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Discover the framework for QA in imaging services, focusing on radiology reporting from an Independent Sector viewpoint. Explore grading systems, feedback mechanisms, and the impact of QA on practice and learning. Learn how QA data can improve patient care and support clinical governance.
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QA – The Independent Sector Perspective Stephen Davies Consultant Radiologist Cwm Taf Health Board Medical Director and Responsible Officer Medica Reporting @sgd999
Declaration • Medical Director Medica Reporting
Overview • Consider a framework for QA of Imaging Services • Relate this to the Independent Sector • Examine one area in detail – radiology reporting • Relate this to UK radiology practice
ISAS and Independent Sector • ISAS: ‘patients have the reassurance that the imaging services central to their core pathway are operating to a high quality standard’ • Quality systems underpin good business practice; manage risk • Required in Tendering process
QA of Radiology Reporting • Quality Assurance – ‘assurance’ • Audit should inform a change in practice
Audit • 10% cross-sectional imaging • 2% plain film • Scoring – binary? • Scoring in Independent Sector
Report Content and Discrepancy ScoringThe Independent Sector or ‘GMC’ scoring • Grade 1: Unequivocal potential for serious morbidity or threat to life • Grade 2: Moderate morbidity but not threat to life • Grade 3: clinical significance is debatable or likelihood of harm is low • Grade 4: Disagreement over style &/or presentation • Grade 5: No disagreement
Radpeer – American College of Radiology • 1 – Concur with interpretation • 2 - Difficult diagnosis, not ordinarily expected to be made • 3 - Difficult diagnosis should be made most of the time • 4 - Diagnosis should be made almost every time – misinterpretation of findings
Medica ‘In House’ system • Patient outcome score 1-5 • Observation score • Interpretation score • Communication score
Teleradiology context • Rapid feedback – through Insight™ • Virtual – unlike departmental consensus – so arbitration • Intelligent management of process - AWT • Large database • Otherwise much is common with real departments
QA data: change in practice • Organisation – client • Organisation – provider • Individual – radiologist • Group - radiologists
Learning Organisation • Individual Learning – reflective review of discrepancies • Group Learning – monthly discrepancy briefings • Organisation – e.g. Nighthawk process; image quality
Individual Learning • Single case – perception, interpretation; knowledge • Trends – reflective review • Feedback: • ‘I realise that I have not looked at the bone windows in every case’ • ‘I have learnt from these cases and my search pattern for acute abdominal imaging will include…..’ • ‘I think that I should take more time checking reports for typos’ • ‘This was a really useful exercise and I will apply it to my NHS practice’
GMC and Revalidation • GMC Revalidation requires doctors to show continuing fitness to practice – outcome audit data of reporting performance can be used. e.g. Domain 2 • A Designated Body needs to demonstrate good clinical governance • A positive audit report reassures the patient and importantly also the radiologist.
Final Thoughts • Independent Sector is focused on quality assurance of imaging services in a number of domains • There are opportunities for the Independent Sector to share practice with the NHS for the benefit of patients • ISAS provides a framework for developing audit relating to imaging services in both sectors – linkage with CQC • QA should be used as a development tool for individuals and organisations
Reference: Is Yours a Learning Organization? Garvin DA et al (2008). Harvard Business Review March 2008. Reprint R0803H.