Daily Bulletin 2015

Participants Reap Benefits from Quality Improvement Program

Wednesday, Dec. 02, 2015

David Larson, M.D.

David Larson, M.D.

A multidisciplinary quality improvement program developed through an academic radiology department improved participants' self-assessed skills and facilitated the execution of multiple department improvement projects, according to a presentation Tuesday.

Radiologist David Larson, M.D., associate chair of performance improvement in the Department of Radiology at Stanford Medicine, began to develop the program more than a year ago after the radiology department was tasked with 55 major improvement projects covering everything from efficiency to patient safety.

"At the time, the department had no structured mechanism to accomplish these goals," he recalled.

Dr. Larson enlisted the help of his Stanford associates Jake Mickelsen, B.S., quality improvement education manager, and Kandice Garcia, R.N., M.S., radiology quality manager, in developing what would become the Realizing Improvement through Team Empowerment (RITE) program, a 10-session, 20-week project-based course.

Teams were assembled—each including a leader, three to seven project participants, a sponsor and a quality improvement coach—for eight different projects. The program leaders made short videos on relevant topics available online prior to each session and each team was expected to share an update of their project at the two-hour sessions, receive feedback on their approach, and provide feedback to others.

The course was led by Dr. Larson and the two quality improvement managers, who also served as team coaches. Forty-one individuals participated in the first cohort of the course, including physicians, administrators, technologists and nurses. Six of the participants were from outside the radiology department.

"We gave the teams five months to get results, but we discussed the projects behind the scenes at least twice a week," said Mickelsen. "The participants really pushed themselves to succeed."

Among the eight projects were improving breast positioning in mammography, decreasing MRI missed appointments and improving emergency department (ED) stroke code response time. All eight projects achieved measurable improvement, with six of the eight achieving substantial improvement.

In one example, a team with representatives from radiology, neurology and the ED set a goal of improving response time for ED patients presenting stroke symptoms. By the end of the course, average response time from stroke code to CT scan had dropped from 25 minutes to 10.

"The participants significantly improved in all areas that we coached them on," Dr. Larson said. "They also understood that by improving processes, they don't just change the lives of patients in their immediate care, they change future patients' lives for years to come."

Participants expressed a high level of satisfaction with the course, with non-trainees reporting an average satisfaction of 4.8 out of a possible 5, and trainees reporting a slightly lower satisfaction level of 3.8 out of 5.

"The texts, comments and evaluations were almost universally favorable," said Dr. Larson.

Question of the Day:

I am treating a patient for thyroid cancer with Iodine 131. He makes pasta for a living and wants to know when he can go back to work.

Tip of the day:

Tendons and ligaments may experience "magic angle artifacts" caused by very short T2 times when the tightly bound collagen is at ~55 degrees from the main magnetic field.

The RSNA 2015 Daily Bulletin is owned and published by the Radiological Society of North America, Inc., 820 Jorie Blvd., Oak Brook, IL 60523.