Radiology Resident Quality Training Program Paul Nagy, PhD
Fauzia Vandermeer, MD Charles Resnik, MD Slide 2 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 Slide 3 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 Slide 4 We do the big things well
Exponential growth in medical knowledge Technological marvels
abound in Radiology Slide 5 The downsides Technology has sterilized
relationships Continual subspecialization challenge consistency and
coordination of care in the 24/7 world. Slide 6 Death by a thousand
cuts Coordination Handoffs Feedback Collaboration Communication
Checklists Follow up The cumulative affect of small barriers
inhibit these important behaviors. Slide 7 Quality Manifesto A
learning culture is built by launching 100s 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? Slide 8 ACGME Systems-based Practice Residents
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 Slide 9 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. Slide 10 Example (Patient Consent Forms) Not applicable
DNAR Procedures by team members Permission to destroy organs
Potentially confusing for patient, radiologist Slide 11 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 Slide 12 Resident Projects
Not another rotation! Projects are self paced (6 months - 2 years)
Often they come up with their own problem We provide resources and
mentoring. Residency directors kept in the loop Hand off to staff
at completion Up to residents to take initiative Slide 13 Steps to
a quality project Effort (hrs) Researching problem Literature
search Read quality material 6-8 Hrs Create team Define problem Map
workflow Identify barriers Identify data Document Meetings 4-6 Hrs
Collect & Analyze data Understand problem Group exercises
Communicate with team Develop intervention 10-12 Hrs Collect &
Analyze data Test solution Meet with team Communicate with team
Develop intervention Document Improvement 6-8 Hrs Verify solution
Present at Academy Publication (+40) 4-6 Hrs Slide 14 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 Slide 15 Tools Process People
Slide 16 UM PACS Context Button Portal.radiology.umm.edu Slide 17
Context Integrated Form Manager Slide 18
Radtracker.radiology.umm.edu Slide 19 Technologist Report Cards
Slide 20 Resident Review Interpretation review Technical accuracy
review Automated report change detection Slide 21 Processes Tools
Process People Take a set of activities and intertwining them to
make an engine for quality. Slide 22 Internally Promoting Quality
Calendar of Events Meeting Agendas Quality Mission Roles and
Members Committee Minutes Project Templates Links to Quality Tools
Slide 23 Project Templates Slide 24 Engine of Quality Present and
Control Improve Identify Identify Issues: Operations Safety Walk
Peer Review Work on Issues: Image Quality Satisfaction Quality
Clinic Present and Control: Quality Academy Operations Slide 25 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 Slide 26 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
