IMPROVINGCOMPLIANCEANDDOCUMENTATIONOFCTQUALITYCONTROLUSINGANELECTRONICQUALITYASSURANCE

PRACTICEMANAGEMENTTOOL

Phuong-Anh Duong MDRebecca Neill MS, Matthew E. Zygmont MD,

Pratik Rachh MD, MBA

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BACKGROUND

• Periodicqualitycontrol(QC)testsarerequiredforcomputedtomography(CT)andothermodalities

• Trackingcomplianceacrosslargerhealthcaresystemscanbechallenging– Time-constrainedtechnologistsmayforgettoperformQCtests

– Resultshistoricallywererecordedonpaper– Oversightandmonitoringofresultsinfrequent– Correctiveactionsareoftendelayed

CURRENT (BASELINE) CONDITIONS

• DailyQCmaintainedonpaperrecordfrom3/2015to3/2016• PaperlogsauditedbyCTphysicistquarterly• ActualQCperformancewastrackedusingsoftware

(Radimetrics,Bayer)todetectthepresenceofadailyphantomscan

• CTphysicistforwardedactualperformancedataonamonthlybasistositeQCleadtoencouragedailycompliance

Duringthebaselineperiod(3/2015to3/2016)themedianactualcompliancewithdailyQCwas89%,asmeasuredbythedailyphantomscan.Thisdatachallengedthenearly100%reportedcompliancedocumentedonpaper.

GOAL: AIM STATEMENT

• ImplementaQCmanagementsystemthatallowsonlinedocumentation,remindersforlateresults,andnotificationofaberrantresults

• ImprovecomplianceanddocumentationofdailyCTQCteststo100%by4/2017usinganonlinemanagementsystem

ONLINE QA PLATFORM

Acommerciallyavailablequalityassurancemanagementsoftware(ZapIT!Medical)wasimplementedtotrackdaily,monthly,andannualQCfor25CTscanners.

DOCUMENTATION

DATA ENTRYStarting3/2016,technologistsweretrainedtoperformdailyandmonthlyQCperACRrecommendationsandrequiredtologresultsinthesystem.

QA HISTORY & APPROVAL

GRAPHICAL VIEWS

NOTIFICATIONS

• Notificationsareconfiguredperindividualpreference• Emailortextremindersareavailable• AlertsremindtechnologistsifQCwasnotperformedby

aspecifiedtime• MedicalphysicistalertedoftestfailuresandmissingQC

QC NOTIFICATIONS IN-PATIENT SETTING

Ifby7AM,QCnotperformedanddocumented,responsibleShift1TechnologistemailedQCreminder.

Ifby8AM,QCnotperformedinShift1,Shift2supervisorreceives

reminder.AssignsQCtoShift2Technologist.

Ifby11AM,QCnotperformed,MedicalPhysicistreceives

notification.MedicalPhysicistescalatestosupervisorandmanager.

SupervisorormanagerassignsQCtoShift2Technologist.

METRICS/RESULTS

• After8/2016,therunchartshowedashift inthemediancomplianceratefrom89%pre-implementationto97.5%postimplementation.

• 24abnormalresultswererecordedandcorrectiveactionsweredocumentedintheonlinetool

24 ABERRANT RESULTS ADDRESSED

ResultNo.ofOccurrences Action

QC ValueIncorrectlyRecorded 8 • Retraining• Exclude resultandrepeatQC

measurement

RingArtifactIdentified 4 • AirCalibrationperformedand/orservicecontacted

QCValueoutoftolerance 4 • RepeatTest• ContactService

QCProtocol requiresadjustment– baselinenoiselevellowerthanselectedrange

6 • Physicist correctedQCprotocol

BrokenPhantom 2 • Siteordered newphantom

CONCLUSIONS

• TheonlineQCmanagementtoolimprovedcompliancewithdailyQCfrom89%to97.5%.

• Abnormalresultsandremediationstepsareeasilydocumentedforauditorreview.

• ThesoftwaretoolenabledasinglephysicisttoeffectivelytrackQCfrom25CTscannersacrossmultiplesites.