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E2232. First Principles: A Primer on Quality Improvement for the Radiologist
Authors
  1. Nicole Li; McMaster University
  2. Ja Kim; McMaster University
  3. Yoan Kagoma; McMaster University
Background
Why is there a need for Quality Improvement (QI)? In 1999, the Institute of Medicine (IOM) landmark report To Err Is Human: Building a Safer Health System, put the spotlight on medical error by estimating that between 44 000 – 98 000 individuals were dying of preventable medical errors annually. The report called for a 50% reduction in medical error; however, this lofty goal has not been achieved. Nonetheless, the report was a catalyst for change with an increased focus on patient safety including well known initiatives focused on hospital acquired infections. Implementing change within healthcare requires structured problem-solving tools which can be implemented to test new ideas in a scientific manner – this is where the principles of QI and its practitioners operate

Educational Goals / Teaching Points
After reviewing this exhibit, the audience will be able to: - Understand the foundations of quality improvement (QI) in healthcare - Recognize the relevance of QI to radiologists - Compare QI, continuous QI, and quality assurance (QA) - Understand the concept of the Swiss cheese model of medical error and the importance of developing a Just Culture within a radiology department - Describe several structured QI problem solving tools for enacting change Target audience: Radiologists, radiologists-in-training, technologists

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Basic Concepts to Know: - QI vs QA: QI improves performance, QA establishes baseline - Continuous quality improvement: QI is everyone’s responsibility from frontline to leadership - Just Culture: Error is inevitable, Error is a product of systems and human fallibility - Swiss Cheese model of error [image] Problem Solving Tools - Plan-Do-Study-Act (PDSA) and A3 Problem Solving: Structured problem solving techniques - Six Sigma: Eliminate defects by decreasing variability - LEAN methodology: Optimize resources and eliminate waste - Creating SMART goals: Specific, Measurable, Achievable, Realistic, Timely - Fishbone and 5 Why techniques: Root cause analysis tools [example of Fishbone chart on next slide: an intuitive visual tool to identify the root causes of a problem. We will incorporate a real-life example from our institution assessing on-call resident report feedback]

Conclusion
Why should radiologists care about QI? Practicing radiologists: - Improve patient care and safety - Improve workflow efficiency and reduce waste - Lead change within multidisciplinary healthcare teams - A rewarding challenge Radiologists in training: - Employable and marketable skill - Prepare for board examinations - Learn about healthcare systems and hospital operations - Understand the role radiologists can play as change agents Common Radiology QI problems - Implementing peer review/peer learning programs - Lowering radiation doses - Improving image quality - Developing efficient imaging protocols - Building patient/clinician centered reporting templates - Improving biopsy yield rates - Implementing new imaging technology