Quality and Efficiency at AHRA 2009
Rather than adhere to that time-honored conference format known as the Q&A session, Tuesday's AHRA '09 featured two talks that emphasized Q&E--quality (as in images) and efficiency (as in workflow).
The equipment of your diagnostic facility might suggest a paragon of diagnostic excellence, but those high-tech offerings don't mean a thing without the zing of efficient workflow, said Eduard Michel, MD, PhD, during his early morning presentation, "Avoiding Eight Pitfalls that Impair Workflow Efficiency."
Articulating how yesterday's workflow attitudes hamstring today's technologies, the medical director and co-founder of Virtual Radiologic Corp. clearly struck a nerve among attendees: Dr. Michel was fielding audience questions until the final seconds of his presentation. Explaining how the workflow of radiologists is traditionally fine-tuned by their predecessors and is therefore highly resistant to change, Dr. Michel identified workflow sinkholes that can harm facilities, and lifelines administrators and practice owners can use to haul themselves out of those holes. Among the areas covered:
Outdated work lists--These lists, insisted Dr. Michel, should not be created on the basis of what radiologists regard as a fair distribution of duties (a system that invites cherry-picking), but rather, what the group president feels is the best distribution of cases. His solution: a programmable "intelligent work list" that organizes studies based on factors such as a radiologist's specialty.
Visually dependent workflow navigation--This phenomenon invites interpretation distractions such as computer program menus and toolbar icons. Dr. Michel's solution: eyes-free navigation, including foot pedals that activate monitors and "claw" devices adapted from the video gaming industry that can be programmed to perform onscreen shortcuts.
Physicians performing nonphysician work--Radiologists fritter away valuable time tracking down clinicians to avoid miscommunication of results. Dr. Michel's solution: Delegate the phone-jockeying to personnel other than radiologists.
Comparison cases on film or disk--Comparing cases on different media invites extreme frustration. His solution: Import films or old PACS data into a new system and build an old-case archive.
These solutions, said Dr. Michel, can help ensure that workflow efficiency is at its peak, and that maximum levels of revenue continue to flow unfettered into the practice.
Shifting to matters of quality in the talk "Image Quality in the Digital Environment," two presenters with ties to Boston's Massachusetts General Hospital explained how the facility used an ambitious pilot program to reduce costly technologist errors following MGH's 1996 transition to digital imaging.
With digital adoption came a new set of problems involving technologists, said Kathy Tabor-McEwan, BS, RT(R), the former director of clinical operations at MGH and the current executive director at Boca Raton (Fla.) Community Hospital. Increasingly, errors including patient misidentification, failure to complete exams and lack of adherence to positioning standards were interfering with radiologists' ability to perform their duties--and the problem wasn't confined to one modality.
"It really begins and ends with technologists," noted speaker Mary-Theresa Shore, MSM, CIIP, RT(R)(CT)(MR), PACS administrator at MGH and a former technologist. Shore and Tabor-McEwan recognized the challenge they faced: to detail on paper exactly how these errors were affecting radiologists' work so they could explain to technologists the repercussions of their mistakes.
Developing categories to measure image integrity, data integrity and data systems at the site, they documented the extent of the problem and launched a six-month image quality pilot program in 2003 that targeted the emergency radiology department. Technologists received a detailed explanation of the various errors that had occurred at MGH and how those errors were impacting the facility. Although the education effort was not punitive in nature, technologists were defensive initially.
"They felt, ‘You're taking away what we're in control of,'" said Tabor-McEwan. Each technologist was required to attend a Digital 101 lecture, for which they received credit from the American Society of Radiologic Technologists (ASRT). They also received a 10-step information sheet that outlined how various errors had been impacting the facility--and how they could be avoided.
The pilot program was a resounding success: Errors in image integrity dropped 73 percent, and data integrity errors fell by 76 percent. Soon, the program expanded to encompass the entire imaging department. Heartened by its success, Tabor-McEwan plans to implement a similar program at Boca Raton Community Hospital.
Click HERE to read notes from the first day of the conference.