for the first time, the awards honor five radiology groups and departments.
The 24 entries were judged on the impact of project; scope of project; project definition; project solutions; and innovation and collaboration by a panel of radiology administrators and business managers who are members of the boards of the AHRA and Radiology Business Management Association (RBMA), as well as the editorial staff of Health Imaging. Each winner received a $1,000 cash award.
Baylor Medical Center, Irving Radiology Department, Irving, Texas
Project: Reports Coded for Joint Quality Improvement Control
Four years ago, the center initiated a plan to improve communication of imaging results that require additional work-up and/or follow-up. The effort grew out of an incident in which pulmonary nodules were detected on a chest x-ray and the radiologist recommended follow-up for an emergency department (ED) patient, but the results were either not communicated effectively to the patient or the importance was not stressed. The patient returned four months later with lung cancer.
The objective was to create a system to ensure patients were made aware that follow-up or additional work-up was necessary. A focus group decided radiologists should code dictations A (normal/negative), B (potential of diagnosis beyond normal) or C (follow-up recommended).
Reports are reviewed by clerical staff, with A letters disregarded, B letters read through to ensure nothing was missed and C reports investigated by the quality coordinator. For C reports, a letter is sent directly to the patient if the patient was seen through the ED or sent to the ordering physician stating that additional follow-up is recommended. After five days, if the patient has not had the recommended procedure, a letter is sent to the patient's home.
The project has been successful, with no failures to communicate key and critical findings to date. "Approximately 1.14 percent of the total reports are coded C per month," Baylor reports. "Of the 1.14 percent, 59.86 percent are mailed to the patient or the ordering physician. The number of patients affected is slightly above 1 percent, however, this practice could affect any patient."
Lake Medical Imaging & Vascular Institute, Leesburg, Fla.
Project: Low Dose Chest CT
In January 2011, this imaging facility, which performs 2,500 chest CTs annually, focused on limiting CT dose to improve patient safety and outcomes. They used guidance from the Image Wisely campaign and the "Chest CT Radiation Exposure Reduction PQI Template" sponsored by the American Roentgen Ray Society, and modified CT protocols accordingly.
Because bismuth shielding can reduce dose to the breast by 26 percent, breast shields were used in all female patients. In addition, thyroid shields were used in all patients. Between February 2011 and July 2011, the team fine-tuned modifications based on the patients' body habitus and automatic tube current modulation. Radiologists saw no significant image quality degradation.
In July 2011, final data collection confirmed the new protocols reduced radiation dose of routine chest CT by at least 30 to 50 percent, and often up to 70 percent. To increase awareness of the improvement in radiation safety, the facility reached out to its patient and referring physician communities by sending hundreds of letters and publishing articles in local newspapers and magazines.
MD Anderson Division of Diagnostic Imaging, Houston
Project: Interventional Ultrasound—Improving Patient Access
Neuro-Interventional Ultrasound (NIR), a specialty diagnostic clinic, embarked on a project to reduce the 25-day backlog for NIR-guided head and neck scans and biopsies. The department completes approximately 10,500 procedures per year.
Following department changes implemented in July 2011, significant success was observed and measured: The average time to the next appointment for diagnostic ultrasound and biopsy decreased from over 25 days to one day; the number of daily patient appointment slots increased from 38 to 55; and room utilization improved with the time to perform one complete study decreasing 6.6 minutes. Also, patient wait-times decreased by two minutes.
The total effort of the team members was analyzed using a time-driven based costing methodology. Initial project development labor cost was $3905.85 with sustainment personnel costs of $0.
Project improvements resulted in four additional procedures in the current year. By modifying the scheduling templates, increasing the number of available time slots, and changing process flow, this project resulted in improved access and efficiency for all referred patients. The project aims were met, and should be sustainable. The project resulted in financial gains with a net present value (three years) of more than $275,000.
Radiology Consultants of Iowa, Cedar Rapids, Iowa
Project: Iowa Rural Health Telecommunications Project (IRHTP)
Radiology Consultants of Iowa (RCI) is a professional radiology group that provides services to 14 hospitals in eastern Iowa, 12 of which are considered critical access hospitals. RCI operates a shared PACS/RIS/dictation system with 10 hospital partners. RCI was challenged to implement appropriate communications (speed and access) that support its goals of rapid turn-around time for final reports.
In 2007, RCI started working with the Iowa Hospital Association and focused on a Federal Communications Commission grant that provides the resources to implement a statewide fiber network. One of the challenges implementing such a project is securing buy in from participating hospitals.
RCI completed the project in August 2011, at which time eight rural hospitals chose to participate. They now have a secure, high-speed, private fiber network. Patient care, safety and department efficiency has been impacted significantly. Report turn-around time has been reduced from hours to minutes and the group is now providing more sub-specialty interpretations. Radiologist wait time to read exams from home has dropped significantly as well.
St. Louis Children's Hospital, St. Louis
Project: Flight Data Recorder for Interventional Radiology
The opening of a Pediatric Interventional Radiology suite offered the opportunity to form a new team. The suite included a recording system analogous to the flight data recorders on modern aircraft. While the team has strived to minimize radiation use during fluoroscopic procedures, the recording system is increasingly being used to score efforts to optimize each exposure. This goal received a boost in April 2011 when the equipment was upgraded to capture details of each radiation exposure recorded in DICOM-SR files.
The recording system provided a rigorous method of scoring timeouts. The reviewer can replay segments to confirm a scoring decision and the facility recently found greater than 95 percent concordance when different reviewers scored the same timeout. Over a 24-month period, the average timeout score has risen from 68 to 96. The time required to complete the timeout is typically 45 seconds.
Work is underway to combine the recordings with the DICOM-SR data to create a library of desired behaviors as well as failure modes. This resource will help the team and collaborators develop shared models of what constitutes optimal and non-optimal radiation use.