Advertisement

Radiology Research in Quality and Safety

Current Trends and Future Needs
Published:November 29, 2016DOI:https://doi.org/10.1016/j.acra.2016.07.021
      Promoting quality and safety research is now essential for radiology as reimbursement is increasingly tied to measures of quality, patient safety, efficiency, and appropriateness of imaging. This article provides an overview of key features necessary to promote successful quality improvement efforts in radiology. Emphasis is given to current trends and future opportunities for directing research. Establishing and maintaining a culture of safety is paramount to organizations wishing to improve patient care. The correct culture must be in place to support quality initiatives and create accountability for patient care. Focused educational curricula are necessary to teach quality and safety-related skills and behaviors to trainees, staff members, and physicians. The increasingly complex healthcare landscape requires that organizations build effective data infrastructures to support quality and safety research. Incident reporting systems designed specifically for medical imaging will benefit quality improvement initiatives by identifying and learning from system errors, enhancing knowledge about safety, and creating safer systems through the implementation of standardized practices and standards. Finally, validated performance measures must be developed to accurately reflect the value of the care we provide for our patients and referring providers. Common metrics used in radiology are reviewed with focus on current and future opportunities for investigation.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Institute of Medicine
        To err is human: building a safer health system.
        (Washington, DC)2000
        • Centers for Medicare and Medicaid Services
        Quality initiatives and patient assessment instruments.
        (Available at) (Accessed July 11, 2016)
        • Muething S.E.
        • Goudie A.
        • Schoettker P.J.
        • et al.
        Quality improvement initiative to reduce serious safety events and improve patient safety culture.
        Pediatrics. 2012; 130: e423-e431
        • Mardon R.E.
        • Khanna K.
        • Sorra J.
        • et al.
        Exploring relationships between hospital patient safety culture and adverse events.
        J Patient Saf. 2010; 6: 226-232
        • Pronovost P.J.
        • Berenholtz S.M.
        • Goeschel C.A.
        • et al.
        Creating high reliability in health care organizations.
        Health Serv Res. 2006; 41: 1599-1617
        • Larson D.B.
        • Kruskal J.B.
        • Krecke K.N.
        • et al.
        Key concepts of patient safety in radiology.
        Radiographics. 2015; 35: 1677-1693
        • Siewert B.
        • Hochman M.G.
        Improving safety through Human Factors Engineering.
        Radiographics. 2015; 35: 1694-1705
        • Cosby K.S.
        • Croskerry P.
        Profiles in patient safety: authority gradients in medical error.
        Acad Emerg Med. 2004; 11: 1341-1345
        • Abujudeh H.H.
        “Just culture”: is radiology ready?.
        J Am Coll Radiol. 2015; 12: 4-5
        • Singer S.J.
        • Gaba D.M.
        • Falwell A.
        • et al.
        Patient safety climate in 92 US hospitals: differences by work area and discipline.
        Med Care. 2009; 47: 23-31
        • Institute of Medicine
        Keeping patients safe: transforming the work environment of nurses.
        National Academies Press, Washington, DC2004
        • The Joint Commission
        Revisions to LD.03.01.01.
        (Hospital Accrediation Program. Jan 2012; Available at) (Accessed October 28, 2015)
        • Agency for Healthcare Research and Quality
        Hospital survey on patient safety culture.
        (Available at) (Accessed October 28, 2015)
        • Donnelly L.F.
        • Dickerson J.M.
        • Goodfriend M.A.
        • et al.
        Improving patient safety: effects of a safety program on performance and culture in a department of radiology.
        AJR Am J Roentgenol. 2009; 193: 165-171
        • Legg J.S.
        • Aaron L.
        • Dempsey M.C.
        Patient safety perceptions among vascular interventional technologists.
        J Allied Health. 2013; 42: 106-111
        • Singer S.J.
        • Meterko M.
        • Baker L.C.
        • et al.
        Patient Safety Climate in Healthcare Organizations (PSCHO).
        Measurement Instrument Database for the Social Science, 2006 (Available at) (Accessed October 28, 2015)
        • Singer S.J.
        • Falwell A.
        • Gaba D.M.
        • et al.
        Patient safety climate in US hospitals: variation by management level.
        Med Care. 2008; 46: 1149-1156
        • Donnelly L.F.
        • Dickerson J.M.
        • Goodfriend M.A.
        • et al.
        Improving patient safety in radiology.
        AJR Am J Roentgenol. 2010; 194: 1183-1187
        • Falcone Jr, R.A.
        • Daugherty M.
        • Schweer L.
        • et al.
        Multidisciplinary pediatric trauma team training using high-fidelity trauma simulation.
        J Pediatr Surg. 2008; 43: 1065-1071
        • Ruddy R.M.
        • Patterson M.D.
        Medical simulation: a tool for recognition of and response to risk.
        Pediatr Radiol. 2008; 38: S700-S706
        • Bump G.M.
        • Calabria J.
        • Gosman G.
        • et al.
        Evaluating the clinical learning environment: resident and fellow perceptions of patient safety culture.
        J Grad Med Educ. 2015; 7: 109-112
        • Accreditation Council for Graduate Medical Education
        Clinical Learning Environment Review (CLER).
        (Available at) (Accessed May 9, 2016)
        • Kadom N.
        • Sloan K.
        • Gupte G.
        • et al.
        Radiology residency quality improvement curriculum: lessons learned.
        Curr Probl Diagn Radiol. 2016; 45: 319-323
        • Institute for Healthcare Improvement
        Open school for health care professionals.
        (Available at) (Accessed May 9, 2015)
        • American Hospital Association
        Hospitals in pursuit of excellence.
        (Available at) (Accessed May 9, 2016)
        • Swensson J.
        • McMahan L.
        • Rase B.
        • et al.
        Curricula for teaching MRI safety, and MRI and CT contrast safety to residents: how effective are live lectures and online modules?.
        J Am Coll Radiol. 2015; 12: 1093-1096
        • Pfeifer K.
        • Staib L.
        • Arango J.
        • et al.
        High-fidelity contrast reaction simulation training: performance comparison of faculty, fellows, and residents.
        J Am Coll Radiol. 2016; 13: 81-87
        • Gould B.E.
        • Grey M.R.
        • Huntington C.G.
        • et al.
        Improving patient care outcomes by teaching quality improvement to medical students in community-based practices.
        Acad Med. 2002; 77: 1011-1018
        • Coleman M.T.
        • Nasraty S.
        • Ostapchuk M.
        • et al.
        Introducing practice-based learning and improvement ACGME core competencies into a family medicine residency curriculum.
        Jt Comm J Qual Saf. 2003; 29: 238-247
        • Oyler J.
        • Vinci L.
        • Arora V.
        • et al.
        Teaching internal medicine residents quality improvement techniques using the ABIM's practice improvement modules.
        J Gen Intern Med. 2008; 23: 927-930
        • Peters A.S.
        • Kimura J.
        • Ladden M.D.
        • et al.
        A self-instructional model to teach systems-based practice and practice-based learning and improvement.
        J Gen Intern Med. 2008; 23: 931-936
        • Patow C.A.
        • Karpovich K.
        • Riesenberg L.A.
        • et al.
        Residents' engagement in quality improvement: a systematic review of the literature.
        Acad Med. 2009; 84: 1757-1764
        • Voss J.D.
        • May N.B.
        • Schorling J.B.
        • et al.
        Changing conversations: teaching safety and quality in residency training.
        Acad Med. 2008; 83: 1080-1087
        • Wong B.M.
        • Etchells E.E.
        • Kuper A.
        • et al.
        Teaching quality improvement and patient safety to trainees: a systematic review.
        Acad Med. 2010; 85: 1425-1439
        • Leape L.L.
        Reporting of adverse events.
        N Engl J Med. 2002; 347: 1633-1638
        • Jones D.N.
        • Benveniste K.A.
        • Schultz T.J.
        • et al.
        Establishing national medical imaging incident reporting systems: issues and challenges.
        J Am Coll Radiol. 2010; 7: 582-592
        • Itri J.N.
        • Krishnaraj A.
        Do we need a national incident reporting system for medical imaging?.
        J Am Coll Radiol. 2012; 9: 329-335
        • World Alliance for Patient Safety
        WHO draft guidelines for adverse event reporting and learning systems.
        2005
        • Altman D.E.
        • Clancy C.
        • Blendon R.J.
        Improving patient safety—five years after the IOM report.
        N Engl J Med. 2004; 351: 2041-2043
        • Leape L.L.
        • Berwick D.M.
        Five years after to err is human: what have we learned?.
        JAMA. 2005; 293: 2384-2390
        • White J.
        Adverse event reporting and learning systems: a review of the literature.
        2007
        • Pennsylvania Patient Safety Authority
        Annual report 2015.
        (Available at) (Accessed May 9, 2016)
        • The Royal Australian and New Zealand College of Radiologists
        Welcome to the Radiology Events Register (RaER): Australian Patient Safety Foundation.
        (Available at) (Accessed December 14, 2015)
        • Welti K.
        Disclosure of medical adverse events: a study of the University of Michigan health system model.
        Massachusetts Bar Association, 2007 (Available at) (Accessed July 11, 2016)
        • Malpass A.
        • Helps S.C.
        • Runciman W.B.
        An analysis of Australian adverse drug events.
        J Qual Clin Pract. 1999; 19: 27-30
        • Kaldjian L.C.
        • Jones E.W.
        • Wu B.J.
        • et al.
        Reporting medical errors to improve patient safety: a survey of physicians in teaching hospitals.
        Arch Intern Med. 2008; 168: 40-46
        • Mendelson D.S.
        • Rubin D.L.
        Imaging informatics: essential tools for the delivery of imaging services.
        Acad Radiol. 2013; 20: 1195-1212
        • Safdar N.M.
        • Siegel E.
        • Erickson B.J.
        • et al.
        Enabling comparative effectiveness research with informatics: show me the data!.
        Acad Radiol. 2011; 18: 1072-1076
        • Post A.R.
        • Kurc T.
        • Cholleti S.
        • et al.
        The Analytic Information Warehouse (AIW): a platform for analytics using electronic health record data.
        J Biomed Inform. 2013; 46: 410-424
        • Chute C.G.
        • Beck S.A.
        • Fisk T.B.
        • et al.
        The Enterprise Data Trust at Mayo Clinic: a semantically integrated warehouse of biomedical data.
        J Am Med Inform Assoc. 2010; 17: 131-135
        • Ferranti J.M.
        • Langman M.K.
        • Tanaka D.
        • et al.
        Bridging the gap: leveraging business intelligence tools in support of patient safety and financial effectiveness.
        J Am Med Inform Assoc. 2010; 17: 136-143
        • VanLare J.M.
        • Conway P.H.
        Value-based purchasing—national programs to move from volume to value.
        N Engl J Med. 2012; 367: 292-295
        • Institute of Medicine, Committee on Quality of Health Care in America
        Crossing the quality chasm: a new health system for the 21st century.
        (Washington, DC)2001
        • Donabedian A.
        Evaluating the quality of medical care. 1966.
        Milbank Q. 2005; 83: 691-729
        • American College of Radiology
        ACR Accreditation.
        (Available at) (Accessed July 14, 2016)
        • Narayan A.
        • Cinelli C.
        • Carrino J.A.
        • et al.
        Quality measurements in radiology: a systematic review of the literature and survey of radiology benefit management groups.
        J Am Coll Radiol. 2015; 12 (e23): 1173-1181
        • Gray C.G.
        Team vs. individual performance appraisals.
        (Available at) (Accessed July 17, 2016)
        • Office of Personnel Management (OPM)
        1998: performance appraisal for teams.
        (Available at) (Accessed July 17, 2016)
        • Hunter J.
        The W. Edwards Deming Institute Blog.
        (Available at) (Accessed July 17, 2016)
        • Deming W.E.
        Out of the crisis.
        Massachusetts Institute of Technology, Center for Advanced Engineering Study, Cambridge (MA)1986
        • Agency for Healthcare Research and Quality (AHRQ)
        2014: safety culture.
        (Available at) (Accessed July 17, 2016)
        • Office of Personnel Management (OPM)
        1993: evaluating team performance.
        (Available at) (Accessed July 17, 2016)
        • Centers for Medicare and Medicaid Services
        Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) incentive under the physician fee schedule, and criteria for physician-focused payment models.
        (Available at) (Accessed July 17, 2016)
        • Morin R.L.
        • Seibert J.A.
        • Boone J.M.
        Radiation dose and safety: informatics standards and tools.
        J Am Coll Radiol. 2014; 11: 1286-1297
        • Centers for Medicare and Medicaid Services
        Physician quality reporting system.
        (Available at) (Accessed March 21, 2016)
        • Hendee W.R.
        • Becker G.J.
        • Borgstede J.P.
        • et al.
        Addressing overutilization in medical imaging.
        Radiology. 2010; 257: 240-245
        • Khorasani R.
        • Hentel K.
        • Darer J.
        • et al.
        Ten commandments for effective clinical decision support for imaging: enabling evidence-based practice to improve quality and reduce waste.
        AJR Am J Roentgenol. 2014; 203: 945-951
        • Zafar H.M.
        • Mills A.M.
        • Khorasani R.
        • et al.
        Clinical decision support for imaging in the era of the Patient Protection and Affordable Care Act.
        J Am Coll Radiol. 2012; 9 (907–18 e5)
        • Johnson C.D.
        • Swensen S.J.
        • Applegate K.E.
        • et al.
        Quality improvement in radiology: white paper report of the Sun Valley Group meeting.
        J Am Coll Radiol. 2006; 3: 544-549
        • Sanelli P.C.
        • Gold R.L.
        • Greenberg E.D.
        • et al.
        Work-in-progress toward incorporating patients' preferences in practice guidelines for imaging aneurysmal subarachnoid hemorrhage.
        Acad Radiol. 2009; 16: 535-540
        • Itri J.N.
        Patient-centered radiology.
        Radiographics. 2015; 35: 1835-1846
        • Lacson R.
        • O'Connor S.D.
        • Andriole K.P.
        • et al.
        Automated critical test result notification system: architecture, design, and assessment of provider satisfaction.
        AJR Am J Roentgenol. 2014; 203: W491-W496
        • Larson P.A.
        • Berland L.L.
        • Griffith B.
        • et al.
        Actionable findings and the role of IT support: report of the ACR Actionable Reporting Work Group.
        J Am Coll Radiol. 2014; 11: 552-558
        • The Joint Commission
        Sentinel event data.
        (Available at) (Accessed May 9, 2016)
        • The Joint Commission
        Hospital national patient safety goals.
        (Available at) (Accessed May 9, 2016)
        • Kelley L.
        Improving satisfaction performance through faster turnaround times.
        Radiol Manage. 2011; 33: 38-41
        • Rosenkrantz A.B.
        • Bonavita J.A.
        • Foran M.P.
        • et al.
        Is there an association between radiologist turnaround time of emergency department abdominal CT studies and radiologic report quality?.
        Emerg Radiol. 2014; 21: 5-10
        • Hussain S.
        • Hussain J.S.
        • Karam A.
        • et al.
        Focused peer review: the end game of peer review.
        J Am Coll Radiol. 2012; 9 (e1): 430-433
        • Borgstede J.P.
        • Lewis R.S.
        • Bhargavan M.
        • et al.
        RADPEER quality assurance program: a multifacility study of interpretive disagreement rates.
        J Am Coll Radiol. 2004; 1: 59-65
        • Brook O.R.
        • Romero J.
        • Brook A.
        • et al.
        The complementary nature of peer review and quality assurance data collection.
        Radiology. 2015; 274: 221-229
        • Abujudeh H.
        • Pyatt Jr, R.S.
        • Bruno M.A.
        • et al.
        RADPEER peer review: relevance, use, concerns, challenges, and direction forward.
        J Am Coll Radiol. 2014; 11: 899-904
        • Butler G.J.
        • Forghani R.
        The next level of radiology peer review: enterprise-wide education and improvement.
        J Am Coll Radiol. 2013; 10: 349-353
        • Loreto M.
        • Kahn D.
        • Glanc P.
        Survey of radiologist attitudes and perceptions regarding the incorporation of a departmental peer review system.
        J Am Coll Radiol. 2014; 11: 1034-1037
        • Larson D.B.
        • Nance J.J.
        Rethinking peer review: what aviation can teach radiology about performance improvement.
        Radiology. 2011; 259: 626-632
        • Johnson C.D.
        • Krecke K.N.
        • Miranda R.
        • et al.
        Quality initiatives: developing a radiology quality and safety program: a primer.
        Radiographics. 2009; 29: 951-959
        • Sorace J.
        • Aberle D.R.
        • Elimam D.
        • et al.
        Integrating pathology and radiology disciplines: an emerging opportunity?.
        BMC Med. 2012; 10: 100
        • Siewert B.
        • Sosna J.
        • McNamara A.
        • et al.
        Missed lesions at abdominal oncologic CT: lessons learned from quality assurance.
        Radiographics. 2008; 28: 623-638
        • Ladley D.
        • Wilkinson I.
        • Young L.
        The impact of individual versus group rewards on work group performance and cooperation: a computational social science approach.
        J Bus Res. 2015; 68: 2412-2425
        • Kanne J.P.
        Peer review in cardiothoracic radiology.
        J Thorac Imaging. 2014; 29 (quiz 277-278): 270-276
        • Mendiratta-Lala M.
        • Eisenberg R.L.
        • Steele J.R.
        • et al.
        Quality initiatives: measuring and managing the procedural competency of radiologists.
        Radiographics. 2011; 31: 1477-1488
        • Bari V.
        Direct observation of procedural skills in radiology.
        AJR Am J Roentgenol. 2010; 195: W14-W18
        • Ahmed K.
        • Keeling A.N.
        • Khan R.S.
        • et al.
        What does competence entail in interventional radiology?.
        Cardiovasc Intervent Radiol. 2010; 33: 3-10
        • Powell D.K.
        • Jamison D.K.
        • Silberzweig J.E.
        An endovascular simulation exercise among radiology residents: comparison of simulation performance with and without practice.
        Clin Imaging. 2015; 39: 1080-1085
        • Nesbitt C.I.
        • Birdi N.
        • Mafeld S.
        • et al.
        The role of simulation in the development of endovascular surgical skills.
        Perspect Med Educ. 2016; 5: 8-14
        • Itri J.N.
        • Jones L.P.
        • Kim W.
        • et al.
        Developing an automated database for monitoring ultrasound- and computed tomography-guided procedure complications and diagnostic yield.
        J Digit Imaging. 2014; 27: 270-279