You don’t have to spend a lot on QI to get a lot back

For the 30 radiologists who staff the medical imaging department at Kaiser Permanente Colorado, the heart of continuous quality improvement lies nearly hidden away in a previously untapped vein of “latent learning” opportunities.

Radiologist Richard Sharpe Jr., MD, MBA, value advisor for the department, defines these as pretty much any points of interest an interpreting radiologist notices in a diagnostic image or report that bear flagging and discussing with the rest of the group.

“Most radiology practices already have a framework in place to track peer-review type cases. We just expanded that to include cases that have latent learning opportunities,” Sharpe explained. “Either you’re looking at a case and you realize, ‘Oh, this is very subtle; any radiologist might have missed this,’ or you’re reading a CT scan of someone who had an x-ray a few weeks ago, and you see with better detail, ‘Oh, this is what was on that x-ray.”

Armed with such additional information on past cases, the team collaborates to improve their clinical performance going forward.

Sharpe will share details on the program at RSNA 2016 Monday afternoon in a four-speaker session titled, “Mission Critical: How to Increase Your Value by Mastering the Intersection of Quality Improvement and Informatics.”

Existing (and free) resources, priceless results

Sharpe said a key to the success of the peer-learning program (PLP)—it’s voluntary, but all 30 radiologists participate to one degree or another—is its design incorporating nonpunitive error catching and anonymized commenting.

“It’s essential that we’re able to leverage anonymity to get people in the door, identifying things and providing content for the entire group,” he said. “In exchange for that, everyone grows. The patients get better care, and the radiologists feel a heightened sense of purpose, renewed passion and engagement.”

Meanwhile, Kaiser Permanente Colorado’s leadership surely appreciates the program’s use of existing resources. The PLP adopts the “Interesting Cases” component of the American College of Radiology’s RadPeer system to partition radiologist-selected cases for continuous quality improvement and curate them for continuing clinical education.

The PLP team also uses existing teleconferencing resources to distribute content and interactivity to numerous sites, and each month, members tap into an online self-assessment/continuing medical education (CME) module.  

Through the latter, nearly 1,000 CME credits have been issued and more than 3,500 learning-point distributions have occurred, Sharpe said.

“With today’s technology you can use Google Hangouts, your existing company’s WebEx subscription, GoToMeeting or any other [digital communications service] to bring people in,” Sharpe said of the conferencing. “We do this during a lunchtime meeting. Everyone is involved, having a conversation, and we’re not incurring any additional cost. We openly discuss cases and teach each other how to improve our quality.”

There’s still more on the existing-resources front. For the most part, surveying participants or voting on cases is “likely not necessary,” Sharpe pointed out. “But if your institution or hospital requires it, resources such as Poll Everywhere allow you to survey up to 40 users for free.”

Showing as well as telling

One of the PLP’s greatest strengths is its grounding in real-world cases, Sharpe said.

“It’s not theoretical that an x-ray could be interpreted better or we could make a difference in patient care,” he said. “All of this is actually from patients who have come to us for care. It’s very practical.”

Sharpe said that, in any given month, as many as three-quarters of the department’s radiologists engage with the PLP in some way.

“Almost every week a radiologist tells me, ‘I am so glad to have this program,’” he said. “‘I would not have caught this fracture or this pneumonia today if we hadn’t discussed a case like it a few months ago.’”

Along with presenting on Kaiser Permanente Colorado imaging’s PLP, Sharpe—whose talk is titled “How to Create a Culture of Continuous Quality Improvement Using Existing and Free Resources”—will moderate the broader Monday afternoon discussion on leveraging quality improvement and informatics to increase radiology’s value.

Also slated to speak as part of the “Mission Critical” session are:

• David B. Larson, MD, MBA (“Using Information Systems to Facilitate Improvement While Keeping Your People Engaged”);
• Samir Patel, MD (“What Quality Improvement Tools are Currently Available, and How Can You Leverage Them to Improve Quality and Demonstrate Value?”); and
• Alex Towbin, MD (“Examples of Informatics Quality Project Successes and Future Opportunities”).

The goal of the session as a whole is to “show that IT tools can be leveraged in very specific ways to build a case for improving value over time,” Sharpe said. “It will be helpful not only for people in the foundational stage who don’t have a value program, but also for those who are establishing their value programs. It’s always good to get tangible examples and see what other people are doing.”