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.