What Computer Tools to Use for Your Quality and Safety Program

Transcription

1 What Computer Tools to Use for Your Quality and Safety Program Lincoln L. Berland, M.D., F.A.C.R. University of Alabama at Birmingham

2 Disclosure Consultant to Nuance, Inc.

3 Learning Objectives Understand what computer systems can be used to extract data for radiological safety and examination quality. Understand the value of trend charts and control charts. Know the meaning of a dashboard and scorecard and how to generate them.

4 Process for Quality Success You have moved to the final stage of grief at having to do this (i.e. denial, anger, bargaining, sadness and acceptance) You understand that you have to do this You appreciate that it is a good thing You want to do it well You know that this will take a lot of time and effort Therefore, this is a brief guide to Quality Management, focused on process and tools needed

5 Important References Nagy PG, Warnock MJ, Daly M, et al. Informatics in Radiology: Automated Web-based Graphical Dashboard for Radiology Operational Business Intelligence. RadioGraphics : Kruskal JB, Anderson S, Yam CS, Sosna J. Strategies for Establishing a Comprehensive Quality and Performance Improvement Program in a Radiology Department. RadioGraphics : Series of JACR articles by Khorasani ACR, RSNA, many other publications, online sites

6 Process to Improve Quality Commitment at the top of your practice Appoint a high-level champion of quality Assemble a Quality Council Include radiologists, IT personnel, technologists, administrators Determine initial objectives (more later) Establish & research local or national guidelines and benchmarks against which to measure success > Policies & Procedures

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8 UAB Radiology Policies & Procedures Body Imaging Index Lesion Measurement Guide Critical Results CT IV Access Guidelines Downtime Procedures GI Protocols Hand Hygiene Guidelines MRI Protocols Outside Exam Policy Peg Tube Policy Policy on BE, CTC After Incomplete Colonoscopy Policy on Changed Reports UAB Radiology Contrast Safety Card UABHS IV Contrast Guidelines UABHS Pregnancy Guidelines

9 Process to Improve Quality Evaluate human and technical resources Human - IT employees and/or outsourced technical support Technical RIS PACS Voice recognition system EMR

10 Technical Support Quality efforts must be integrally related to technical team support Assess capacity of each system to collect data related to objectives At this point may find that cannot address some objectives Should consider replacing or upgrading some systems - software revisions can bring (or eliminate some capabilities) All new systems must be assessed for data acquisition and mining features Treat this process like any major equipment acquisition

11 Targeting Objectives Limit objectives to available resources and systems under your control National Patient Safety Goals (NPSGs) Other TJC requirements ACR RadPeer (or homegrown equivalent) Lab accreditation GRID (General Radiology Improvement Database) ABR Quality project requirement ACGME

12 Figure 2b. Key performance indicator domains Kruskal J B et al. Radiographics 2009;29: by Radiological Society of North America

13 Figure 5. Graph and chart illustrate the monitoring of compliance with the Joint Commission s NPSGs and several radiology-specific metrics Kruskal J B et al. Radiographics 2009;29: by Radiological Society of North America

14 Finally - the Tools No universal commercial comprehensive tools, although some are becoming available Depends on your systems, design capability Some of best tools are proprietary to academic institutions, although some now licensed to companies Inside your institution: EMR data acquisition tools Excel, other consumer graphics applications May need to borrow from outside medicine: Business intelligence software Web development tools

15 Dashboards Dashboard monitors data continuously Variably short intervals - preferably automatically updated Case management Resource utilization, undictated examinations, no show rate Customer (patient or referring physician) service TAT, patient delays, scheduling delays

16 The main page of the dashboard provides an overview of the major key performance indicators Nagy P G et al. Radiographics 2009;29: by Radiological Society of North America

17 Figure 7. Screen shot shows a dashboard that indicates the number of unread, nondictated, and unapproved cases per clinical section on a daily basis. Drilling down into each box reveals the case type and the responsible radiologist. Kruskal J B et al. Radiographics 2009;29: by Radiological Society of North America

18 Figure 6. Screen shot shows examples of radiology s vital signs Kruskal J B et al. Radiographics 2009;29: by Radiological Society of North America

19 Scorecards Scorecards list data periodically Departmental performance Section performance Individual performance

20 Departmental Performance

21 REGISTRATION MEAN SCORE PAT SAT Target MR/PET Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08

22 Figure 3. Performance indicators used in a radiology department. Spider ( radar ) chart illustrates the major categories of indicators that can be used to monitor technical and clinical performance in a radiology department Kruskal J B et al. Radiographics 2009;29: by Radiological Society of North America

23 Figure 8. Clinical quality indicators report Kruskal J B et al. Radiographics 2009;29: by Radiological Society of North America

24 Figure 10. Service levels and access to services Kruskal J B et al. Radiographics 2009;29: by Radiological Society of North America

25 Figure 12. Environmental and safety walkabout Kruskal J B et al. Radiographics 2009;29: by Radiological Society of North America

26 Sectional Performance

27 Figure 4. Graph illustrates the performance indicators for an abdominal imaging section Kruskal J B et al. Radiographics 2009;29: by Radiological Society of North America

28 Bubble chart shows radiologists report turnaround time for 1 month by departmental section Nagy P G et al. Radiographics 2009;29: by Radiological Society of North America

29 Individual Performance

30 Figure 14. Schematic illustrates options that can be used to assess the performance of a radiologist (scorecard), including an anonymous process for comparing performance with that of peers; means of evaluating diagnostic or procedural performance (chart, morbidity and mortality reviews); and a variety of metrics defined by departments (good citizenship criteria), the hospital administration (general competencies and peer evaluations), and the ABR (maintenance of certification). Kruskal J B et al. Radiographics 2009;29: by Radiological Society of North America

31 Figure 9. Graph illustrates the overall report turnaround time (in hours) for different faculty (y-axis) (names removed for peer review purposes) and shows the amount of time from completion of examination to dictation (blue), from dictation to transcription (red), and from transcription to approval (yellow) 2009 by Radiological Society of North America Kruskal J B et al. Radiographics 2009;29:

32 Figure 13. Screen shot illustrates how data from a selected performance indicator ( Peer Review of Radiologist Performance ) are collected and depicted as a dashboard. Kruskal J B et al. Radiographics 2009;29: by Radiological Society of North America

33 Data Analysis

34 Dual-axis graph shows the average outpatient waiting time for mammography (green line) as a function of the time of day (24-hour clock) Nagy P G et al. Radiographics 2009;29: by Radiological Society of North America

35 Dual-axis graph shows high-priority inpatient study requests from the time of ordering to the time of procedure completion Nagy P G et al. Radiographics 2009;29: by Radiological Society of North America

36 Results and Transparency

37 Graph shows the 2-year progression in the percentage of reports that were signed promptly in the radiology department after implementation of automated quality control and dashboarding tools. Nagy P G et al. Radiographics 2009;29: by Radiological Society of North America

38 Graph shows number of case submissions before and after implementation of online QA reporting system Kruskal J B et al. Radiology 2006;241: by Radiological Society of North America

39 Summary Selecting tools follows commitment of human and other resources Tools depend on existing and planned information systems Should evaluate at multiple levels Share data with faculty to communicate and motivate further improvement