QUALITY IMPROVEMENT ON A GLOBAL LEVEL- HOW CAN THIS TASK BE ACCOMPLISHED?
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1 QUALITY IMPROVEMENT ON A GLOBAL LEVEL- HOW CAN THIS TASK BE ACCOMPLISHED? Marilyn J. Goske MD Chair, Alliance for Radiation Safety in Pediatric Imaging Corning Benton Endowed Chair for Radiology Education Professor of Radiology Cincinnati Children s Hospital Medical Center
2 Quality Improvement on a global level- how can this task be accomplished? The purpose of this talk is to review successful strategies that have promoted large scale quality improvement. While there is an increasing body of work that discussed practice quality improvement at a facility level, how can this knowledge be leveraged for quality improvement on a much larger scale in medical physics? This talk will review successful strategies and discuss how these strategies can be applied to the medical physicist community for the purpose of optimizing radiation dose and improving care of children worldwide
3 Goal At the end of the talk, the participant will understand strategies to improve quality in radiology practice and how this can be applied to the world community
4 Objectives Review an example of large scale quality improvement Define the steps of the PQI cycle Discuss the QMP role as part of team Provide example of PQI at a local and international level Use of Image Gently resources for PQI
5 Objectives Review an example of large scale quality improvement Define the steps of the PQI cycle Discuss the QMP role as part of team Provide example of PQI at a local and international level Use of Image Gently resources for PQI
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8 Actions to achieve large system improvement Roman Empire 100 AD Systematic transfer of knowledge Creation of an environment that facilitated the uptake of ideas Unified policy framework and infrastructure for spread adapted locally Create an army to spread change
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10 What is the justification for practice quality improvement?
11 Why do we care about Practice Quality Improvement (PQI)? In 1999, the Institute of Medicine (IOM), a scientific advisory group, issued a report called To Err is Human: Building a Safe Health System* It stated that medical error was a significant cause of morbidity and mortality in the Unites States (US) Medical error is a more common cause of death in the U.S. than breast cancer or motor vehicle accidents! *Corrigan JM, Kohn LT, Donalsons, MS, eds. To Err is Human: Building a Safe Health System, Institute of Medicine 44,000 to die each 98,000 year from medical die error. annually in U.S. It is estimated that up to 98,000 U.S. citizens
12 Quality and safety in radiology First, do no harm After the Hippocratic oath
13 Medical error in radiology New York Times July 31, 2010
14 Medical error in radiology
15 February 28, 2011
16 Goals of PQI Improve quality of care for patients Reduce error Minimize medical legal risk Save money
17 Objectives Review an example of large scale quality improvement Define the steps of the PQI cycle Discuss the QMP role as part of team Provide example of PQI at a local and international level Use of Image Gently resources for PQI
18 What is Practice Quality Improvement? Ongoing, organization-wide framework to monitor all aspects of an organization s activities for the purpose of continuous improvement. Applegate KE. Continuous Quality Improvement for Radiologists Acad Radiol 2004;11:
19 The American College of Radiology summarizes PQI as: PQI is a path to establish best practices, determine variations in practice, and standardize these practices to minimize error Hillman BJ, Amis ES, Neiman HL, et al. The future quality and safety of medical imaging: proceedings of the Third Annual ACR Forum. J Am Coll Radiol 2004;1:33-9.
20 The United Kingdom Health Foundation stresses the following key principles Courtesy of UK Health Foundation: Used with permission
21 Quality can be difficult to assess in a complex medical system Break the process into simple steps or metrics - a standard of measurement - a reference point against which other things can be measured
22 Important components of PQI Focus on the patient Break down the process into steps Understand variation that may lead to error Test on a small scale before implementing Teamwork
23 Implementing practice quality improvement PLAN DO STUDY ACT (PDSA) is an improvement method that includes 4 steps: 1. Plan a test 2. Do the test 3. Study the outcomes of the test 4. Act on knowledge gained from the test ACT PLAN STUDY DO
24 PQI project: Reduce variation A goal of PQI in pediatric CT is to reduce the variation for CT scans of the same body part for patients of the same body size. While a facility has protocols for patient of the same age, weight or size (the preferred method), what process is in place to ensure that this happens? Monitoring variation through the use of a chart may be helpful.
25 PLAN the test Example: Identify a problem: wide variability in image quality in 2008 Verify problem exists based on data from previous scans Create a corrective plan of action Establish a goal of 95% compliance Baseline scan Follow-up is 2X dose! Follow-up a month later
26 DO the test Developed an intervention to ensure that CT scans are performed reliably and with minimal variation based on patient body size Test on small scale Re-test on a larger scale
27 STUDY the test ACT PLAN DO STUDY Is the subjective image quality the same for a patient of the same size for the same scan indication? What is the variation?
28 ACT on the results ACT PLAN DO STUDY Evaluate for best practice best practice Check for outliers Data collection and feedback continue until 95 % compliance achieved
29 RESULTS: Reducing variation in image noise Larson DB et al. System for verifiably optimizing CT radiation dose based on patient size and desired image quality, enabling large-scale quality control. Part 2. Clinical application. Radiology,. Published online before print June 19, 2013, doi: /radiol With permission by the authorr.
30 Objectives Review an example of large scale quality improvement Define the steps of the PQI cycle Discuss the QMP role as part of team Provide example of PQI at a local and international level Use of Image Gently resources for PQI
31 PQI takes team-work Medical Imaging Physicist Manufacturer Radiologist Radiologic Technologist
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35 Objectives Review an example of large scale quality improvement Define the steps of the PQI cycle Discuss the QMP role as part of team Provide example of PQI at a local and international level Use of Image Gently resources for PQI
36 PQI is a science 2013 Vol 35 (1)
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38 Examples of large scale quality improvement in Radiology
39 Conduct research
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41 Large scale improvement Slide courtesy of Dr. Karen Thomas, Sick Kids Hospital, Toronto
42 Applications of the PDSA cycle To analyze estimated radiation dose from a hospital or facility enrolled in the ACR Dose Index Registry (DIR) To compare its pediatric doses to those from similar facilities For patients of the same body size For the same clinical scan indication
43 Promote awareness
44 International organizations that promote radiology protection for children on a large scale
45 There are many international organizations that work toward radiation protection ALATRO: Latin American Society of Therapeutic Radiology and Oncology ASTRO: American Society of Therapeutic Radiology and Oncology EANM: European Association of Nuclear Medicine EC: European Commission ESTRO: European Society of Therapeutic Radiology and Oncology FORO: Iberoamerican Forum of Nuclear Regulators. IAEA: International Atomic Energy Agency IAMRA: International Association of Medical Regulatory Authorities; ICRP: International Commission on Radiological Protection IFMSA: International Federation of Medical Students' Associations ILO: International Labour Organization IOMP: International Organization of Medical Physics IRPA: International Radiation Protection Association IRQN: International Radiology Quality Network ISR: International Society of Radiology ISRRT: International Society of Radiographers and Radiological Technologists NEA: Nuclear Energy Agency UN: United Nations UNSCEAR: United Nations Scientific Committee on the Effects of Atomic Radiation WFME: World Federation for Medical Education WFNMB: World Federation of Nuclear Medicine and Biology WMA: World Medical Association
46 International Radiology Quality Network Promote quality in radiology since 2002 Collaboration is strength Promote evidencedbased and appropriate utilization Work with WHO, IG to develop simple guidelines
47 International Radiation Protection Agency Arose from Health Physics Society 1960s One of first to create international umbrella association Large regional and international meeting
48 International Society of Radiology Founded in 1925 Sponsors international congress and virtual congress Open source textbooks Journals to underserved populations Hans Ringertz, Past President
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50 International Society of Radiographers and Radiologic Technologists
51 Brazilian College of Radiology and Diagnostic Imaging
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53 Provide Education and Training
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55 Strengthen infrastructure Building workforce
56 What can be done to increase the number of radiologic technologists worldwide?
57 Creating communities of learners
58 Implement Policies
59 Regulatory actions European Commission Euratom Treaty FDA International Electrotechnical Commission
60 Objectives Review an example of large scale quality improvement Define the steps of the PQI cycle Discuss the QMP role as part of team Provide example of PQI at a local and international level Use of Image Gently resources for PQI
61 Alliance for Radiation Safety in Pediatric Imaging Founded in 2007 To improve radiation protection for children worldwide >74 health care organizations/agencies >800,000 radiologists radiology technologists medical physicists
62 Social marketing Social marketing is similar to an advertising campaign Target audience 1. Public 2. Health professionals 3. Vendors 4. Government 5. Agencies 6. Parents/public 1. Print Media 2. Internet 3. Television 4. Posters Scientific publications 7. Social media
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67 Susan John, MD Chair of CR/DR Education committee
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69 Online PQI project and worksheet Funded by FDA contract
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72 Actions to achieve large system improvement Systematic transfer of knowledge Creation of an environment that facilitated the uptake of ideas Unified policy framework and infrastructure for spread Create an army to spread change
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75 THANK YOU
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