QI/PI ResearchNadja Kadom, MD

Overview

• Why do QI?• What is the difference between QI or PI?• How is a QI/PI project done?• Where does the Model for Improvement come

from?• What type of projects should I do?

Why do QI/PI?

Overview

• Why do QI?• What is the difference between QI or PI?• How is a QI/PI project done?• Where does the Model for Improvement come

from?• What type of projects should I do?

What is the difference between QI and PI?

Patient SafetyCompliance Performance• PQRS• ACR accreditation• ACR center of

Excellence• Critical results

reporting

• TAT• Decision support• Anything else…..

• Radiation dose• Contrast reactions• ACR-AC

Local Level

Quality and Safety

National Level

Overview

• Why do QI?• What is the difference between QI or PI?• How is a QI/PI project done?• Where does the Model for Improvement come

from?• What type of projects should I do?

Reducing Radiology Voice Recognition (VR) Errors

Mohammadali Mojarrad1, Kristin MacDougall2, Nadja Kadom2, 3

1Boston University School of Medicine, Boston, MA2Boston University Medical Center, Boston, MA3Emory University, Atlanta, GA

One day……….

How could a highly

educated professional

make mistakes like that?

11

Eliminate VR errors from my reportsHelp others to do the same

My personal goal

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Improve the value of the radiology report

My mission

Percentage of reports with ≥1 errors:

35% (Pezzulo et.al. 2008)22% (*Quint et al. 2008)

*Radiologist error rates from 0-100%*No difference native vs. non-native*No difference faculty alone vs. faculty/trainee

Information gathering

Hawkins 2014

Technical errors: VR

•F.I.R.E.Feasible, Interesting, Relevant, Ethical

• S.M.A.R.T.Specific, Measurable, Actionable, Realistic, Timely

15

Feasibility

16

Feasibility

17

Relevance

We will reduce the number of VR errors

in Dr. Kadom’s reports by 20%

by August 31, 2014.

What?For Whom?How good?By When?

Initial Aim

Team Members

Name Type FunctionMohammadali Mojarrad Medical student Day-to-Day leaderKristin McDougall RIS Manager Data accessNadja Kadom Physician Stakeholder

Decrease VR errors by 20% • Quality of

microphone• Quality of

software• Background

noise• Trainable

• Proof reading• Enunciation• Use of macros• Switch off

microphone

Driver Diagram

Improvement Ideas ReasoningProofreading NecessaryChecklist To prompt proof reading habitFix “disk-disc” error Easy fix in softwareFix “insert macro” error Insert manually rather than

dictateUser profile reset Manufacturer requestBackground noise Cannot improveNotify manufacturer of issues

Voice files deleted

New software No money

Improvement Ideas

Outcome measure% of reports with errors# errors / report

Process measureProofreading evidenced by observer

Balancing measureTime spent proofreading

Family of measures

Resident(n=428)

Faculty(n=518)

Total(n=946)

#reports with errors 157 (37%) 269 (52%) 426 (45%)

#errors per report 0.5 1.0 0.75

July 2013 – June 2014

1 weekday (resident) and 1 weekend day (attending) each month

Baseline

Changed aim: < 22%Added aim: < 0.5 errors/report

baseline

Aim

We will reduce the number of VR errors

in Dr. Kadom’s reports

to below 22% and reduce errors per

report to below 0.5by August 31, 2014.

What?For Whom?How good?By When?

Revised aim

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History: spelling errors Technique: contrast dose Findings: Proofread

No displaced Nondisplaced

Conus colon isColon :Comma CommonNo Do‘Slight’‘Marked’

Insert macro

Checklist/Prompt

Intended Transcribed Error typehypodensities hyperdensities Mis-senseAnd extracranial

And except for the area ofNon-sense

glenoid deniedpresented with Omission

Is normalcoronalover

Addition

through to Translationalherniated hernited Editorial/Typ-o

Study data

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• Proofreading• Proofreading• Course in proofreading• New job- new VR system

Pdsa cycles

Attending: % reports with errors

Summer staff

shortage

Goal

New Erro

r

Attending: #errors per report

Summer staff

shortage

Goal

Lessons learned

• Proofreading technique helps• Staff shortage does not help• New error types with templates• QI project now a QA project

PassionIOM goals

Team,Current state,

metrics etc.

Measure& Observe

Celebrate successes

Overview

• Why do QI?• What is the difference between QI or PI?• How is a QI/PI project done?• Where does the Model for Improvement

come from?• What type of projects should I do?

Dr. W. edwards Deming Biography• Born October 14, 1900 in Sioux City Iowa• Died December 20, 1993• BS in electrical engineering from the University of Wyoming 1921• MS in Mathematics & Mathematical Physics from the University of Colorado 1925• PHD in in Mathematics & Mathematical Physics from Yale 1928• Mathematical physicist at the United States Department of Agriculture (1927–39) • Statistical Advisor US Census Bureau 1935-1945• Professor of Statistics at NY University 1946-1993• As a census consultant under general Douglas MacArthur taught statistical control methods to Japanese business leaders • 1947 – taught Japanese engineers and managers statistical process controls – the message: improving quality will reduce expenses while increasing productivity and market share.• Credited with enabling Japan to become a world business power by the 1980’s due to image of quality• 1979-1982 – worked for Ford Motor Co. credited for making Ford the most profitable US Auto manufacturer by 1986

Deming’s System of Profound Knowledge

1. Appreciation of a system: understanding the overall processes involving suppliers, producers, and customers (or recipients) of goods and services

2. Knowledge of variation: the range and causes of variation in quality, and use of statistical sampling in measurements

3. Theory of knowledge: the concepts explaining knowledge and the limits of what can be known

4. Knowledge of psychology: concepts of human nature

PDSA cycle

STUDY PLAN

DO

ACT

PROCESSIMPROVEMENT

RAPID CYCLE TESTING

P

D

S

A

P

D

S

A

P

D

S

A

P

D

S

A

Overview

• Why do QI?• What is the difference between QI or PI?• How is a QI/PI project done?• Where does the Model for Improvement come

from?• What type of projects should I do?

Donabedian - 1980STRUCTURE

PROCESS

OUTCOME

Donabedian, Avedis. 1980. Explorations in Quality Assessment and Monitoring, Volume I & II: The definition of quality and approaches to its assessment and monitoring. Chicago: Health Administration Press.

QUALITYP + S + O = QUALIY

Harvey HB, Hassanzadeh E, Aran S, Rosenthal DI, Thrall JH, Abujudeh HH. Key Performance Indicators in Radiology: You Can't Manage What You Can't Measure. Curr Probl Diagn Radiol. 2016 Mar-Apr;45(2):115-21.

How is care organized?Stable elements of the

health care system

What is done to the patient?

Technical & Interpersonal

Patient health?End result?

Thank you.nkpiano@gmail.com