Background and Rationale

Resident Driven Quality Improvement

Arash R. Zandieh MD1, Danielle DeMulder MD1, Matthew J. Minn MD1, Cirrelda J. Cooper MD2

1 = Resident Physician, Medstar Georgetown University Hospital, Department of Radiology, Washington DC2 = Vice Chair, Professor and Co-Chief of Abdominal Imaging, Medstar Georgetown University Hospital, Department of Radiology, Washington DC

Example Quality Improvement & Patient Safety Projects Discussion

Conclusion

Acknowledgements

Abstract

At our institution, we hold a regular monthly

Radiology Departmental meeting to review

quality metrics and patient safety in a

comprehensive manner. Resident-driven

quality improvement and safety projects are a

central feature of the conference. The

meeting serves as a platform for integrating

clinical education and quality improvement

while encouraging trainee initiative and

leadership in a practical, hands-on approach.

Such an approach is easily reproducible and

may be employed at other educational clinical

sites to facilitate resident education and

foster a commitment to patient safety.

The Department of Radiology at our

institution hosts a one hour monthly Quality

and Safety Conference in a consistent time

slot and day. The conference is targeted to

attending physicians, fellows and residents

but open to the entire department, including

nurses, technologists, administrators, support

staff and medical students. The conference is

designed to review quality metrics, recent

occurrence reports and safety. The

centerpiece is a resident-driven 20 minute

segment on quality improvement, which

provides a highly visible platform for residents

to showcase individual projects before the

entire department.

The conference is organized and run by the

Vice Chair, who oversees departmental

operations and patient safety. Resident

participation is sanctioned by the residency

program director. Each Radiology resident

selects a project in consultation with the Vice

Chair.

A regular departmental meeting with

structured participation provides residents the

opportunity to gain hands-on experience in

quality improvement and to make positive

and publicly recognized impact on quality and

safety in their daily work environment. Such

an approach can be easily adopted by clinical

sites and integrated into resident education

curricula. Moreover, this approach actively

engages residents and encourages trainee

initiative, with the goal of fostering a life-long

commitment to patient safety and high quality

health care.

Residents review relevant literature on their

topic and outline their approach with the Vice

Chair. In most cases, initial presentations are

structured to briefly review background

information, present current baseline

department data, strategies to improve

outcomes and are followed by group

discussion. After initiation of process

changes, follow-up metrics are obtained and

presented at later conferences. Most

individual projects are designed to be

longitudinal in nature, encompassing more

than one process improvement cycle.

In some cases, presentations are mostly

educational, without measurable outcomes,

to increase awareness of active safety issues

or to develop consensus policies. Residents

are encouraged to make their presentations

interesting and entertaining. The Vice Chair

provides evaluations to the resident and

program director.

Resident-driven projects have generated

visible process changes, improved outcomes

and increased department interest in quality

improvement. For example, the contrast

allergy project resulted in significantly

improved department metrics. “Error-Bot” has

been highly successful in decreasing targeted

report errors, fostering multiple creative spin-

off projects.

The authors gratefully acknowledge Ashley

Stowell for organizing and facilitating the

monthly meetings; Patricia Cloonan PhD,

Bernard J Horak PhD FACHE, and Eileen

Moore MD for their editorial insights; Ross

Filice MD for developing and implementing

Error-Bot, and the Medstar Georgetown

radiology residents for their enthusiastic

participation.

Sources for Topics

Hospital Initiatives

- Patient identification

- Falls

- Line-associated

infections

Occurrence Reports

- Contrast reactions

- Extravasation events

- Wrong exam

Literature Review

- Radiation dose and

shielding

- Dictation errors

Daily Work

- ED / clinical history

reconciliation

- Gender errors

- Left/right errors

Departmental Topics

- Exam quality

- On-call corrections

- Pre-procedure labs

and policy

- Intra-department

communication

- Power-injectable ports

Resident project reviewed contrast media reactions generated from technologist occurrence reports and assessed

documentation in radiology reports and in variably linked, in some cases noncommunicating, databases used for

inpatient and outpatient care. Initial data indicated a disconnect in dissemination of information on allergic reactions in

both radiology reports and hospital IT systems. Intervention with education, follow-up and feedback shows significant

improvement in the documentation of allergies in radiology reports but continuing challenges in the integration and

dissemination of contrast allergy information in other systems.

After presenting a review of literature on errors in mammography reports, this resident noted the erroneous mention of

seminal vesicles in the CT report of a female patient. He and Dr. Ross Filice were inspired to create a detection

system, termed Error-Bot, to flag gender mismatch errors by comparing patient gender with key words in the dictation.

If incompatible elements are found, dictating physician(s) are immediately and automatically paged. Multiple spin-off

projects have resulted, some addressing targeted right-left errors .

Quality of CT PE studies: How can we improve? Arash Zandieh, MD

Tell me where it hurts: Clinical history

in studies ordered by the ED

Amit Kalaria, MD

Inspired by daily work encounters, this resident selected

“r/o stone” abdomen pelvis CT studies from the ED as a

case model to assess if relevant clinical history –

specifically the site of pain – was provided by ordering

physicians and verified by CT technologists at the time

of study. In this case, information provided by the ED

was better than anticipated. Follow-up now underway is

geared toward increasing technologist verification.

Consensus policy Dan daSilva, MD

Falls in radiology PJ Bergquist, MD

Resident reviewed occurrence

reports, outlining root causes

and risk factor analysis, and

proposed strategies for fall

prevention.

Projects also include the

development of department

wide consensus policies.

Contrast allergy reconciliation: How well do we communicate contrast reactions?

Danielle DeMulder, MD

Dictation errors: Why does the CT report say this woman has seminal vesicles?

Matthew Minn, MDError-Bot Improvements

Follow-up

Source: https://www.mededportal.org/icollaborative/resource/741