Repeat Analysis in the Digital Environment

Transcription

1 Repeat Analysis in the Digital Environment Maureen Seluta, RT(R) Operations Manager Faezeh Abedi-Tari, RT(R), BS Operations Manager 1 2 Massachusetts General Hospital The third oldest general hospital in the United States and the oldest and largest hospital in New England At our Main Campus and four Health Centers Mass General annually: Admits 47,000 inpatients Handles nearly 1.5 million outpatient visits Records 83,000 emergency room visits Performs 37,000 operations Delivers 3,700 babies 3

2 4 Emergency and Inpatient Imaging Total number of technologists IP 18 ER 31 Volume IP 1900 per week ER 1200 per week Portables 1750 Equipment IP 2 DR, CR, 4 RF ER 3 DR, CR Portables 12 C-ARMS 8 Context Problem statement Objective Goals Pilots Department rollout QA Electronic Repeat Analysis 5 Problem Statement Repeat Analysis is currently not performed on a regular basis. Vendors of digital technology focus on the supremacy of the technology and its ability to reduce the number of repeats, resulting in less radiation doses given to patients and increased productivity in the department. However, few vendors, if any, offered software to track and document repeats on the equipment. The digital x-ray equipment currently installed at MGH do not have software to track repeat rates. 6

3 7 Exposed Objective Develop and implement a program to identify, document and track digital x-ray x repeat rates across the radiology department at MGH. 8 Goals Reduce patient exposure Increase productivity and image quality Identify educational opportunities Develop departmental standards for acceptable repeat rates* * According to The Conference of Radiation Control Program Directors tors- CRCPD; the criteria associated with repeating a film is subjective. Each facility should decide on its own, but should strive for a repeat rate of 9 no greater than 5 to 7%

4 10 Pilot #1 Where: Emergency Radiology When: 10/07, 11/07, 12/07 & 5/08 Equipment: CR and DR Materials Computed Radiography System Digital Radiography System Resources: Managers, Supervisors 11 Method Data was collected using a manual process: All exams were reviewed at the modalities to determine the total number of images acquired for each patient/exam. The number of images repeated (not transmitted to PACS) was documented and categorized by exam type and reason for repeat. The total number of images transmitted to PACS were confirmed by using a script developed by MGH PACS team. 12

5 13 Exam Categories Repeat Reasons Chest Abdomen/Pelvis Extremity Spine Positioning Motion Technique Artifact Miscellaneous Equipment Malfunction Results ER 8 % of Repeats % 8.3% 7.6% 7.8% Oct 07 Nov 07 Dec 07 May

6 16 Pilot #2 Where: Inpatient Radiology When: 12/07, 1/08 and 5/08 Equipment: CR and DR Results Ellison % Repeat of Repeats Rate (%) % 5.3% 4.7% Dec 07 Jan 08 May QA Rollout Where: Inpatient and Emergency Radiology When: January 2008 Why: Quality of portable imaging Equipment: CR 18

7 19 Utilization of Data Communicate results of Repeat Analysis with staff Identify trends (techs/room/exams/equipment) Target key areas where there is opportunity for improvement Steps to QA Radiologist input CR Vendor Engineers (equipment check) Target key areas of opportunity Retrain technologists in Imaging 101 In-services QA Audits 20 QA, Input from Radiologists Reviewed results of Repeat Analysis Reviewed images with Radiologists Revised Portable Protocol Green Cards 21

8 22 Portable QA Portable CXR Protocol Using Lead Markers with initials Collimation Digital cropping Positioning: supine or upright, no semi-upright Central Ray Artifacts SID Annotation Exposure level QA, CR Vendor Changed the algorithm Added Exposure level Presentation on Digital Imaging Engineers Check portable equipment for exposure level Check collimation accuracy Applications adjusted the chest parameters on DR equipment 23 QA, Retraining Technologists Positioning 101 Technique 101 In-services Chest Imaging Installation of PACS Workstations in work areas 24

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10 28 Departmental Rollout Where: All Diagnostic X-ray Departments When: January 2009 Equipment: CR and DR 29 Outpatient, Health Centers and Off Campus Imaging Total number Department of technologists Total OP 27 Diagnostic Technologists HC 5 84 OCI 3 Volume OP 1700 per week Department Total HC 335 per week Volume per week OCI 125 per week 5,260 Exams Equipment OP 13 DR, CR, 2 RF HC 1 DR, CR OCI 1 RF, CR Department Total Equipment 19 DR CR 12 Portables 8 C-Arms 30

11 31 Results: January 2009 Department Wide Repeat Rate: 6.58% 25,000 21,164 20,000 16,366 Number 15,000 of Images 10,000 5,000 1,570 5, ,010 4, , Total # of Images Total # of Repeats 0 OP IP ER HC OCI 7.42% 4.13% 6.17% 8.77% 3.68% Results January 2009 Exam Categories % 38.2% Number 800 of Repeat 600 Images 31.9% 31.9% 17.1% % 8.9% 4.0% 4.0% 0 Extremity Chest Spine Abd / Pelvis Misc. 32 Results January 2009 Repeat Reasons # of 2000 Repeated Images , % % % 5.24% % Positioning Technique Equipment Artifact Motion 33

12 34 Radiation Exposure Category # Repeats msv / Repeat Collective Dose (msv) Extremity 1, Chest 1, Spine Abdomen/Pelvis Misc Strategic Initiatives Strategic Growth Creates a consistent system of continuous improvement centered around patient safety and operational excellence Safety & Quality Reduced radiation exposure to patients Innovation Develop automated tracking systems and/or collaborate with Vendors to enhance current product offerings. People Collaborative educational in-services Identify future educational opportunities for technologists 35 Next Steps Collaborate with Enterprise Medical Imaging (EMI) to develop automated data collection Interdepartmental collaboration on development of educational in-services for technologists. Pilot GE Definium 8000 electronic data collection in Outpatient Radiology Perform another Repeat Analysis Engage Radiologists in review process 36

13 37 Electronic Repeat Analysis Involved EMI Worked with EMI Project Manager Dedicated Server Pilot Dicom Tags from PACS 38 Report Sample 39

14 40 Specialties Implementation of Electronic Repeat Analysis January

15 43 44 January 2010 ERA Compare to January ,164 20,763 16,366 14, Total 2010 Total ,645 4,986 4,377 3,678 2,310 1,045 OP IP ER HC OCI 45

16 46 Repeat Rate Comparison 2009 to 2010 % of Repeats 10.00% 9.00% 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% 8.74% 8.8% 7.74% 7.4% 6.2% 5.83% 5.12% 4.69% 4.1% 3.7% OP IP ER HC OCI Jan-09 Jan-10 What Came Next? Repeat or not to Repeat an image Recorded in-services on Quality Management Educational Website QA Audits 47 QA AUDITS 48

17 49 QA AUDITS QA AUDITS 50 The Saga Continues Annual Repeat Analysis Continue QA audits Peer Review Continue education and training for staff Radiologist Feedback Feedback to staff 51

18 52 Conclusion Performing Repeat Analysis has been beneficial to our department. Improving Image Quality Developing educational opportunities Annual Repeat Analysis Increased productivity Project Team Mary Theresa Shore & Patti Doyle - Clinical Directors Inpatient Radiology Maureen Seluta and Debbie Ricciardelli Emergency Radiology Della Abedi-Tari and Jennifer Davenport Outpatient Radiology Sharon Gibson and Marie Oliver OP Health Centers Trish Daunais MGH West Tyler Martin 53 Questions OLD EBBETTS 54

19 Thank you! 55