When radiologists can easily report issues with image quality, the entire practice benefits

Implementing a workflow-integrated program that helps radiologists provide feedback to technologists can increase radiologist engagement and help a practice identify and address ongoing issues, according to a new study published in the Journal of the American College of Radiology.

“Consistent diagnostic image quality along with timely and accurate performance of technical and clerical tasks is a requisite for high-level radiology patient care,” wrote lead author Shlomit Goldberg-Stein, MD, Albert Einstein College of Medicine in the Bronx, New York, and colleagues. “To achieve these goals, radiologist input into the process of image acquisition is of paramount importance. At fast-paced, high-volume, or multisite radiology practices, where radiologists’ time is limited, and subspecialty oversight is often distributed, there are many challenges to the efficient delivery of constructive feedback and discovery of technical failure patterns.”

The authors, who work at a large urban academic medical center that performs approximately 700,000 imaging exams each year, believed their reporting system for identifying technical issues was “cumbersome and heterogeneous across sites, resulting in underreporting of suboptimal studies.”

To address the issue, the authors introduced the practice to a web-based program for technologist feedback. The program allows radiologists to easily submit feedback from the electronic medical record, either writing their own comments or selecting an option from a modality-specific list. Local technologist managers are then expected to address each issue within three days, and the feedback is all dumped into a searchable database. In addition, status reports are automatically generated at the end of each month.  

Goldberg-Stein et al. noted that their project had three primary goals:

  • Increase radiologist engagement
  • Identify systems issues and areas of common weakness
  • Encourage improvement through a “Just Culture” framework, meaning technologists are not shamed for their mistakes and discipline is limited to reckless behavior

The program, the authors added, was a success on all three fronts.

During the six months before implementation, 10 x-rays, 6 CT exams and 34 ultrasound exams were reported by radiologists. In the six months after implementation, however, 75 x-rays, 83 CT exams and 78 ultrasound exams were reported. “Praise for exceptional performance by technologists was also reported,” the authors wrote, showing that engagement had truly been improved.

The program also taught the authors a lot about their practice.

“A searchable database, created to allow the identification of enterprise-wide systems issues, quickly identified several easily remediable deficiencies,” the authors wrote. “For example, multiple submissions regarding missing reformats on CT studies from specific sites led to the discovery that the built-in protocols on those units were incomplete. Similarly, dose reports from sinus CT studies performed at one site were not being transmitted to the PACS because of incorrect default settings built into the protocol.”

The Just Culture framework was also successfully implemented. This encourages technologists to report issues they see within the system without being held accountable, the authors wrote. Technologists were also recognized for positive feedback from radiologists by being entered into a monthly drawing for a gift certificate.

“Our workflow-integrated quality improvement tool has empowered radiologists in a busy academic practice to more easily and efficiently provide feedback to technologists and managers regarding examination quality,” the authors concluded. “The tool is applied within a just culture paradigm, breeding goodwill, acceptance of the program, and opportunities for continuous improvements in patient care.”