16/10/2014. Acknowledgement. Contributing Authors:

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1 Acknowledgement Improving Quality And Safety In Delivering Radiology Services Through Innovative Technology Solutions In A Tertiary Care Teaching Hospital In The Developing World Contributing Authors: Syed Mohammad Sohail; Dr. Zafar Sajjad; Mohammad Yusuf; Amin Rajani Syed Mohammad Sohail Senior Manager, Radiology Agenda Pakistan Aga Khan University Hospital Radiology Department Innovative Solutions Pakistan Pakistan Demographics Population 180 million* Male : Female 52 : 48 Urban: Rural 36 : 64 Growth Rate 1.8% p.a. Under 15 years 35% *Estimated 1

2 Pakistan Pakistan Burden of Disease Communicable Diseases 38% Non-communicable Diseases 38% Maternal and Perinatal conditions 13% Injuries 11% Availability of Healthcare Population per Doctor : 1,234 (US: 413) Population per Nurse : 1,785 (US: 101) Population per bed : 1,666 (US: 333) The Aga Khan University Hospital, Karachi, Pakistan () Aerial View of 2

3 Aga Khan University Hospital, Karachi Acute Tertiary Care Teaching Hospital All services under one roof Comprehensive Inpatient and Outpatient services in almost all major disciplines using a multi-disciplinary approach 16 inpatient unitswith a total capacity of 685 beds, including 70 critical care beds High brand equity and quality of care 3

4 ,K On and Off Campus Activities Statistics 2013 Admissions 53,388 ALOS 3.26 Patient Days 174,000 ADC 486 Outpatient Visits 707,000 Lab Volumes 8.44M - Health Services Growth in Pakistan Impact Key Statistics Health Services Trend CAGR No of Hospitals % No of Outreach Centres % Average Available Beds % Inpatient Daily Census % Admissions 31,524 76,545 7% Surgeries 13,806 24,632 5% Deliveries 2,981 15,616 14% Outpatient Visits (in 000s) 325 1,017 9% Laboratory Volumes (in 000s) 2,102 8,440 11% Patient Welfare Disbursed $2.2M $7.8M 10% Patient Welfare (No. of cases) 12, ,025 23% 225,000+ Annual Procedures 12 Diagnostics Radiology Services State-of-the-art Modalities 240 Person team What makes the difference? The People The commitment to Quality and the pursuit of Excellence 4

5 Publications 200 International Recognitions o RSNA Radiological Society of North America o ISQua International Society for Quality in Healthcare o MIR Management in Radiology o IHF International Hospital Federation o SIIM Society for Imaging Informatics in Medicine Cum Laude Award Dr. M Kashif Mirza RSNA Education Exhibit Award Winner-2008 Cum Laude Award for research project on Radiology Report Search Engine using Google Desktop Recognition at ISQua-2012, Geneva Recognition at IHF Congress-2013, Oslo-Norway Participated in Parallel Session in International Hospitals Congress by IHF on June 18-20, 2013 in Oslo. Radiology Poster won the Best Poster Presentation award. Credentialing checks in Radiology reporting Innovative Technology Solutions Tele-radiology Reporting CTs and MRIs for Afghanistan CPOE Eliminating wrong patient identification Critical Radiology Reporting through IT Application Instant Patient Feedback Through SMS 5

6 Credentialing Checks in Radiology Reporting Credentialing Checks in Radiology Reporting CHALLENGES: Complex workflows involving IT Applications -Radiology Information System (RIS) and Voice Recognition System (VRS) Third party applications -Limitations of making amendments in off-the-shelf software. Developing credentialing checks in Voice Recognition System(VRS) for detecting Radiology reporting violations and ensuring 100% reporting by credentialed radiologists. ACHIEVEMENTS: Preventedreporting from non-credentialed radiologist Automated System eliminating credential violation Reporting of MRIs and CTs for underprivileged using Tele-Radiology Infant Mortality (per 1,000 births) War/Conflict > 30 years Indicators Afghanistan Region 3 Global 4 Mortality under 5yrs(per 1,000 births) Adult Mortality, b/w years (per 1,000) 2 Male/Female 289/ / /129 To provide Tele-Radiology service in ensuring quality reporting of CT (Computed Tomography) Scans and MRI (Magnetic Resonance Imaging) for effective healthcare delivery in Afghanistan. Maternal Mortality(per 100,000 live births) Health Workforce(per 10,000 population) Trends-WHO- 2 Afghanistan: health profile (WHO)- 3 WHO Eastern Mediterranean Region 4 WHO Global Historical Background A Partnership Among: 1. The Aga Khan University/Aga Khan Development Network 2. La chainede l espoir 3. The Government of France 4. The Government of Afghanistan 6

7 Reporting of MRIs and CTs for underprivileged using Tele-Radiology Tele-Radiology Services (2007-April2013) * Total CT scans sent to AKU for reporting ,388 1,640 MRI sent to AKU for reporting ,145 1,423 CT scans sent to AKU for quality assurance MRIs sent to AKU for quality assurance Computerized Physician Order Entry (CPOE) System for Radiology CHALLENGES: Heavy patient inflow from: Inpatients Emergency services scheduled patients walk-in patients Stress on: Receptionists Nursing staff Physicians Total ,776 3,660 To Implement Radiology Electronic Order Entry System to enhance Patients Safety And Process Efficiency. Computerized Physician Order Entry (CPOE) System for Radiology Process before improvement Computerized Physician Order Entry (CPOE) System for Radiology Process after improvement Critical Radiology Reporting through IT Application Critical Radiology Reporting through IT Application CHALLENGES: Compromised or delayed care Unreliable dependence on manual communication system To ensure fast communication to Emergency Physicians on critical radiology finding through IT application for timely care decision making. ER Complaints of delayed or no communication from Radiology Chancesof loss of communication 7

8 Critical Radiology Reporting through IT Application Instant Patient Feedback through SMS IMPROVEMENT/BENEFITS: PACS -based logging of Panic finding System -based automated communication to ER physician To obtain instant feedback from patients through SMS and its correlation with standard patient satisfaction survey results. Instant Patient Feedback through SMS Patient-Centered approach Closer-to-real Feedback due to being sought immediately after the service experience Measurement ofpatient Satisfaction: We capture, analyze and monitor patient satisfaction for Radiology service through on-going patient satisfaction surveys. Definition: All patients included in the sample are requested to respond to the question, were you overall satisfied with the quality of the service you received, in terms of strongly agree, agree, neutral, disagree and strongly disagree. Those who respond to this question in terms of strongly agree and agree are classified as overall satisfied patients. Numerator: # of overall satisfied patients Denominator: Total patients in the sample TargetGoal: 90% Quarter Q Q Q Q Q Numerator Denominator RESULT(%) Low-Cost way of seeking feedback Direct but impartial feedback communication between patient and service provider Target (90%) Thank You 8