Increasing Patient Access to MRI Examinations in an Integrated Multispecialty Practice.

A multidisciplinary team evaluated and improved the MRI processes within the authors' integrated health care system, with the aim to increase patient access to MRI. The authors created a SMART (specific, measurable, achievable, relevant, and time-based) goal of decreasing the average number of days to wait for MRI examination by 50%, from 15 to 7.5 days, while also creating capacity to meet demand for same-day and next-day MRI appointment requests. The current performance metrics and processes were compared with available benchmarking and best practice data. Several work groups were created to empower and support frontline teams to identify and capture improvement opportunities. Across all MRI processes, teams focused on creating standard work, advancing practice to top of scope, removing waste, improving communication, reducing rework, and improving patient experience. Patient access to MRI was monitored, measured as the average number of days to wait from the time of scheduling to the MRI examination and time to the third-available appointment. The authors also monitored secondary outcomes (patient satisfaction, throughput metrics) and a balancing measure (technical repeat examination rates). The access improved after intervention: the average number of days to wait for MRI access decreased from 14.2 days to 5.8 days after the intervention (-8.4 days, -59.2%, P < .0001) and third-available appointment decreased from 18 days to 0 days. Ten to 20 same-day and next-day appointments became routinely available. The throughput metrics improved, and balancing measures were not changed. This project resulted in significant improvements in patient access to MRI examinations. The findings demonstrate the value of a multidisciplinary team applying comprehensive improvement strategies to increase patient access to complex services, such as MRI. ©RSNA, 2021.

Sustained Increases in the Quality of Imaging Histories Provided by Ordering Providers Resulting From Multidisciplinary Collaboration and Systems Design.

OBJECTIVE. The purpose of this quality improvement project was to create sustained improvement in the frequency of more complete imaging histories provided with imaging examinations submitted directly by ordering providers. A secondary purpose was increasing the number of characters submitted by ordering providers with imaging examinations. MATERIALS AND METHODS. A multidisciplinary team defined the components of a complete imaging history, a process that underwent several improvement cycles. Audits were regularly performed using consensus, and the project team regularly evaluated the completeness of the imaging histories. The final components of the definition of a complete imaging history included responses regarding what happened, when it happened, where the patient was experiencing pain, and the ordering provider's concern. Prompts were inserted into the electronic physician order entry process, and performance was monitored for an additional 18 months. RESULTS. A total of 10,236 orders were placed by providers in the study clinic from March 13, 2017, to December 16, 2018. Of the orders audited in the baseline period, 16.0% (64/397) of orders audited in the baseline period contained all four history components, which increased to 52.0% (2200/4234; absolute increase of 36.0%, relative increase of 225.0%; p < 0.0001) in the subsequent time periods, and improvement was sustained. The mean number of characters providers entered in the imaging histories they submitted increased from 45.4 characters per order during the baseline period to 75.4 (66.1% increase, p < 0.0001) after the intervention. CONCLUSION. By collaborating with a multidisciplinary team, we created a standardized definition of an imaging history, engineered our systems to include supportive prompts in the order entry interface, and sustainably improved the quality of imaging histories provided.

Implementation of a Peer Learning Program Replacing Score-Based Peer Review in a Multispecialty Integrated Practice.

OBJECTIVE: The aim of this study was to compare the efficacy of a peer learning program to score-based peer review in a radiology department. MATERIALS AND METHODS: Our score-based peer review program was transitioned to an open, inclusive, education- and improvement-oriented peer learning program. Program performance was evaluated by learning opportunity submissions, program participation, number of learning opportunity distributions to radiologists, number of practice improvement projects resulting from program, and radiologist survey results before and after interventions. RESULTS: Outcomes for the score-based peer review program compared with those of the peer learning program were as follows. The mean number of radiologists participating monthly increased from 5.0 to 35.2 (p < 0.01); submissions increased from 3.0 discrepancies per month to 36.0 learning opportunities per month (p < 0.01); the mean monthly learning opportunity distributions to radiologists increased from 18 to 352 (p < 0.01); improvement projects performed during the study periods increased from 5 to 61 (p < 0.01); and mean monthly continuing medical education credits earned by radiologists increased from 7.7 to 50.6 (p < 0.01). Radiologists felt peer learning accomplished goals better than did score-based peer review. CONCLUSION: In transitioning our score-based peer review program to a peer learning program, our radiologists identified, discussed, and converted more learning opportunities into practice improvement and perceived peer learning to be of higher value than score-based peer review.