Paul Nagy

Mandatory Child Life Consultation and Its Impact on Pediatric MRI Workflow in an Academic Medical Center.

Pediatric patients undergoing MRI often require general anesthesia, which may improve image quality but is associated with significant medical risk and economic cost. It has previously been shown that certified child life specialists using high-tech interventions (eg, MRI-compatible video goggles) significantly reduce the number of pediatric MRI patients who require sedation. Most imaging centers lack such technology, however, and it remains unclear whether simpler and less costly child life interventions may be equally effective in avoiding general anesthesia. The aim of this study was to assess the impact of requiring mandatory child life evaluation for all patients aged 5 to 18 years undergoing MRI before referral for general anesthesia. Inserting this simple step into the scheduling workflow significantly reduced the use of general anesthesia in this population: general anesthesia was required in 564 of 2,433 MRI cases during the 1-year baseline period compared with 484 of 2,526 cases during the 1-year intervention period (P < .01 by z test for proportions; absolute reduction, 4.0%; relative reduction, 14.8%). The authors estimate that instituting mandatory child life evaluation avoided the use of general anesthesia in approximately 102 patients during the intervention period. Further subgroup analysis revealed that avoidance of general anesthesia was highly significant in the 5- to 10-year-old age group, whereas those aged 11 to 18 years experienced only a trend toward modestly decreased use of general anesthesia. These results suggest that mandatory evaluation for standard child life interventions is a worthwhile step that can save many children from unnecessary exposure to the risks, cost, and inconvenience of general anesthesia.

Patient Satisfaction: Opportunities for Quality Improvement

INTRODUCTION Creating “patient-centered” care is at the heart of the quality movement in an effort to reduce errors and deliver more effective care, as described in the Institute of Medicine report in 2001 [1]. Listening to and learning directly from patients have long been key performance measures for radiology practice leaders [2] and are part of the ACR’s Imaging 3.0 pillars of value-based radiology [3]. The RSNA launched the Radiology Cares campaign in 2013 to foster and enhance direct interaction between radiologists and patients [4]. Gaining experience with the strengths and weaknesses of subjective patient satisfaction surveys is invaluable as health care begins to deploy patientreported outcome tools as measures of quality and value. Creating an effective patient satisfaction surveying system can help in discovering opportunities for adding greater value to patients’ experiences. Aspects of patients’ experiences that are frequently surveyed in radiology pertain to the registration process (wait times, ease of registration, front desk staff members’ helpfulness), the facility (comfort in the waiting area, cleanliness), the examination (technologist friendliness andcourtesy, staff members’ concern for patients’ comfort and safety, answering questions, explaining tests), and personal items (concern for protecting patients’ privacy, response to patients’ needs and complaints). Several versions of radiology patient satisfaction surveys can be found on the internet, but there are many arguments in favor of creating your own survey instrument [5]. Satisfaction surveys can be used as valuable “internal” metrics [5] for practice quality improvement (QI) projects in the domain of patient

Using Quality Improvement Methods to Improve Patient Experience

Patient experience is an important component of the overall medical encounter. This paper explores how patient experience is measured and its role in radiology, including its impact on clinical outcomes and reimbursement. Although typically applied to safety and clinical outcomes, quality improvement methodology can also be used to drive improvement efforts centered on patient experience. Applying an established framework for patient-centered care to radiology, this paper provides a number of examples of projects that are likely to yield significant improvement in patient satisfaction measures.

How Effective are Your Mentoring Relationships? Mentoring Quiz for Residents

Mentoring is an essential part of a residents career development. It plays an important role in nurturing, and sustaining success along the career path of a young physician. Mentoring is a long-term goal that is development-driven rather than performance-driven. Although specific learning goals may be used as a basis, the focus of mentoring may also include self-confidence, self-perception, and work-life balance. A number of residency programs have implemented mentoring programs in their institutions. This article discusses the importance of mentoring, illustrates dos and donts for mentees and demonstrates how to choose the ideal mentor. Finally, a mentoring quiz is designed to evaluate your mentoring relationship.

The Armstrong Institute Resident/Fellow Scholars A Multispecialty Curriculum to Train Future Leaders in Patient Safety and Quality Improvement

The objective was to determine if a year-long, multispecialty resident and fellow quality improvement (QI) curriculum is feasible and leads to improvements in QI beliefs and self-reported behaviors. The Armstrong Institute Resident/Fellow Scholars (AIRS) curriculum incorporated (a) a 2-day workshop in lean sigma methodology, (b) year-long interactive weekly small-group lectures, (c) mentored QI projects, and (d) practicum-based components to observe frontline QI efforts. Pre–post evaluation was performed with the Quality Improvement Knowledge Application Tool (QIKAT) and the Systems Thinking Scale (STS) using the Wilcoxon matched-pairs signed-rank test. Sixteen residents and fellows started the AIRS curriculum and 14 finished. Scholars’ pre and post mean scores significantly improved: STS 3.06 pre versus 3.60 post (P < .01) and QIKAT 1.24 pre versus 2.46 post (P < .01). Most scholars (92%) agreed that skills learned in the curriculum will help in their future careers. A multispecialty QI curriculum for trainees is feasible and increases QI beliefs and self-reported behaviors.

Quality Improvement Projects for Value-Based Care in Breast Imaging

INTRODUCTION The Mammography Quality Standards Act [1], finalized in 1999, provides a strong foundation for demonstrating value-based patient care. The act requires an outcomes audit that correlates pathologic results with positive mammographic findings, requires the review of falsenegative mammographic results, and mandates that mammographic reports include an overall assessment of findings using structured terminology based on the ACR’s BI-RADS [2]. Now in its fifth edition, the 2013 BIRADS Atlas is a mature reporting lexicon, including finding descriptors across modalities and guidance on performing amedical outcomes audit. Mammography is particularly well suited for value-based care, with its focus on screening healthy populations. This creates continuity of care, with patients returning on an annual basis. Radiologists frequently explain diagnostic mammography and breast ultrasound results directly to patients and perform imagingguided procedures. Breast imaging is frequently practiced at multidisciplinary breast care centers, where radiologists, surgical oncologists, medical oncologists, and plastic surgeons are collocated and work in an integrated practice. In breast imaging, direct patient contact and close working relationships with related subspecialists create opportunities to identify patient-centered quality improvement (QI) projects. The ACR’s Imaging 3.0 initiative is a program that seeks to engage radiologists, referring physicians, and patients in a team-based approach to maintain the health of the population with high-quality care [3]. Value in health care is the health outcome per dollar of cost [4].With its long history