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Decrease Radiology Liability Risks with a Quality Improvement Program (QIP)

June 22, 2017

Many radiology claims involve fragmented care and lack of reliable information with which to support clinical decisions, which leads to patient injury. Quality improvement programs (QIP) can increase patient safety, decrease liability risk and increase practice revenue.1

Notes from Risk Management Fieldwork

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A NORCAL Group risk management specialist met with a radiologist who had been tasked with creating a QIP for the radiology group. The radiologist’s group had recently been involved in a lawsuit. During the litigation process, the group leadership realized that too many diagnostic errors were being made, and the risk of future liability was high. When asked to describe some recent problems, the radiologist told the risk management specialist that one of the radiologists in the group had recently missed a recurrence of a gastrointestinal tumor. Luckily, a different radiologist diagnosed the tumor two weeks later, when it was captured incidentally during studies for an unrelated condition. The risk management specialist asked if the radiology group had discussed the error in an internal practice forum in order to identify its root cause(s).

Example QIP Programs and Resources

The radiologist said the practice had no current policy or mechanism to do this, especially since there was no injury or lawsuit associated with the event.

The risk management specialist explained that scrutinizing “near misses” such as this one to uncover process gaps is the first stage in planning and implementing new procedures designed to plug the gaps and prevent future mistakes. For this practice, as for many practices in all specialties, establishing a QIP may seem like a daunting undertaking; however, any steps healthcare professionals and staff can take to strengthen patient safety will be valuable and satisfying.

Implementing a Quality Improvement Program and a “Culture of Safety”

One of the first steps in improving quality is reviewing errors, whether or not they result in injuries or lawsuits. A crucial part of any QIP is the review of mistakes that affected a patient as well as analysis of “near misses” in which an error was caught before it had an impact on a patient. However, studies indicate that staff and physicians are afraid they will suffer repercussions for reporting their mistakes.2,3 Consequently, any radiology practice that wants to improve quality must also create a practice culture in which error reporting is not associated with blame and recrimination. This is often referred to as a “just culture” or a “culture of safety.”3,4 (Making this work may require reporter anonymity.) In addition to creating a “just culture,” implementing a QIP will include:

  • Structuring a quality improvement committee.
  • Developing a charter to define the program, including its structure, reporting lines, mission and goals, and scope.
  • Collecting and analyzing data, including incidents and complaints, billing and utilization reports, professional liability claims, and patient satisfaction information.
  • Reviewing and assessing professional competencies.
  • Identifying best practices.
  • Standardizing protocols and procedures.
  • Testing new processes.
  • Educating staff and clinicians to change behavior and decrease variance based on data-driven policies and protocols.
  • Consulting with an attorney to ascertain whether the QIP meets the requirements of state peer review protection legislation or how to de-identify the information to protect it from discovery in the event of a lawsuit.

Establishing and maintaining a culture necessary for a successful QIP requires explicit and unwavering support of the practice’s top leadership. Establishing buy-in may be encouraged by implementing a process improvement program, such as Lean or Six Sigma, which can also increase revenue.4 More information about these process improvement programs in a radiology practice context is available in the JACR article “Fundamentals of Quality and Safety in Diagnostic Radiology” (December 2014).4

References

1. Steele, JR et al. "Guidelines for Establishing a Quality Improvement Program in Interventional Radiology." J Vasc Interv Radiol. 2010; 21:617–625. (accessed 3/27/2017)

2. O’Reilly, KB. Fear of punitive response to hospital errors lingers. American Medical News. 2012 Feb 20.

3. Matthews M. "Playing It Safe at AHRA." Imaging Economics. 2014 Aug 29. (accessed 3/27/2017)

4. Bruno MA, Nagy P. "Fundamentals of Quality and Safety in Diagnostic Radiology." JACR. 2014 Dec;11(12A):1115–1120. (accessed 3/27/2017)

Filed under: Diagnosis & Testing, Practice Management, Radiology, Article, Practice Manager, Practice Communication, Patient Care

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