The winners of the TMC-ESR Radiology Quality Award 2014 from the Silkeborg Clinic (Denmark) with members of the jury. (From left to right: Lluís Donoso Bach (jury), Annette Meyer Balle, Jarl Jakobsen (jury), Rikke Aarhus, Peter Mildenberger (jury), Agnete Hedemann Nielsen, Hans Billing (jury), Susanne Skovlund Petersen, Ian McCall (jury))
The TMC-ESR Radiology Quality Award recognizes innovation and excellence in the European radiology community. It is an annual award designed to promote, inspire and recognize quality initiatives and innovation. Application is open to any radiology employee or group across Europe. A high level Pan-European jury (Ian McCall (UK, Chairman), Peter Aspelin (Sweden), Lluís Donoso Bach (Spain), Hans Billing (Sweden), Jarl Jakobsen (Norway), Peter Mildenberger (Germany), Emanuele Neri (Italy), Elisabeth Schouman-Claeys (France)) evaluates the contributions based on originality, usability, demonstrated impact and presentation. The submission period for the 2015 award opens on the 1st of April. Submissions are done via the myesr.org website. A direct link to the submission page will be published here when the submission period starts.
As “Knowledge Sharing” is one of TMC’s core values, we would like to share the conclusions of the three best abstracts with the radiology community.
At the inaugural edition 2014 the 10,000 € first prize was awarded to Agnete Hedemann Nielsen, Annette Meyer Balle, Susanne Skovlund Petersen and Rikke Aarhus of the Silkeborg Clinic in Denmark.
A significant quality defect was identified with the hospital only meeting national standards for diagnosis of minor stroke in 70% of cases. The team decided to take action to improve the situation. Problems that they had to overcome included reluctance towards changes in the hospital environment, the radiology department being seen as a service department only and developmental tasks usually being carried out by administrators not involved in the clinical practice.
The team’s efforts led to the creation of a so called “Plastic Organic Group”. The concept involved open meetings of short duration (15-30 min) with a focus on quality improvements for a certain patient category or pathway. The interdisciplinary meetings involved front-line staff, had no agenda and required continuous minutes. Initially secretaries, nurses, radiographers, medical doctors and radiologists were involved with other participants being added when needed. Equality among participants and disciplines was one of the cornerstones of the meetings. This setting allowed a fast and iterative development process, the results of which were assessed through regular audits and continuous measurements.
The initiative almost immediately had an impact. After 2 weeks national standards for diagnosis of minor stroke were met for 90% of patients. After 4 weeks waiting time was reduced fourfold. After 6 weeks diagnostic methods had been improved and reorganization led to increased outpatient scanning. Overall results included a reduced length of stay, reduced time of diagnosis, faster initiation of treatment as well as improved diagnostic accuracy. All of this was made possible by moving leadership closer to clinical practitioners and thus bridging the knowing-doing gap.
In second place was Antoni Malet, of the UDIAT Diagnostics Centre, which is part of the healthcare corporation Corporació Sanitària Parc Taulí (CSPT) in Sabadell, Spain. The goal of Antoni Malet’s project was to ensure ongoing quality control of on-call CT reports and to improve the assessment of resident radiologists.
At the UDIAT on-call night time and weekend reporting is performed by residents only, with senior residents supporting junior residents in their first year and partially in their second year. The reports are controlled by the attending subspecialist radiologists on the following workday. Through implemented changes in the RIS an assessment of discrepancies between residents and subspecialists in reporting of urgent chest and abdominal CT examinations was made possible. The results showed increased discrepancies between residents in their second year without senior resident support and the attending radiologist. Senior resident support for second year residents during on-call was thereafter made mandatory. Another finding was an increased discrepancy for residents reporting after 2 AM. Thus reporting after this time was limited as far as possible. Furthermore the analysis showed that reports delivered through teleradiology had the same discrepancy rates as locally produced reports.
The second challenge was related to the current assessment of residents by attending subspecialist radiologists, which was carried out through a questionnaire and was thus highly subjective. The discrepancy assessment in the new RIS allowed to document discrepancies of each resident and to evaluate the residents’ performance more objectively. The system also made it possible for residents to analyse their reports with discrepancies and to thus learn from their mistakes.
Vincent Cappendijk and Erik Ranschaert of the Jeroen Bosch Hospital in the Netherlands made third place with a solution that provides peer advice for severe cases of acute pancreatitis. Medical decisions related to this disease can be difficult due to the relative rarity of patients with severe acute pancreatitis and physicians usually having no support when diagnosing and treating it. The team has introduced the so called “Expertmail” concept to deal with this problem. They assembled a panel of 16 experts (8 surgeons, 4 gastro-enterologists and 4 radiologists) to give advice on complex forms of pancreatitis. The service is accessible 24/7, available nationwide and voluntary. A response is given within 24 hours of the request.
The first version of the service “Expertmail 1.0” is based on a simple e-mail request which includes a word document with relevant patient information and selected radiological images. The information provided is anonymized. Overall more than 60 hospitals in the Netherlands have used the service. The number of requests is increasing steadily, having reached around 12 requests per month in 2013. A survey of Expertmail 1.0 users revealed that the service is valuable to most, with 86% of requesting physicians stating that the advice received through Expertmail is a good support to build a treatment plan. However the survey also revealed that selecting the relevant images and completing the form takes a considerable amount of time for the requesting physicians. Another drawback is that the experts don’t have access to prior exams.
The updated Expertmail 2.0 makes use of the secured teleradiology network “Radiologienetwerk (RNW)” which allows sharing image data in a safer and more efficient way. Easy access is provided through a web-based image viewer and the requesting physician can provide patient information and ask questions through a web-based form instead of email. A pilot project including 8 hospitals will be setup to evaluate the new Expertmail 2.0 service.
The peer advice concept presented here is transferable and will hopefully be applied to other disease areas as well.