IT-based quality review process improves technologist performance

Implementing an IT-based quality review process can improve technologist performance over time, according to a new study published in the Journal of the American College of Radiology.

The study’s authors, unhappy with how their institution was collecting data on technologist performance, introduced a new IT-based system that allowed each modality’s imaging technical coordinator (ITC) to review examination quality and completeness. Studies performed by each technologist were chosen at random every quarter, with the ITC categorizing image quality as “excellent,” “acceptable” or “not acceptable.” Free text could be entered to clarify decisions as necessary.

The authors studied four quarters of data to judge the effectiveness of this new process. In the first quarter, more than 23 percent of studies were scored as not acceptable. In the second quarter, more than 14 percent of studies were scored as not acceptable, a significant drop. In the third quarter, the number of studies scored as not acceptable barely changed. In the fourth quarter, however, that number was down to 12 percent.

“Our current workflow acts as both a quality control measure for radiology examinations and as a learning tool for technologists,” wrote lead author Jonathan H. Chung, MD, department of radiology at the University of Chicago, and colleagues. “Some may argue that much, if not all, of the improvement in radiology examination quality is attributable to the often cited Hawthorne effect—the concept that improvements in performance may be due to the simple act of being observed by others. However, multiple studies have cast doubt upon the Hawthorne effect. Although we believe that our results are largely a direct consequence of the directed feedback our workflow encourages between the manager, ITC and technologists, our workflow and IT tool may reinforce the Hawthorne effect, if this is indeed a bona fide phenomenon.”

During the first quarter after implementation, more than 18 percent of studies scored as not acceptable were due to “poor patient positioning.” In addition, more than 13 percent were due to “inadequate image collimation” and more than 7 percent were due to the absence of proper documentation. By the fourth quarter, the numbers were down, but poor patient positioning and inadequate image collimation remained the biggest two issues being experienced by technologists.

“To capitalize on this information, managers and ITCs will focus their quarterly feedback sessions with technologists on patient positioning and collimation,” the authors wrote. “In addition, we will ask radiologists to be more diligent in providing constructive feedback to technologists, especially in regard to these two issues.”

Chung et al. also noted that two modalities did not see significant improvement: ultrasound and pediatric radiography. This may have been because the quality was so high already due to previous quality improvement projects, the authors wrote, or because either study is necessarily common at the institution in question.

“We surmise that the lack of improvement of ultrasound examinations could be additionally due to the technically challenging task of ultrasound image acquisition,” the authors added. “Given this more complicated task, one would expect the not acceptable rate to be higher and improving ultrasound images may, therefore, be more difficult than in other modalities. To evaluate this further, we will assess the ultrasound image quality relative to technologist experience level, time of day, and imaging volume at the time of image acquisition.”