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QA – The Independent Sector Perspective
Stephen Davies
Consultant Radiologist Cwm Taf Health Board
Medical Director and Responsible Officer Medica Reporting@sgd999
DeclarationMedical Director Medica Reporting
OverviewConsider a framework for QA of Imaging ServicesRelate this to the Independent SectorExamine one area in detail – radiology reportingRelate this to UK radiology practice
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
QA of Radiology Reporting Quality Assurance – ‘assurance’
Audit should inform a change in practice
Audit10% cross-sectional imaging2% plain film
Scoring – binary?Scoring in Independent Sector
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 lifeGrade 3: clinical significance is debatable or likelihood of
harm is lowGrade 4: Disagreement over style &/or presentationGrade 5: No disagreement
Radpeer – American College of Radiology
1 – Concur with interpretation2 - Difficult diagnosis, not ordinarily expected to be made3 - Difficult diagnosis should be made most of the time4 - Diagnosis should be made almost every time –
misinterpretation of findings
Medica ‘In House’ systemPatient outcome score 1-5Observation score Interpretation scoreCommunication score
Teleradiology context
Rapid feedback – through Insight™Virtual – unlike departmental consensus – so arbitrationIntelligent management of process - AWTLarge database Otherwise much is common with real departments
QA data: change in practiceOrganisation – clientOrganisation – providerIndividual – radiologistGroup - radiologists
Learning OrganisationIndividual Learning – reflective review of discrepanciesGroup Learning – monthly discrepancy briefingsOrganisation – e.g. Nighthawk process; image quality
Individual LearningSingle case – perception, interpretation; knowledgeTrends – reflective reviewFeedback:‘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’
GMC and RevalidationGMC 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.
Final ThoughtsIndependent 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
Reference: Is Yours a Learning Organization? Garvin DA et al (2008). Harvard Business Review March 2008. Reprint R0803H.
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