Improving the Quality of Magnetic Resonance Cholangiopancreatography Images

The purpose of this study was to address the variability in quality of magnetic resonance cholangiopancreatography (MRCP) images by examining differences in quality grades before and after modifying the MRCP protocol to include placement of physical bellows while scanning. This single institution quality improvement initiative included 727 MRCP examinations performed from July 2019 to December 2020 in patients 18 years and older. The Define, Measure, Analyze, Improve, and Control (DMAIC) strategy was utilized to explore factors related to MRCP image quality and identify solutions that could create effective change. Based on the results of this analysis, MRCP protocols were changed in December 2019 to include physical bellows. Examinations were grouped as occurring either pre- or postintervention as well as whether they occurred in an inpatient or outpatient setting. MRCP examinations were evaluated for quality and labeled either nondiagnostic or diagnostic. A logistic regression model was fit to compare the odds of a diagnostic QA grade between preintervention and postintervention groups and inpatient and outpatient settings. The preintervention group had 41.12% of MRCP studies of diagnostic quality, and the postintervention group had 60.57% of studies of diagnostic quality. The estimated odds of an image being of diagnostic quality in the postintervention group were 2.46 times the odds for the preintervention group across all departments and patient classes (P < 0.001). The estimated odds of an image being of diagnostic quality in the outpatient group were 2.01 times the odds for those in the inpatient group (P < 0.001). Utilizing a standardized quality improvement method can lead to sustained improvements in the diagnostic quality of MRCP studies.

Transition from Peer Review to Peer Learning: Lessons Learned

Landmark publications, such as To Err is Human, confronted the healthcare community with the egregious toll medical errors played in both patient safety and overall healthcare costs. This heralded a paradigm shift and a call for action by professional organizations to enact methods to ensure physician competency and quality assurance. The American College of Radiology similarly convened a task force to discuss these concerns and how best to address quality assurance in radiology practice, leading to the development of RADPEER, a score-based peer review system. However, critics were quick to point out the deficiencies of this model, highlighting it as punitive and a poor evaluator of physician performance. The recognized deficiencies in score-based peer review prompted the pursuit of an alternate model that would instead emphasize learning and improvement. Peer learning was proposed and highlighted the necessity of an inclusive and collaborative environment where colleagues could discuss case errors as learning opportunities without fear of punitive consequence. This paper explores peer learning, its benefits and challenges, as well as how to identify specific learning opportunities by utilizing case examples.