Reporting and qa blr 2016 v2

Carl Aschkenasi, MD

Emergency Teleradiology:Reporting Standards & Quality Assurance

Reporting Standards & Quality Assurance

1. You cannot standardize descriptions of individual humans.

2. I’m not a robot.

3. I’m a professional who expresses himself.

4. Not all cases fit a mold.

5. I use standard language already.

Barriers to implementation

“When I use a word,” Humpty Dumpty said in a rather scornful tone, “it means just what I choose it to mean – neither more or less.”


1. You can’t assure quality.

2. It’s a never-ending process.

Barriers to implementation

Reporting Standards

Quality Assurance

IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE

IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY

exophytic, enhancing mass likely

Where in the study?

Image/series number?…image 43/189 of the cor recons….”

Size mattersUnitsCaliper placementDimensions Appropriate terms

LesionStructureCystTumorPhlegmonProcessInfiltrateGoober

Certainty

Adapted from: The radiology report: A guide to thoughtful communication for radiologists and other medical professionals 2015, Curtis P Langlotz MD PhD

“On the post-contrast images, a 1-cm is present in the anterior upper pole of the left kidney.”

Accurate anatomy

Descriptors

vs.

Action!

What’s normal?

UnremarkableEssentially/relatively/fairly normalNo radiologic evidence of diseaseWithin normal limitsNo significant abnormalityAge-appropriateNegative for trauma

I see nothing wrong in the foot.


OR

The foot is normal.

How would you report this?

What’s normal?

Acad Radiol. 2003 Jun;10(6):685-8. Khorasani R1, Bates DW, Teeger S, Rothschild JM, Adams DF, Seltzer SE.

What’s certainty?

?

…cannot be excluded.

Host abdominal wall

What’s certainty?

Severity


Kijowski R1, Blankenbaker D, Stanton P, Fine J, De Smet A. Arthroscopic validation of radiographic grading scales of osteoarthritis of the tibiofemoral joint. AJR Am J Roentgenol. 2006 Sep;187(3):794-9

Mild/mod/severely limited by respiratory motionExam is limited by nonstandard positioningNormal given small lung volumesPulsation/beam hardeningEctopic disclaimerSubtle stroke disclaimer

Disclaimers

The organ recital – “Yes, I looked.”

“Yes, I am thinking.”

What clinicians want to see: “No ICH, shift, or mass effect”

Billing/coding purposes

Pertinent negatives

C spine for radicular pain

C spine for trauma

Chest radiograph

PE chest CT

C7-T1 Moderate posterior disk bulge

BodyImpression

Body ? ?Body

C7-T1 Minimal posterior disk bulge

Body No No No

Acute C7 fracture

BodyImpression

BodyImpression

BodyImpression

BodyImpression

Cardiomegaly NA NA BodyImpression

Body+/- impression

Aortic calfication No No Body Body

Find

ing

ExamRelevance

Sistrom CL, et al. Recommendations for additional imaging in radiology reports: multifactorial analysis of 5.9 million examinations. Radiology. 2009 Nov;253(2):453-61 Grieve FM, Plumb AA, Khan SH. Radiology reporting: a general practitioner's perspective. Br J Radiol. 2010 Jan;83(985):17-22.

The majority of PCPs want radiologists’ recommendations.

12% of radiology reports recommend follow-up imaging.

Recommendations


Signal-to-noise ratio model


Remove the noise!Reporting Standards & Quality Assurance

Recommend clinical correlation.Recommend follow-up.Too small to characterize…. NOT an adjective.

ProminentMarkedlyBilaterallyIrregular Significant

Reporting Standards

Quality Assurance

www.radreport.orgopen.radreport.org

For the clinician:

Consistent & clear Logical format and organizationStandard terminology

Benefits of standardization


For the radiologist:

ChecklistMemory aid for various diagnoses e.g., splenic v. patency in pancreatitis

Computer searchable for research, QANational Radiology Data RegistryACR appropriateness criteriaConsistent PACS taggingRadiologic decision support tools


For the patient:

Critical value communication (JCHAO)Medical society guidelines (ACR, ACOG, ASTS, AOA)Physician Quality Reporting System compliance (CMS)

We can’t:

Set the technical parametersPrevent/manage procedure complications….or technical failures at a client facilityEasily get follow-up (although we try)Get access to EHR/RIS

IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE

IDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTION * IMPORTANT SLIDE PAY ATTENTIO

We can:

Track turnaround timeTrack CV/Call return timeTrack case volume/productivityMeasure accuracy c/w peers

WHY REPORTING QUALITY IS SO IMPORTANT TO US AT TELERAD SOLUTIONS

Demonstrate gen-leading reporting

Thanks!

Reporting and qa blr 2016 v2

Health & Medicine

Transcript of Reporting and qa blr 2016 v2