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Robertson SH, Owenby E, Beasley C, Wall L, Gray B, Boru I, Kalisz KR, Kruse DE, Marin D, Thomas SP, Macdonald EB, Purysko AS, Gupta RT. Optimization of non-endorectal prostate MR image quality using PI-QUAL: A multidisciplinary team approach. Eur J Radiol 2023; 166:110998. [PMID: 37506475 DOI: 10.1016/j.ejrad.2023.110998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE To evaluate the utility of the PI-QUAL score in assessing protocol changes aimed to improve image quality from a non-endorectal coil prostate MR imaging protocol during a 9-month quality improvement (QI) project and to quantify the inter-reader agreement of PI-QUAL scores between radiologists, technologists, and physicists. METHODS This retrospective study audited 1,012 multiparametric prostate MRI examinations as part of a national QI project according to the PI-QUAL standard. PI-QUAL scores were used to inform MR protocol changes. Following the project, 4 radiologists, 2 technologists, and 1 medical physicist collectively audited an additional set of 150 examinations to identify statistical improvements in image quality using the two-tailed Wilcoxon rank sum test. The improvements due to individual protocol changes were assessed among subsets of the 1,012 examinations which compared examinations occurring before and after the isolated protocol change. Inter-reader variability was assessed using the percent majority agreement and the average standard deviation of PI-QUAL scores between evaluators. RESULTS During this QI project, PI-QUAL scores improved from 3.67 ± 0.75 to 4.16 ± 0.59 (p < 0.01) after implementing a series of protocol changes. Among a subset of 451 cases, we found that adopting R/L rather than A/P phase encoding reduced distortion in diffusion-weighted imaging (DW) from 21.6% (41/190 A/P phase encoded cases) to 11.5% (30/261 R/L phase encoded cases) (p < 0.01). Similarly, in the same 451 cases, adopting R/L phase encoding in T2WI reduced breathing motion artifacts from 34.6% (94/272 A/P phase encoding cases) to 12.8% (23/179 R/L phase encoding cases) (p < 0.01). DWI wraparound artifact was mitigated by employing a full-pelvis shim and enabling the abdomen shim option. The occurrence of low signal-to-noise ratio was reduced from 19.4% (19/98 cases without a weight-based threshold) to 6.3% (10/160) by instituting a weight-based threshold for using an endorectal coil (p < 0.01). The percent majority agreement was similar between radiologists, technologists and physicists, and all evaluators combined (72%, 77%, and 67%, respectively). CONCLUSIONS PI-QUAL can evaluate image quality changes resulting from protocol optimizations at both the exam- and series-levels. With training, radiologists, technologists, and physicists can perform PI-QUAL scoring with similar performance. Broadening the scope of the quality improvement team can result in meaningful and lasting change.
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Affiliation(s)
- Scott H Robertson
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Erica Owenby
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Christopher Beasley
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Lisa Wall
- Department of Radiology, Duke University Medical Center, Durham, NC, United States
| | - Bradley Gray
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Issack Boru
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Kevin R Kalisz
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Danielle E Kruse
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Sarah P Thomas
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Erin B Macdonald
- Department of Radiology, Duke University Medical Center, Durham, NC, United States.
| | - Andrei S Purysko
- Section of Abdominal Imaging, Imaging Institute, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, Durham, NC, United States; Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, United States; Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University Medical Center, Durham, NC, United States.
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Flug JA, Stellmaker JA, Tollefson CD, Comstock EM, Buelna E, Truman B, Ponce L, Milosek A, McCabe J, Jokerst CE. Improving Turnaround Time in a Hospital-based CT Division with the Kaizen Method. Radiographics 2022; 42:E125-E131. [PMID: 35622490 DOI: 10.1148/rg.210128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Kaizen method is an approach to lean process improvement that is based on the idea that small ongoing positive changes can lead to major improvements in efficiency and reduction of waste. The hospital-based CT division at Mayo Clinic Arizona had been receiving numerous concerns of delays in the performance of examinations from inpatients, outpatients, and patients presenting to the emergency department. These concerns, along with a planned hospital expansion, provided the impetus to perform a process improvement project with the goal of reducing inpatient, emergency department, and outpatient turnaround times by 20%. Kaizen process improvement was chosen because of the emphasis on reduction of waste, standardization, and empowerment of frontline staff. The project was led by a process improvement coach who was trained in lean process improvement and A3 thinking. At the end of a weeklong Kaizen event, inpatient turnaround time decreased by 54%, emergency department turnaround time decreased by 29%, and outpatient turnaround time decreased by 45%. These results were achieved and sustained by establishing standardized work, developing frontline problem solvers, instituting visual management, aligning with relevant metrics, emphasizing patient and staff satisfaction, and reducing lead time and non-value-added work. When done properly, a Kaizen event can be an effective tool for process improvement in the health care setting. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Jonathan A Flug
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., C.D.T., E.M.C., E.B., B.T., L.P., A.M., J.M. C.E.J.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.A.S.)
| | - Jessica A Stellmaker
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., C.D.T., E.M.C., E.B., B.T., L.P., A.M., J.M. C.E.J.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.A.S.)
| | - Chris D Tollefson
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., C.D.T., E.M.C., E.B., B.T., L.P., A.M., J.M. C.E.J.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.A.S.)
| | - Elaine M Comstock
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., C.D.T., E.M.C., E.B., B.T., L.P., A.M., J.M. C.E.J.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.A.S.)
| | - Efren Buelna
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., C.D.T., E.M.C., E.B., B.T., L.P., A.M., J.M. C.E.J.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.A.S.)
| | - Brooke Truman
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., C.D.T., E.M.C., E.B., B.T., L.P., A.M., J.M. C.E.J.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.A.S.)
| | - Lisa Ponce
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., C.D.T., E.M.C., E.B., B.T., L.P., A.M., J.M. C.E.J.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.A.S.)
| | - Amy Milosek
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., C.D.T., E.M.C., E.B., B.T., L.P., A.M., J.M. C.E.J.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.A.S.)
| | - John McCabe
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., C.D.T., E.M.C., E.B., B.T., L.P., A.M., J.M. C.E.J.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.A.S.)
| | - Clinton E Jokerst
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., C.D.T., E.M.C., E.B., B.T., L.P., A.M., J.M. C.E.J.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.A.S.)
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Flug JA, Stellmaker JA, Sharpe RE, Jokerst CE, Tollefson CD, Bowman AW, Nordland M, Hannafin CL, Froemming AT. Kaizen Process Improvement in Radiology: Primer for Creating a Culture of Continuous Quality Improvement. Radiographics 2022; 42:919-928. [PMID: 35333633 DOI: 10.1148/rg.210086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Kaizen process improvement is an element of lean production that is an approach to creating continuous improvement. Kaizen is based on the idea that small ongoing positive changes in workflow and elimination of waste can yield major improvements over time. A focused Kaizen event, or rapid process improvement event, can lead to sustainable process improvement in health care settings that are resistant to change. This approach has been proven to be successful in health care. These events are led by a trained facilitator and coach who provides appropriate team education and engagement. To ensure success, the team must embrace the Kaizen culture, which emphasizes the development of a "learning organization" that is focused on relentless pursuit of perfection. The culture empowers all staff to improve the work they perform, with an emphasis on the process and not the individual. Respect for individual people is key in Kaizen. In radiology, this method has been successful in empowering frontline staff to improve their individual workflows. A 5-day Kaizen event has been successful in increasing on-time starts, decreasing lead time, increasing patient and staff satisfaction, and ensuring sustainability. Sustainable success can occur when the team stays true to lean principles, engages leaders, and empowers team members with the use of timely data to drive decision making. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Jonathan A Flug
- From the Departments of Radiology of Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., R.E.S., C.E.J., C.D.T., C.L.H.); Mayo Clinic Rochester, Rochester, Minn (J.A.S., M.N., A.T.F.); and Mayo Clinic Florida, Jacksonville, Fla (A.W.B.)
| | - Jessica A Stellmaker
- From the Departments of Radiology of Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., R.E.S., C.E.J., C.D.T., C.L.H.); Mayo Clinic Rochester, Rochester, Minn (J.A.S., M.N., A.T.F.); and Mayo Clinic Florida, Jacksonville, Fla (A.W.B.)
| | - Richard E Sharpe
- From the Departments of Radiology of Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., R.E.S., C.E.J., C.D.T., C.L.H.); Mayo Clinic Rochester, Rochester, Minn (J.A.S., M.N., A.T.F.); and Mayo Clinic Florida, Jacksonville, Fla (A.W.B.)
| | - Clinton E Jokerst
- From the Departments of Radiology of Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., R.E.S., C.E.J., C.D.T., C.L.H.); Mayo Clinic Rochester, Rochester, Minn (J.A.S., M.N., A.T.F.); and Mayo Clinic Florida, Jacksonville, Fla (A.W.B.)
| | - Chris D Tollefson
- From the Departments of Radiology of Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., R.E.S., C.E.J., C.D.T., C.L.H.); Mayo Clinic Rochester, Rochester, Minn (J.A.S., M.N., A.T.F.); and Mayo Clinic Florida, Jacksonville, Fla (A.W.B.)
| | - Andrew W Bowman
- From the Departments of Radiology of Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., R.E.S., C.E.J., C.D.T., C.L.H.); Mayo Clinic Rochester, Rochester, Minn (J.A.S., M.N., A.T.F.); and Mayo Clinic Florida, Jacksonville, Fla (A.W.B.)
| | - Michelle Nordland
- From the Departments of Radiology of Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., R.E.S., C.E.J., C.D.T., C.L.H.); Mayo Clinic Rochester, Rochester, Minn (J.A.S., M.N., A.T.F.); and Mayo Clinic Florida, Jacksonville, Fla (A.W.B.)
| | - Cathy L Hannafin
- From the Departments of Radiology of Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., R.E.S., C.E.J., C.D.T., C.L.H.); Mayo Clinic Rochester, Rochester, Minn (J.A.S., M.N., A.T.F.); and Mayo Clinic Florida, Jacksonville, Fla (A.W.B.)
| | - Adam T Froemming
- From the Departments of Radiology of Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (J.A.F., R.E.S., C.E.J., C.D.T., C.L.H.); Mayo Clinic Rochester, Rochester, Minn (J.A.S., M.N., A.T.F.); and Mayo Clinic Florida, Jacksonville, Fla (A.W.B.)
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Rosier AS, Tibor LC, Turner MA, Phillips CJ, Kurup AN. Improving Root Cause Analysis of Patient Safety Events in Radiology. Radiographics 2021; 40:1434-1440. [PMID: 32870771 DOI: 10.1148/rg.2020190147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patient safety events occur in health care, and root cause analysis (RCA) meetings held after these incidents often reveal valuable insights into systemic barriers between optimal processes or stated policies and actual practice, providing critical opportunities for improvement. The patient safety team that facilitates RCA meetings in the radiology department at the authors' institution received feedback suggesting dissatisfaction with the RCA process. The team followed a structured process improvement framework to analyze the root causes of this dissatisfaction and create a better system. Using a post-RCA survey to target satisfaction scores as an improvement goal, the team successfully increased participant and facilitator satisfaction levels with sustained results. The patient safety team applied structured process improvement methodologies to their own daily work, learning lessons about measuring difficult processes and choosing appropriate metrics, the benefits of standardized work, and how to continuously improve a quality program. In the course of improving the satisfaction of employees participating in the RCA process, a more robust, continuously improving patient safety program has emerged to enhance the ability of those within the department to report, learn from, and hopefully prevent patient safety events in the future.©RSNA, 2020.
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Affiliation(s)
- Ashley S Rosier
- From the William J. von Liebig Center for Transplantation and Clinical Regeneration (A.S.R.) and Departments of Radiology (C.J.P., A.N.K.), Radiation Oncology (L.C.T.), and Quality Management Services (M.A.T.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Laura C Tibor
- From the William J. von Liebig Center for Transplantation and Clinical Regeneration (A.S.R.) and Departments of Radiology (C.J.P., A.N.K.), Radiation Oncology (L.C.T.), and Quality Management Services (M.A.T.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Mara A Turner
- From the William J. von Liebig Center for Transplantation and Clinical Regeneration (A.S.R.) and Departments of Radiology (C.J.P., A.N.K.), Radiation Oncology (L.C.T.), and Quality Management Services (M.A.T.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Carrie J Phillips
- From the William J. von Liebig Center for Transplantation and Clinical Regeneration (A.S.R.) and Departments of Radiology (C.J.P., A.N.K.), Radiation Oncology (L.C.T.), and Quality Management Services (M.A.T.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - A Nicholas Kurup
- From the William J. von Liebig Center for Transplantation and Clinical Regeneration (A.S.R.) and Departments of Radiology (C.J.P., A.N.K.), Radiation Oncology (L.C.T.), and Quality Management Services (M.A.T.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Using Quality Improvement Methodology to Reduce Costs while Improving Efficiency and Provider Satisfaction in a Busy, Academic Musculoskeletal Radiology Division. J Med Syst 2020; 44:104. [PMID: 32318828 DOI: 10.1007/s10916-020-01569-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
Within an everchanging healthcare system, continuous evaluation of standard operating procedures must be performed to ensure optimization of system level organization, communication, and efficiency. Using the Lean management approach, our institution introduced modifications to our musculoskeletal (MSK) radiology workflow in order to facilitate beneficial change that improved clinical workflow efficiency, reduced moonlighting costs, and improved radiologist satisfaction without sacrificing quality of care. The scope of our study included the MSK division of adult inpatient and outpatient populations at three hospitals in a single academic medical center. A root cause analysis was executed to determine the causative factors contributing to clinical inefficiency. Five main factors were identified, and appropriate countermeasures were introduced. Efficiency was measured via the turnaround time (TAT) for radiographic examinations, measured from exam completion to final report submission. Moonlighting expenses were monitored for the fiscal year in which the modifications were implemented. Surveys were administered to MSK radiologists before and after the countermeasures were introduced to determine subjective ratings of efficiency and satisfaction. The average TAT within our MSK division decreased from 40 h to 12 h after introducing changes to our workflow. During one fiscal year, moonlighting expenses decreased from $26,000 to $5000. Post-study survey results indicated increased efficiency of and satisfaction with our implemented modifications to the scheduling and clinical workflow. Optimization of our radiology department's workflow led to increased productivity, efficiency, and radiologist satisfaction, as well as a reduction in moonlighting costs. This project leveraged Lean management principles to combat clinical inefficiency, waste time, and high costs.
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Improving Performance of Mammographic Breast Positioning in an Academic Radiology Practice. AJR Am J Roentgenol 2018; 210:807-815. [PMID: 29412019 DOI: 10.2214/ajr.17.18212] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this project was to achieve sustained improvement in mammographic breast positioning in our department. MATERIALS AND METHODS Between June 2013 and December 2016, we conducted a team-based performance improvement initiative with the goal of improving mammographic positioning. The team of technologists and radiologists established quantitative measures of positioning performance based on American College of Radiology (ACR) criteria, audited at least 35 mammograms per week for positioning quality, displayed performance in dashboards, provided technologists with positioning training, developed a supportive environment fostering technologist and radiologist communication surrounding mammographic positioning, and employed a mammography positioning coach to develop, improve, and maintain technologist positioning performance. Statistical significance in changes in the percentage of mammograms passing the ACR criteria were evaluated using a two-proportion z test. RESULTS A baseline mammogram audit performed in June 2013 showed that 67% (82/122) met ACR passing criteria for positioning. Performance improved to 80% (588/739; p < 0.01) after positioning training and technologist and radiologist agreement on positioning criteria. With individual technologist feedback, positioning further improved, with 91% of mammograms passing ACR criteria (p < 0.01). Seven months later, performance temporarily decreased to 80% but improved to 89% with implementation of a positioning coach. The overall mean performance of 91% has been sustained for 23 months. The program cost approximately $30,000 to develop, $42,000 to launch, and $25,000 per year to maintain. Almost all costs were related to personnel time. CONCLUSION Dedicated performance improvement methods may achieve significant and sustained improvement in mammographic breast positioning, which may better enable facilities to pass the recently instated Enhancing Quality Using the Inspection Program portion of a practice's annual Mammography Quality Standards Act inspections.
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Kadom N, Kruskal JB. Invited Commentary on “Realizing Improvement through Team Empowerment (RITE)”. Radiographics 2016; 36:2183-2185. [DOI: 10.1148/rg.2016160181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Larson DB, Mickelsen LJ, Garcia K. Realizing Improvement through Team Empowerment (RITE): A Team-based, Project-based Multidisciplinary Improvement Program. Radiographics 2016; 36:2170-2183. [DOI: 10.1148/rg.2016160136] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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