Quality in emergency radiology dr.dinesh

1. Quality in Emergency Radiology
How we do it
Dinesh Varma
Associate Professor
Acting Director of Radiology
Head of Emergency and Trauma Radiology
The Alfred & Monash University. Melbourne
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2. Quality
• Practice Management System
• Equipment
• Personnel
• Regisitration and Licencing
• CPD
• Professional Supervision
• Appropriateness of Request and Patient
Preparation
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3. Safety
• Safety of the Practice Environment
• Infection control
• Patient management
• Radiation Safety
– ALARA Principle
– Compliance with Radiation Safety
Legislation
– Radiation Safety Officer
– Waste Management
– Use of Contrast Media
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4. Purpose
• Commitment to Best Practice through an evidence-based
culture,
• Focus on patient outcomes and equity of access to high quality
care
• An attitude of compassion and empathy.
• Acting with Integrity
• Ethical approach: doing what is right, not what is expedient;
• Forward thinking and collaborative attitude and patient-centric
focus.
• Accountability
• Strong leadership that is accountable to patients
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5. Quality Manager
•The practice personnel records identify: the quality manager and his/her
associated job description; OR
•that the role of quality manager is fulfilled within the practice across more
than one position, and the practice can identify which personnel members
fulfill this role and how this is co-ordinated.
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6. Quality Manual
The quality manual includes a quality policy defining the quality objectives.
The quality policy is issued under the authority of senior management,
Ensures continual improvement of the effectiveness of the management
system and to the quality of all services provided.
•It includes policies relating to the management system.
•It outlines the structure of the practice’s documentation hierarchy.
•It makes reference to supporting documentation.
•It defines the role and responsibilities of management personnel, including
the Quality Manager.
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7. Documentation
Document on policies, guidelines and procedures
A master list of controlled documents shall be maintained
which identifies the current version and distribution of
documents.
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8. Documentation
Established documentation system
All documents are uniquely identified to include the date
of issue or revision number, page numbering and the
issuing authority.
Define how changes to documents are to be made and
controlled including documents maintained in
computerised systems.
Periodically reviewed and revised when necessary
Only current versions of documents are available.
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9. Documentation
Master copies of old and/or superseded document versions
are retained or archived for legal and knowledge
preservation purposes and are appropriately identified.
When its examinations involve remote reporting via
teleradiology, the practice has documentation clearly
defining the agreed responsibilities of both the examining
and reporting sites.
This includes issues of liability, patient safety, transmission
arrangements, report turnaround times and confidentiality.
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10. Records
Procedures shall be established for the integrity,
identification, collection, storage, protection and disposal
of records.
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11. Corrective and Preventive Action
Have a process for identifying and investigating
non-conforming work and departures from
authorised policies and procedures, and for
implementing corrective action/s accordingly.
It has a process for identifying and implementing
preventive action to eliminate the causes of
potential non-conformities, incidents and adverse
clinical events.
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12. Continuous Quality Improvement
Establish a program of continuous quality improvement
for the key areas of operations.
This program of activity will include corrective and
preventive action and be supported by internal audits,
and assessments conducted by external bodies where
applicable.
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13. Audit of documentation of pregnancy status
July 2013- June 2014
Pregnancy status
recorded, 473, 52%
Pregnancy status
not recorded, 435,
48%
Angiography and Fluoroscopy cases
(2013-2014) Females aged 15-50 y •Total 908 exams
• No unplanned foetal exposures
• Difficulties with compliance
• Manual data entry and non-mandatory
field
• Definition of child-bearing capacity
• Question might have been asked, but
documentation needed improvement
• Pregnancy status has become a mandatory
field as of 1 July 2014
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14. Pregnancy Status Check updated and Included on Procedure Worksheet
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15. 2. Quality Program
Patient ID Incidents Per Annum
Monthly- Consistently more in first half of year Incidents PA
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16. Feedback and Complaints
Feedback is actively sought from patients and referrers
to ensure appropriate service provisions, patient and
referrer satisfaction and continuous quality improvement.
Have a policy covering the procedure for handling
complaints
Records are maintained of all feedback, complaints,
investigations and corrective actions taken.
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18. Patient Delay Audit
Main Radiology CT/US/Angio/Fluoro
• Total - 73 patients
experienced a delay
across a period of 9 days
• Multitude of different
reasons for delay
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19. What this equates to in terms of patients
• CT - 13 hours = 34 pts
• US - 8 hours = 16 pts
• Angio - 7 hours = 5 pts
• Fluoro – 6.5 hours = 5 pts
Next steps :
• Feedback to NM group
• Look at solutions to issues
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20. Management Review
Senior management shall regularly review the practice
management system to ensure continuing suitability and
effectiveness in support of patient care and to introduce
any necessary changes for improvements.
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21. Facilities for Imaging Procedures
Allow the safe and correct performance of diagnostic
and/or interventional radiology services.
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22. Diagnostic Equipment
• Monitors
• Workstations
• Digital data image management
• Exchange of digital image data and reports
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23. Equipment Inventory
Maintain a current equipment inventory, which is
supplemented by an equipment register.
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24. Equipment
Ensure that all equipment (including software) is
appropriate to its use and that it is appropriately
maintained so that imaging results are consistently of
diagnostic quality.
The practice complies with legislation concerning the
procurement, sale or disposal of any equipment which
generates ionising radiation.
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25. Personnel
• Recruitment of Personnel
• Orientation
• Training
• Qualifications, Registration and Licensing
– Radiologist
– Radiograpgers
– Nurse
– Physicist
– Admin staff
– Service personnel
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26. CPD/CME/Credentialing
– Radiologist
– Radiograpgers
– Nurse
– Physicist
– Admin staff
– Service personnel
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27. Performance of the Imaging Examination
• Review of Appropriateness of Request and Patient
Preparation
• Utilisation of Medical Imaging Techniques
• Administration of Contrast
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28. Interpretation and Reporting
A single named radiologist is to be responsible for the
supervision, interpretation and reporting of the entire
study.
Where a trainee radiologist has reported under
supervision, this should be indicated in the report.
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29. Communication of Imaging Findings
and Reports
Ensure that reports are made available in a clinically
appropriate, timely manner and shall carry out regular
reviews at least once every year on the time between the
performance of the study and the issuing of the report.
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30. Infection Control
All applicable regulatory health-related infection control
guidelines shall be followed.
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31. Hand Hygiene- One moment Compliance
Average compliance = 12/13 - 60% 13/14 – 64%
General x-ray remain the best!!
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32. Radiation Safety
• ALARA Principle
• Compliance with Radiation Safety Legislation
• Radiation Safety Officer
• Waste management
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33. Reportable Radiation Incidents
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34. Patient Management
• Patient Identification and Records
• Correct Patient, Site and Procedure
• Discharge Procedure
• Patient Consent
• Privacy Policy
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35. Patient Identification and Verification
The aim of this Standard is to ensure that the health workforce correctly
identifies all patients whenever care is provided and correctly matches
patients to their intended treatment.”
– Examples of patient identifiers
> patient name (family and given names)
> date of birth
> gender
> address
> medical record number and/or Individual Healthcare Identifier.
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36. Open Disclosure
Open disclosure is the open discussion of
incidents that result in harm to a patient while
receiving health care with the patient, their family,
carers and other support persons.
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37. Open Disclosure
Implement an open disclosure program
which is consistent with the National Open
Disclosure Framework
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38. IV Contrast Extravasation
Retrospective Study May 2010 - March 2015
Contrast Injections n = 57,148 CT = 39,629, MRI = 17,519
Number of extravasations: CT = 124, MRI = 13
CT incidence = 0.31%,
reported range in literature 0.1-1.2%(1-4)
MRI incidence = 0.07%,
reported incidence in literature of 0.05%(3)
IP - fully documented compliance with protocol 82%
OP - fully documented compliance with protocol 75%1. Wang CL,et al. Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69,657 intravenous injections. Radiology. 2007;243(1):80-7.
2. Wienbeck S, et al. Prospective study of access site complications of automated contrast injection with peripheral venous access in MDCT. AJR Am J Roentgenol. 2010;195(4):825-9.
3. Cochran ST,et al. Trends in adverse events after IV administration of contrast media. AJR Am J Roentgenol. 2001;176(6):1385-8.
4. Sinan T, et al. Contrast media extravasation: manual versus power injector. Med Princ Pract. 2005;14(2):107-10.
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39. Conclusion
High-quality patient care is our most important product and
it requires a deliberate and organized approach.
Important to embed quality and safety in everyday care that
embraces continuous improvement around key outcome
measures related to quality, safety, process improvement,
outcome assessment, and patient and staff satisfaction.
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40. Thank you
D.Varma@alfred.org.au
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