New advances have revolutionized Radiology, and demand for imaging service has exploded over the last 30 years, imposing faster turnaround and more sophisticated diagnoses. With this, the potential for error has increased accordingly, therefore placing an ever greater emphasis on patient safety and quality in imaging practice.

HOW DO WE IMPROVE QUALITY?

In order to establish and maintain effec­tive quality, safety, and performance improvement, the initial step is collecting and analyzing relevant quality and performance data. Subsequently, analy­sis and ranking of causes that likely contribute to process failures or adverse events; implementation of solutions, and careful monitoring of outcomes are all essential elements of a successful quality and safety program.

Quality improvement requires a careful and con­tinuous effort by a dedicated, skilled and committed team. In radiology, the focus of quality improvement is to improve the perfor­mance of and processes related to diagnostic and therapeutic procedures, the selection of imaging and procedural services, the quality and safety of healthcare delivered, and the effectiveness and management of all imaging services.

Institutional leadership and support is necessary to signal that quality-related efforts are val­ued and represent one of the core missions of the institution.

Creation of a Just Culture for Quality and Safety is essential. An environment in which staff mem­bers feel comfortable disclosing errors, includ­ing their own, without fear of punitive actions ensures that errors are identified and provide the opportunity for correction. Whereas many traditional healthcare cultures hold individuals accountable for all errors, a just culture recognizes that individuals are not at fault for system failures and that even competent professionals can make mis­takes. It seeks to introduce proactive, rather than reactive, monitoring processes.

Managing “customer” relations with patients, referring physicians and third-party payers, among others, is important to collect feedback that can be analyzed and leveraged to improve service and the delivery of care.

Generally speaking, Quality Improvement is an umbrella term that includes:

1. Quality assurance programs for continuous improvement in quality
2. Pro­cesses to improve staff and patient safety
3. Procedures to improve the clinical, techni­cal and diagnostic performance of all staff.

QUALITY AND SAFETY INITIATIVES

Here at Loyola, excellence in imaging and patient safety has always been a core element of our practice and today is a requirement of many regulatory organizations. The following are some of the Quality and Safety Initiatives within our department.

1. The department has sought and obtained accreditation in all of the imaging programs provided by the American College of Radiology. This includes:

• CT
• MRI
• Ultrasound
• Nuclear Medicine & PET
• Breast MRI
• Breast Ultrasound
• Mammography
• Stereotactic Breast Biopsy Ultrasound

Further, by virtue of obtaining accreditation in all areas of Breast Imaging and Intervention, Loyola has been designated as a Breast Imaging Center of Excellence

2. While subspecialty radiologists are required to engage actively in Maintenance of Certification, practicing safe, effective, value-added radiology is a common goal for our entire faculty, as we con­tinually strive to achieve the highest quality of patient care in the most timely fashion.

3. Our faculty has been actively engaged in a formal peer-review process since 2006. The RAD-PEER program of the American College of Radiology collects data nationwide through a large number of departments voluntarily participating, thus providing robust statistical benchmarks to measure individual, subspecialty and department-wide performance in diagnostic interpretation.

4. Our faculty supports radiation-protection initiatives such as the Image Gently (imagegently.org) and the Image Wisely (imagewisely.org) campaigns, both aimed at decreasing overall exposure to ionizing radiations in pediatric and adult patients, respectively. These are implemented through a multilevel approach to patient care relying on increased communication with the referring physician, education to alternative imaging studies in select clinical scenarios, utilization of the latest technology to decrease dose to patients within the same studies. Our newest CT scanners and most recent digital radiography equipment represent the state-of-the-art in lowering the dose to patients without compromising image quality. Our on-site medical physicists are dedicated to equipment monitoring and maintenance as well as constantly reviewing imaging protocols and parameters in order to minimize patient exposure.

5. Our department closely monitors the complication rate of both diagnostic and invasive procedures, through ongoing data collection and analysis, from the incidence of IV contrast extravasation to serious complications following image-guided invasive procedures.

6. Access to care is an important quality indicator; the most sophisticated diagnosis is of marginal clinical value if not delivered in time to effect change in patient management. We monitor time to access select exams on a weekly basis and implement measures to reduce that time to access where needed.

Here are some of the quality and safety initiatives in the Imaging Department:

• Extravasation and infiltration reporting /tracking
• Reducing Emergency Department CT patient cycle time
• Dose reduction using the state-of-the-art Fuji gadolinium detector system
• Blood pressure and oxygen SAT training for diagnostic radiology staff
• Reduce patient cycle time and scheduling in fluoroscopy
• Using state-of-the-art dose-reduction software for GE 64-slice CT scanners
• Reduce patient cycle time and scheduling in diagnostic and screening mammography. This project won the “People’s Choice Award” at the 2012 Loyola Quality and Safety Fair.
• Reduce technical repeats in mammography
• Monitor utilization of bismuth shields in CT to decrease breast tissue exposure to ionizing radiation

CONTACTS

- Davide Bova, MD

- Charles J. Andel MBA, BSRT