Email notification combined with off site signing substantially reduces resident approval to faculty verification time

System approach to prevent lost studies and improve radiology report turnaround time

Purpose

On our picture archiving and communication system worklist, there was no way to differentiate body imaging (BI) from musculoskeletal (MSK) MR pelvis examinations. They were listed on only the BI worklist. This resulted in ‘lost’ MSK MR pelvis studies with high report turnaround time (TAT). Some exams had preliminary reports with substantiative changes made days later when found. The goals of this project were to create a solution to prevent ‘lost’ exams and improve TAT.

Methods

A report of 3 months of MR pelvis studies was reviewed to determine time to first view by MSK radiologists, time of completion, time of preliminary report and time of final signature. Mean TAT was calculated and exams with delays in reporting resident misinterpretation recorded.

An MSK reserve flag was created for the BI radiologists to use when they found an MSK study on their worklist. The flag moved them onto the MSK reserve worklist. A second intervention included technologists placing the reserve on examination completion. After this, another 3 months of data was analysed.

Results

There was a significant improvement (p=0.0018) in time to view by MSK from preintervention mean of 1125 min (n=107) to postintervention mean of 526 min (n=127). There was also a significant improvement (p=0.0033) in time to view inpatient and Emergency department cases from 927 min to 357 min. Time from study completion to final signature also improved from a mean of 1764 min to 838 min, though not statistically significant (p=0.08). There were five cases of delay in reporting resident misinterpretation preintervention and none postintervention.

Conclusion

Our intervention shows the importance of modifying human and informatics factors to solve a patient safety issue. Introduction

Use of Iterative Cycles in Quality Improvement Projects in Imaging: A Systematic Review

PURPOSE

Studies suggest that quality improvement (QI) projects in health care lack scientific rigor, but the actual frequency of use of proven scientific QI methodology is unknown. The purposes of this study are to (1) conduct a systematic review of QI projects in radiology journals on the frequency of use of iterative cycles, a marker of proven QI methodology, and (2) assess association of the use of iterative cycles with characteristics of these projects.

MATERIALS AND METHODS

We searched English-language radiology journals on MEDLINE between 2008 and 2015 for published QI studies. Three reviewers appraised studies and extracted data. Use of iterative cycles was identified, and results were summarized qualitatively. χ² Analysis evaluated associations of iterative cycles with other data elements.

RESULTS

Of 3,134 potentially eligible citations, 44 studies met inclusion criteria. Only 46% of these used iterative cycles to refine intervention. Use of iterative cycles were associated with projects designed to improve process, QI expert support, reporting of unintended effect of intervention, and explicitly stated use of iterative cycles. General lack of scientific rigor was represented by failure to report baseline data (9%), describe unintended effects (66%), and discuss limitations (36%).

CONCLUSIONS

Our systematic review found fewer than half of the QI projects in radiology journals used iterative cycles to refine intervention, a scientific strategy central to many proven improvement methodologies. Use of iterative approach was associated with projects designed to improve processes, QI expert support, report of unintended effect, and explicitly stated use of iterative cycles.