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DOI: 10.1148/radiol.2412051400
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Implementation of Online Radiology Quality Assurance Reporting System for Performance Improvement: Initial Evaluation1

Jonathan B. Kruskal, MD, PhD, Chun S. Yam, PhD, Jacob Sosna, MD, Donna T. Hallett, BS, RT, Yolanda J. Milliman, RN and Herbert Y. Kressel, MD

1 From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215. From the 2005 RSNA Annual Meeting. Received August 29, 2005; revision requested October 13; revision received December 5; accepted January 6, 2006; final version accepted January 9. Address correspondence to J.B.K. (e-mail: jkruskal{at}bidmc.harvard.edu).


Figure 1
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  		Figure 1: Flowchart shows basic workflow (initial steps that occur after submission of a case) of online QA reporting system. Once a case is submitted, a member of RQMT assigns it to an appropriate reviewer. Once reviewed, the case is returned and reviewed by RQMT. If the team is satisfied with the review and outcome, the submitter is notified in an e-mail that the case has been reviewed and he or she can view the outcome or action items. At times, RQMT may request additional review, data, or actions from the reviewer. Once a case is closed, several steps occur (see Fig 2).

 

Figure 2
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  		Figure 2: Flowchart shows steps that occur after review by RQMT of a case submitted to online QA reporting system. Once its members are satisfied with review of a case, RQMT will submit data into a database that is monitored and analyzed to identify trends. Findings from case review may also result in the institution of a performance improvement (PI) action or the initiation of a quality improvement (QI) project. Data resulting from this quality improvement project are then analyzed, and a performance improvement action is introduced.

 

Figure 3
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  		Figure 3: Online status screen. In this example, status of each case is color coded to distinguish between new submissions (red), cases that have been assigned and date of assignment (green), cases that have been reassigned after 2 weeks (bold green), cases that have been reviewed (blue), red-flagged cases (bold red), and cases that have been reviewed and closed by the RQMT (black). These cases are simply illustrative examples. The accession number relates to the specific case being reported, allowing us to automatically import the report from that specific case. wet = Preliminary.

 

Figure 4
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  		Figure 4: Graph shows number of case submissions before and after implementation of online QA reporting system. Data are total numbers of clinical and technical cases submitted per month. Arrow = month in which online system was deployed. Letters on x-axis indicate months, from April of one year through June of the next.

 

Figure 5
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  		Figure 5: Examples of improvements to online QA reporting system since initial deployment. Identification of these additions was made possible through continuous evaluation of the system (plan), rapid implementation of additions (do), evaluation of the implemented change (study), and continuous monitoring of the effects of these additions (act). Additions and changes were also made in response to feedback solicited from users. PDSA = plan-do-study-act.

 




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