Designing a safer radiology department.

OBJECTIVE: Patients presume safety in radiologic services, but the potential to do harm exists in every area of imaging. Radiology department personnel need to understand basic regulatory requirements for safety and how to promote and improve safety in the future. CONCLUSION: This article reviews key safety metrics that we think are relevant to radiology and discusses how to define the measures and how we are attempting to translate the metrics into a culture of safety.

Patient safety event reporting in a large radiology department.

OBJECTIVE: The purpose of this article is to describe our experience developing a Web-based radiology-specific event reporting system. CONCLUSION: The Web-based safety event reporting system has been a valuable tool permitting us to address potential safety concerns in our department.

Quality initiatives: improving patient flow for a bone densitometry practice: results from a Mayo Clinic radiology quality initiative.

Lean Six Sigma process improvement methodologies have been used in manufacturing for some time. However, Lean Six Sigma process improvement methodologies also are applicable to radiology as a way to identify opportunities for improvement in patient care delivery settings. A multidisciplinary team of physicians and staff conducted a 100-day quality improvement project with the guidance of a quality advisor. By using the framework of DMAIC (define, measure, analyze, improve, and control), time studies were performed for all aspects of patient and technologist involvement. From these studies, value stream maps for the current state and for the future were developed, and tests of change were implemented. Comprehensive value stream maps showed that before implementation of process changes, an average time of 20.95 minutes was required for completion of a bone densitometry study. Two process changes (ie, tests of change) were undertaken. First, the location for completion of a patient assessment form was moved from inside the imaging room to the waiting area, enabling patients to complete the form while waiting for the technologist. Second, the patient was instructed to sit in a waiting area immediately outside the imaging rooms, rather than in the main reception area, which is far removed from the imaging area. Realignment of these process steps, with reduced technologist travel distances, resulted in a 3-minute average decrease in the patient cycle time. This represented a 15% reduction in the initial patient cycle time with no change in staff or costs. Radiology process improvement projects can yield positive results despite small incremental changes.

Process improvement: what is it, why is it important, and how is it done?

OBJECTIVE: The purpose of this study was to provide enough information so beginners can feel comfortable starting and completing a simple radiology process improvement project. CONCLUSION: Medical practices (including radiology departments) need to address outstanding quality and safety issues that threaten their patients. Addressing these issues improves patient care and operational efficiency. We provide a review of our approach to process improvement and the established improvement methods. Many organizations and companies are available to support medical practices as they enter this field.

Plain-radiographic image labeling: a process to improve clinical outcomes.

PURPOSE: To determine the rate of film-labeling errors and to describe a process for improved plain-film image labeling and the clinical outcomes from this process improvement. METHODS: Image-labeling errors (absent or incorrectly assigned left or right lateral identifier marker, absent or incorrect patient-identifying number, absent or incorrect examination date, incorrect marker placement, absent technologist initial marker, or incorrect body-part order) were measured among 2,536 consecutive plain-film radiographs over a 2-week period. Following a process improvement initiative based on failure mode effectiveness analysis, left-side and right-side indicator markers, patient demographics, and date labels were identified as the most common sources of error. An improvement initiative using larger and colored left and right lateral indicator markers, an automated process to label patient demographics, and direct patient verification of identification was begun. The numbers of labeling errors were again assessed in 2,421 consecutive plain radiographs over a 2-week period. The error rates before and after the improvement initiatives were compared. RESULTS: Plain-radiographic labeling errors occurred in 62 of 2,536 (2.4%) images before the improvement initiative. Labeling errors were reduced to 17 of 2,421 (0.70%; 95% exact binomial confidence interval, 0.4% to 1.1%; P < .001, chi-square test) by using the improvement tools. CONCLUSIONS: Plain radiographic image labeling can be improved using bar-code reading of patient demographic information, linked to patient Digital Imaging and Communications in Medicine modality work lists and image printing. Patient verification of demographic information is key and can be electronically managed. Lateral marker identification can be improved with larger (more easily read) and color-coded indicators.