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ABR PQI Summit. Patient Safety Breakout. August 19, 2006. Break Out Session: Patient Safety. ABR Trustees Gary Becker, M.D. Janet L. Strife, M.D. Ann Roberts, M.D. Participants Linda Bresolin, PhD, RSNA Dennis Foley, M.D., SCBT/MR Michael Darcy, M.D., SIR Tony Parker, M.D., ABNM

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ABR PQI Summit

Patient Safety Breakout

August 19, 2006


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Break Out Session:Patient Safety

  • ABR Trustees

    • Gary Becker, M.D.

    • Janet L. Strife, M.D.

    • Ann Roberts, M.D.

  • Participants

    • Linda Bresolin, PhD, RSNA

    • Dennis Foley, M.D., SCBT/MR

    • Michael Darcy, M.D., SIR

    • Tony Parker, M.D., ABNM

    • Marilyn Goske, M.D., SPR


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ABMS Guidelines for Part 4Adopted March, 2002

  • Safe

  • Effective

  • Patient-centered

  • Timely

  • Efficient

  • Equitable

Demonstrate to patients, the public, and the profession, that physicians provide care that is:


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5 PQI Project Categories for DR

  • Practice guidelines & technical standards

  • Referring physician surveys

  • Patient safety

  • Double reading

  • Turnaround time


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  • PQI timeline & milestone tracking

  • Draft personal Webpage PQI forms

  • Draft personal Webpage competency report

  • Iodinated contrast PQI project: objectives and metrics

  • Iodinated contrast PQI individual patient data form

  • ACR practice guideline for use of intravascular contrast media

Resource Materials


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Resource Materials

  • NCRP conference report: dose reduction in CT

  • JCAHO national patient safety goals

  • NQF 30 safe practices for better healthcare

  • IOM: preventing medication errors

  • MOC Part 4 in DR: slide presentation


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  • Radiation safety (ALARA)

  • MR safety

  • Safe use of iodinated contrast media

  • Conscious sedations standards

  • Invasive procedure topics

    • -JCAHO universal protocol

    • -JCAHO national patient safety goals

    • -NQF-endorsed safe practices & voluntary consensus stds

    • -Prevention of central line infections

    • -Safe use of fluoroscopy

  • Prevention of medication errors

Sampling of Safety Topics


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In my busy practice, 2 of my partners and I do predominantly body CT.

PQI Selection: Patient Safety

Subtopic: Safe Use of Iodinated Radiographic Contrast Media


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Data Sheet Design, Metrics body CT.

  • Pre-procedure evaluation

  • Prevention, minimization of nephrotoxicity

  • Prevention, minimization, management of (other) idiosyncratic reactions, anaphylaxis

  • Identification, management of non-idiosyncratic reactions


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PQI Project body CT.Safe Use of Iodinated Contrast Material

N=61

N=33

(2 with renal risk)

N=6

Cr>1.5

Cr<1.5

Cr not measured

Baseline Data Collection—100 Patients

All

4 Lower dose

2 MRI

2 Lower dose

31 Standard

Standard contrast dose

Next step, improvement planning…


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  • Pre-procedure evaluation body CT.

    • Hx from referring physician available in advance; 100%

    • Serum Creatinine available in advance; 100%

  • Prevention, minimization of nephrotoxicity in high risk patients

    • Pre-procedure hydration; N=

    • Acetylcysteine; N=

    • Other; N=

    • Selection of alternative contrast material; N=

    • Change examination type (eg. MRI); N=

Elements of Improvement Plan


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  • Prevention, minimization, management of (other) idiosyncratic reactions, anaphylaxis

    • Identify high-risk patients by history; 100%

    • Lasser or Greenberger pre-med regimen; 100%

    • Hx severe rxn: number benadryl + number cimetidine or ranitidine+number alternative (eg. MRI); 100%

    • High-risk, un-medicated, I.V. contrast; 0%

    • Preparedness: trained personnel, inventoried crash cart; 100%

  • Identification, management of non-idiosyncratic reactions

  • Identification of delayed reactions

Elements of Improvement Plan


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Specific Objectives with Associated Metrics idiosyncratic reactions, anaphylaxis

PATIENT SAFETY Safe Use of Iodinated Radiographic Contrast Media (RCM)

Consecutive Cases to be used: Baseline – 100; Improvement data sets: 1st – 200, 2nd – 300, 3rd – 400


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PQI Timeline & Milestone Tracking idiosyncratic reactions, anaphylaxis

DR Diplomates


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PQI Timeline & Milestone Tracking idiosyncratic reactions, anaphylaxis

DR Diplomates


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Pediatric idiosyncratic reactions, anaphylaxisPATIENT SAFETY

Review: Imaging Practice as it applies to the Pediatric Patient


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Goals of the Program idiosyncratic reactions, anaphylaxis

  • Radiation Safety Program of the SPR fully supports ALARA “as low as reasonable achievable”.

  • Individual practices/ Group practices/ or Institutions develop strategies to reduce radiation to those populations at risk and or prevent unnecessary radiation.

  • Utilize systems based practice evaluation, clinical guidelines when diagnostic imaging is performed.

  • Work towards benchmarking, national guidelines


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Goals of Practice Performance: idiosyncratic reactions, anaphylaxisPediatric Safety: SPR

  • Reduce Unnecessary Radiation In Populations At Risk

  • Evaluate Equipment and Studies to Decrease Radiation

  • Increase Awareness of Individual Performance Compared to Databases Concerning Radiation Exposure in Performing Studies

  • Standardize Approach To Patients


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Reduce Unnecessary Radiation In Populations At Risk idiosyncratic reactions, anaphylaxisEquipment and Procedure Evaluation

  • Adjusting KV/MAS based on weight of the patient during CT imaging

    • Does your equipment in CT currently adjust radiation dose based on patient weight?

    • If the equipment does not, do you routinely adjust KV/MAS during CT imaging of pediatric patients?

    • Do you routinely breast shield during chest CT?

    • Do you routinely include the thyroid during chest imaging?

  • Review 25 pediatric cases


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Reduce Unnecessary Radiation In Populations At Risk idiosyncratic reactions, anaphylaxisAvoid Radiation To Fetus

  • Pregnancy tests prior to imaging studies in child bearing ages.

    • Do you routinely obtain pregnancy tests prior to imaging studies such as CT, fluoroscopy, interventional cases?

    • Do you document that you know that the patient’s pregnancy test is negative prior to study?

    • Review any “sentinel” cases and document the processes initiated to decrease errors

  • Review 25 adolescent cases


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Reduce Unnecessary Radiation In Populations At Risk idiosyncratic reactions, anaphylaxis Increasing Awareness of Radiation Dose and Standardization Of Techniques

  • Select a fluoroscopy study that is done and review radiation exposure

    • Was radiation time documented in the radiology report?

    • How many images were obtained on routine studies?

    • Benchmark your fluoroscopy time and number of images with other radiologists; local and national

  • Review at least 25 studies


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Reduce Unnecessary Radiation In Populations At Risk idiosyncratic reactions, anaphylaxis Increasing Awareness of Radiation Dose and Standardization Of Techniques

  • Select a routine fluoroscopy study that is done and review imaging time and number of images

    • Was time documented in the radiology report?

    • Study selected to study

    • Average time per all physicians in practice vs. your time

  • Review at least 25 studies


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Standardize Approach To Patients idiosyncratic reactions, anaphylaxisReduce Unnecessary Studies, Appropriateness of Imaging

  • Select a clinical indication for a study (such as RLQ pain)

    • Is clinical information included in the radiology report?

    • Was the study that was performed appropriate for the clinical indication?

  • Review 25 studies and compare with institutional or ACR guidelines for Appropriateness of study


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Standardize Approach To Patients: idiosyncratic reactions, anaphylaxisReduce Unnecessary Studies, Appropriateness of Imaging

  • Select a known pathology/surgical diagnosis (such as appendicitis) and evaluate the imaging studies performed for appropriateness of imaging.

    • Is clinical information included in the radiology report?

    • Did radiology imaging report include the diagnosis in the report?

    • Was the study that was performed appropriate for the clinical indication?

  • Review 25 studies and compare with institutional or ACR guidelines for Appropriateness of study


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PQI Timeline & Milestone Tracking idiosyncratic reactions, anaphylaxis

DR Diplomates


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PQI Timeline & Milestone Tracking idiosyncratic reactions, anaphylaxis

DR Diplomates


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