QA – The Independent Sector Perspective

1. QA – The Independent Sector Perspective Stephen Davies Consultant Radiologist Cwm Taf Health Board Medical Director and Responsible Officer Medica Reporting @sgd999

2. Declaration • Medical Director Medica Reporting

3. Overview • Consider a framework for QA of Imaging Services • Relate this to the Independent Sector • Examine one area in detail – radiology reporting • Relate this to UK radiology practice

5. ISAS and Independent Sector • ISAS: ‘patients have the reassurance that the imaging services central to their core pathway are operating to a high quality standard’ • Quality systems underpin good business practice; manage risk • Required in Tendering process

7. QA of Radiology Reporting • Quality Assurance – ‘assurance’ • Audit should inform a change in practice

8. Audit • 10% cross-sectional imaging • 2% plain film • Scoring – binary? • Scoring in Independent Sector

9. Report Content and Discrepancy ScoringThe Independent Sector or ‘GMC’ scoring • Grade 1: Unequivocal potential for serious morbidity or threat to life • Grade 2: Moderate morbidity but not threat to life • Grade 3: clinical significance is debatable or likelihood of harm is low • Grade 4: Disagreement over style &/or presentation • Grade 5: No disagreement

10. Radpeer – American College of Radiology • 1 – Concur with interpretation • 2 - Difficult diagnosis, not ordinarily expected to be made • 3 - Difficult diagnosis should be made most of the time • 4 - Diagnosis should be made almost every time – misinterpretation of findings

11. Medica ‘In House’ system • Patient outcome score 1-5 • Observation score • Interpretation score • Communication score

12. Teleradiology context • Rapid feedback – through Insight™ • Virtual – unlike departmental consensus – so arbitration • Intelligent management of process - AWT • Large database • Otherwise much is common with real departments

13. QA data: change in practice • Organisation – client • Organisation – provider • Individual – radiologist • Group - radiologists

14. Learning Organisation • Individual Learning – reflective review of discrepancies • Group Learning – monthly discrepancy briefings • Organisation – e.g. Nighthawk process; image quality

15. Individual Learning • Single case – perception, interpretation; knowledge • Trends – reflective review • Feedback: • ‘I realise that I have not looked at the bone windows in every case’ • ‘I have learnt from these cases and my search pattern for acute abdominal imaging will include…..’ • ‘I think that I should take more time checking reports for typos’ • ‘This was a really useful exercise and I will apply it to my NHS practice’

16. GMC and Revalidation • GMC Revalidation requires doctors to show continuing fitness to practice – outcome audit data of reporting performance can be used. e.g. Domain 2 • A Designated Body needs to demonstrate good clinical governance • A positive audit report reassures the patient and importantly also the radiologist.

17. Final Thoughts • Independent Sector is focused on quality assurance of imaging services in a number of domains • There are opportunities for the Independent Sector to share practice with the NHS for the benefit of patients • ISAS provides a framework for developing audit relating to imaging services in both sectors – linkage with CQC • QA should be used as a development tool for individuals and organisations

18. Reference: Is Yours a Learning Organization? Garvin DA et al (2008). Harvard Business Review March 2008. Reprint R0803H.