Download - Radiology Resident Quality Training Program
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Radiology Resident Quality Training Program
Paul Nagy, PhDFauzia Vandermeer, MD
Charles Resnik, MD
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Systems-Based Practice
“Very few doctors understand what is happening to the health care system in which they practice, why the system is changing so rapidly, and what they can do about it.”
Relman, Academic Medicine, 1998
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Goals
• Non didactic physician leadership training• Lightweight practical training in quality
methods• Create a learning culture of quality• Leverage IT as important tool for quality
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We do the big things well• Exponential growth in medical knowledge• Technological marvels abound in Radiology
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The downsides
• Technology has sterilized relationships• Continual subspecialization challenge
consistency and coordination of care in the 24/7 world.
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Death by a thousand cuts
• Coordination• Handoffs• Feedback• Collaboration• Communication• Checklists• Follow up
The cumulative affect of small barriers inhibit these important behaviors.
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Quality Manifesto
• A learning culture is built by launching 100’s of small projects to fix the cracks in our system.
• Large multiyear system upgrades merely enable a higher potential. You still need to roll up your sleeves and customize it to your local workflow and culture.
• What are you waiting for?
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ACGME Systems-based PracticeResidents must demonstrate an awareness of and responsiveness to the larger context
and system of health care, ..Residents are expected to:
(5) work in interprofessional teams to enhance patient safety and improve patient care quality; and,
(6) participate in identifying system errors and implementing potential systems solutions.
(8) be trained to identify existing systems problems that compromise their ability to provide the
most efficient and effective patient care. They must be trained to analyze systematically the problems, develop solutions, implement solutions, and evaluate the effectiveness of the intervention.
“Program Requirements ACGME Radiology”
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Education in practice mgmt
“When the researchers compared the five-year results from two medical schools, they found that students were significantly more satisfied with their education.”
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Example (Patient Consent Forms)
• Not applicable– DNAR
• Procedures by team members
• Permission to destroy organs
• Potentially confusing for patient, radiologist
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Resident Quality Requirements
• Core Curriculum in Quality– Attend Quality Academy for didactic training in Quality
Management– Participate in Peer Review conference– Perform one Quality Improvement Project– Present Quality Improvement Project at the Quality Academy
• Satisfies ACGME requirements for Practice-based Learning and Improvement and Systems-based Practice
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Resident Projects
Not another rotation!Projects are self paced (6 months - 2 years)Often they come up with their own problemWe provide resources and mentoring.Residency directors kept in the loopHand off to staff at completionUp to residents to take initiative
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Steps to a quality project
Effort (hrs)
Researching problemLiterature searchRead quality material
6-8 Hrs
Create teamDefine problemMap workflowIdentify barriersIdentify dataDocument Meetings
4-6 Hrs
Collect & Analyze dataUnderstand problemGroup exercisesCommunicate with teamDevelop intervention
10-12 Hrs
Collect & Analyze dataTest solutionMeet with teamCommunicate with teamDevelop interventionDocument Improvement6-8 Hrs
Verify solutionPresent at AcademyPublication (+40)
4-6 Hrs
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Project List• Patient Consent Forms• Mild contrast reaction medication access• Surgical followup• Pathology biopsy concordance• OR miscount handoff• ED Pneumonia • ED appropriateness of CT orders• Delayed study sending into PACS• Resident dictation accuracy• ACR appropriateness guidelines• Interventional resident consult checklist• Uncompleted studies delaying reporting process
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Tools
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UM PACS Context Button
Portal.radiology.umm.edu
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Context Integrated Form Manager
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Radtracker.radiology.umm.edu
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Technologist Report Cards
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Resident Review
• Interpretation review• Technical accuracy review• Automated report change
detection
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Processes
Take a set of activities and intertwining them to make an engine for quality.
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Internally Promoting Quality
Calendar of Events
Meeting AgendasQuality MissionRoles and
MembersCommittee
MinutesProject
TemplatesLinks to Quality
Tools
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Project Templates
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Engine of QualityIdentify Issues:
OperationsSafety WalkPeer Review
Work on Issues:Image Quality
SatisfactionQuality Clinic Present and Control:
Quality AcademyOperations
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Six Sigma/ Lean Certification
• Special Elective• Elective requirements also developed to provide more in depth training
in all “pillar” areas for residents interested in pursuing further study– Reading list on Quality– Attend one Operations meeting– Attend one Quality Leadership meeting– Attend one Image Quality meeting– Participate in safety walkabout inspection– Perform a survey design exercise– Submit an abstract on a project to a national meeting– Submit a peer review manuscript for publication– Act as a mentor to a junior resident on a Quality Project
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Univ of Maryland Results
• 25/32 residents have started a project• 11 2009 Abstracts to RSNA• 7 2009 Presentations on quality at RSNA• Six Sigma/Lean certification