Four words can help community radiologists perform PQI projects

Radiologists can use a four-step process created by the American Board of Radiology (ABR) to turn day-to-day hard work into Practice Quality Improvement (PQI) projects, according to recent analysis in the Journal of the American College of Radiology.

“Most radiologists who practice outside the university setting are community radiologists,” Govind Mukundan, MD, and colleagues wrote. “These radiologists practice in various settings, including hospitals, imaging centers, multispecialty practices, and private offices, that share the common characteristic of a predominant focus on patient care, rather than the additional missions of education and research that characterize university practice settings.”

It can sometimes be difficult for community radiologists to perform PQI projects, the authors wrote, due to a lack of administrative and IT support. In addition, these radiologists may not have substantial access to data, and educational resources may be limited. This is where the four-step process comes into play: “plan, do, study, act,” or PDSA.

Mukundan and colleagues looked at four examples of starter PQI cases and examined how each case took a basic practice-related issue and used the PDSA sequence of events to improve the overall quality of the practice.

In one example, a practice hoped to reduce esophagography fluoroscopy time. The “plan” was noting that current esophagography fluoroscopy times averaged 60 seconds. The “do” was coming up with new protocol based on pulsed fluoroscopy that led to a time that averaged 30 seconds. The “study” was comparing 20 examples of the new protocol with original protocol and determining that there was no difference in diagnostic quality. The “act,” finally, is replacing the old protocol with the new one. The practice has been improved.

In another example, a practice looks closely at mammography call-back rates after tomosynthesis. The “plan” was noting that mammography recall rates were more than 20%, which lead to concerns from a payor. The “do” was analyzing the rates as a group before and after ACR mammography courses and peer consultations with individuals who have the highest call-back rates. The “study” was seeing that the call-back rates dropped to less than 10% after ACR courses and peer consultations. The “act” was deciding to continue ongoing ACR courses, following up on call-back rates, and informing the payor that an improvement has been made. Again, the practice has been improved.

The other two examples followed this same pattern. Thanks to the PDSA sequence, each situation was turned into a worthy PQI case that meets ABR’s Maintenance of Certification requirements.

“As can readily be seen, PQI projects are not a superfluous burden on radiologists; rather, they are recognition of work already being performed by conscientious radiologists,” Mukundan et al. wrote. “PQI sets the stage for demonstrating the value of radiology to our patients, referring providers, and payers.”