IMPROVINGCOMPLIANCEANDDOCUMENTATIONOFCTQUALITYCONTROLUSINGANELECTRONICQUALITYASSURANCE
PRACTICEMANAGEMENTTOOL
Phuong-Anh Duong MDRebecca Neill MS, Matthew E. Zygmont MD,
Pratik Rachh MD, MBA
1
BACKGROUND
• Periodicqualitycontrol(QC)testsarerequiredforcomputedtomography(CT)andothermodalities
• Trackingcomplianceacrosslargerhealthcaresystemscanbechallenging– Time-constrainedtechnologistsmayforgettoperformQCtests
– Resultshistoricallywererecordedonpaper– Oversightandmonitoringofresultsinfrequent– Correctiveactionsareoftendelayed
CURRENT (BASELINE) CONDITIONS
• DailyQCmaintainedonpaperrecordfrom3/2015to3/2016• PaperlogsauditedbyCTphysicistquarterly• ActualQCperformancewastrackedusingsoftware
(Radimetrics,Bayer)todetectthepresenceofadailyphantomscan
• CTphysicistforwardedactualperformancedataonamonthlybasistositeQCleadtoencouragedailycompliance
Duringthebaselineperiod(3/2015to3/2016)themedianactualcompliancewithdailyQCwas89%,asmeasuredbythedailyphantomscan.Thisdatachallengedthenearly100%reportedcompliancedocumentedonpaper.
GOAL: AIM STATEMENT
• ImplementaQCmanagementsystemthatallowsonlinedocumentation,remindersforlateresults,andnotificationofaberrantresults
• ImprovecomplianceanddocumentationofdailyCTQCteststo100%by4/2017usinganonlinemanagementsystem
ONLINE QA PLATFORM
Acommerciallyavailablequalityassurancemanagementsoftware(ZapIT!Medical)wasimplementedtotrackdaily,monthly,andannualQCfor25CTscanners.
DOCUMENTATION
DATA ENTRYStarting3/2016,technologistsweretrainedtoperformdailyandmonthlyQCperACRrecommendationsandrequiredtologresultsinthesystem.
QA HISTORY & APPROVAL
GRAPHICAL VIEWS
NOTIFICATIONS
• Notificationsareconfiguredperindividualpreference• Emailortextremindersareavailable• AlertsremindtechnologistsifQCwasnotperformedby
aspecifiedtime• MedicalphysicistalertedoftestfailuresandmissingQC
QC NOTIFICATIONS IN-PATIENT SETTING
Ifby7AM,QCnotperformedanddocumented,responsibleShift1TechnologistemailedQCreminder.
Ifby8AM,QCnotperformedinShift1,Shift2supervisorreceives
reminder.AssignsQCtoShift2Technologist.
Ifby11AM,QCnotperformed,MedicalPhysicistreceives
notification.MedicalPhysicistescalatestosupervisorandmanager.
SupervisorormanagerassignsQCtoShift2Technologist.
METRICS/RESULTS
• After8/2016,therunchartshowedashift inthemediancomplianceratefrom89%pre-implementationto97.5%postimplementation.
• 24abnormalresultswererecordedandcorrectiveactionsweredocumentedintheonlinetool
24 ABERRANT RESULTS ADDRESSED
ResultNo.ofOccurrences Action
QC ValueIncorrectlyRecorded 8 • Retraining• Exclude resultandrepeatQC
measurement
RingArtifactIdentified 4 • AirCalibrationperformedand/orservicecontacted
QCValueoutoftolerance 4 • RepeatTest• ContactService
QCProtocol requiresadjustment– baselinenoiselevellowerthanselectedrange
6 • Physicist correctedQCprotocol
BrokenPhantom 2 • Siteordered newphantom
CONCLUSIONS
• TheonlineQCmanagementtoolimprovedcompliancewithdailyQCfrom89%to97.5%.
• Abnormalresultsandremediationstepsareeasilydocumentedforauditorreview.
• ThesoftwaretoolenabledasinglephysicisttoeffectivelytrackQCfrom25CTscannersacrossmultiplesites.