ASNR PRACTICE QUALITY IMPROVEMENT (PQI)
PRACTICE QUALITY IMPROVEMENT REQUIREMENT FOR MAINTENANCE OF CERTIFICATION:
The American Board of Radiology (ABR) requires delegates to participate in a Practice Quality Improvement Project in order to meet maintenance of certification (MOC) Part IV requirements. As a benefit to our members, ASNR provides resources to assist in the fulfillment of these requirements, including general information, an ABR-approved project template in pediatric dose reduction, and a sample project of implementing a standardized nomenclature for MR of Lumbar Disk Disease and referring physician survey to measure the impact of the initiative.
In general PQI Projects broadly conform to the following template. Select a topic and decide what you will measure to assess current performance and future improvement. A data collection form is usually needed to record the measurements
- Make a baseline measurement in an appropriate number of cases
- Analyze results
- Identify the potential causes of error or suboptimal performance
- Develop a written improvement plan
- Implement the plan
- Re-measure: Determine whether or not you have met your performance goal; if so, select another project to start, while maintaining the gains made in the initial project; if not, continue with the initial project.
ABR suggested PQI topics include:
- Patient Safety
- Clinical Practice Guidelines*
- Accuracy of Interpretation - double read (RadPEER)
- Referring physician surveys*
- Report timeliness and Critical Value Reporting
- Quality awareness
* To view an example PQI project based on these topics
EXAMPLE PQI PROJECT
In this example we will be using "Referring Physician Surveys" to measure the impact of implementing a standardized nomenclature for MR of Lumbar Disk Disease on physician-to-physician communication.
Referring Physician Lumbar Spine Nomenclature Survey
In many instances the benefits of diagnostic imaging are not realized until the referring physician acts upon the results of the study. Thus the neuroradiologist's communication with that physician and the feedback on the quality of care the neuroradiologist delivers is highly valuable. This PQI project will focus on use of standard nomenclature and classification for lumbar disc disease.
The Nomenclature and Classification of Lumbar Disc Pathology was initially published in March 2001 and is currently being updated. The classification has been endorsed by the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology and other societies. It is now officially supported, recommended or web-linked by multiple organizations and scientific societies.
PQI STEP ONE: The ASNR member or group reviews three documents: 1) ACR Guidelines for Communication, 2) ACR Guideline for Interpretation of MRI of the Lumbar Spine and 3) ASNR/ASSR/NASS Document on Nomenclature and Classification of Lumbar Disc Pathology.
PQI STEP TWO: Circulate the survey below to the referring surgeons, sports medicine physicians or other appropriate groups to obtain baseline measurement of the consistency and accuracy of MRI Lumbar Spine reports. As part of the survey communicate to the referring surgeons, sports medicine physicians or other appropriate groups that the ASNR/ASSR/NASS recommendations for the Nomenclature and Classification of Lumbar Disc Pathology will be used in the future. Include a copy of the document for their review.
PQI STEP THREE: Implement the ASNR/ASSR/NASS recommendations for the Nomenclature and Classification of Lumbar Disc Pathology in your practice. The use of templates or macros is encouraged. The nomenclature and classification can be added to templates in reporting systems such as PowerScribe.
PQI STEP FOUR: Approximately 12 months after the introduction of the standard nomenclature and classification a repeat survey is conducted. Scores from the two surveys are compared. If appropriate, statistical analysis can be done to determine the significance of any change.
PQI STEP FIVE: Review data with colleagues and determine if there are descriptions or classifications that are inconsistently used. Revise templates as needed and conduct a follow up survey in approximately 12 months.
REFERRING PHYSICIAN NOMENCLATURE SURVEY
The quality of one's practice can be improved by assessing its strengths and weaknesses and developing a plan to improve the areas of greatest opportunity. In most cases, the benefits of diagnostic imaging are not realized until the referring physician acts upon the results of the study. Thus the neuroradiologist's communication with that physician and the feedback on the quality of care the neuroradiologist delivers is valuable.
A sample referring physician survey is below. This survey instrument, or others developed by you or your own health care system, may be used.
For those selecting this project, the survey must be administered at least three points in time. A minimum of 20 responses at each administration is recommended, to ensure that an adequate number of data points can be plotted to detect improvement. After tabulating the results, an improvement action plan for improving the use of the standard nomenclature is being developed. The second survey should be sent after the action plan has been in place for at one year. This process of tabulating survey results and developing an action plan for improvement must be done again and followed with a third survey at least one year after the improvement plan has been implemented.
The survey results and improvement plans are to be kept by the participant(s). The survey materials, either paper or electronic, must be retained by the participants throughout the 10 year cycle.
Referring Physician Survey
PQI PROJECT VARIATION: DEPARTMENT CONSISTENCY
An alternative to the referring physician survey PQI project, would be to work toward within-department consistency, since there may be wide variability within a radiology group. An initial review should be conducted to see how often the interpreting radiologists used the standard terminology. (A sample 20+ of MR of lumbar spine dictations are recommended). After the initial review, an in-service lecture reviewing the accepted terminology could be presented and a second review conducted 6-12 months later to determine improvement in consistency.
ABR-APPROVED TEMPLATES FOR PQI
ASNR and ASPNR have cooperated to produced an ABR-approved template on "Reducing radiation exposure in children for evaluation of ventriculomegaly," which can be used to satisfy ABR MOC PQI requirements. The template was authored by Pina Sanelli and Jill Hunter.
Another set of three distinct modules on Fluoroscopic Lumbar Procedure was contributed by Ryan B Peterson, MD; Kimberly Applegate, MD, MS; Ivan Dequesada, MD; Srikanth Boddu, MD; and Amanda Corey, MD.
Fluoroscopic Guided Lumbar Puncture PQI
a. Module A: Radiation Safety
b. Module B: Pre & Post Procedure Considerations
c. Module C: Professionalism and Procedure Management