How the nation’s largest teleradiology group significantly strengthened stroke reporting
The nation’s largest teleradiology group is detailing how it has significantly strengthened stroke reporting via a recent quality improvement project.
The Alberta Stroke Program Early CT Score (or ASPECTS) helps to assess such clinical scenarios, reliably predicting recovery after initial treatment. Around early 2018, Virtual Radiologic (commonly known as vRad) started receiving requests from clients to report such ASPECTS scores for suspected middle cerebral artery strokes, the most common type of this clinical concern.
However, vRad at the time witnessed variability in this practice among its 500-plus teleradiologists, according to new research published Sept. 25 in Clinical Imaging. The Eden Prairie, Minnesota-based imaging group—which is now part of the larger Radiology Partners—sought to improve ASPECTS use through a variety of approaches between 2018 and 2019. Changes have included email reminders, educational materials, retrospective data analysis and workflow prompts.
“Our study demonstrated that radiologists initially reported ASPECTS infrequently,” Christine Lamoureux, MD, vRad’s clinical chief of MSK radiology, and co-authors concluded. “However, a significant increase was observed during and after the implementation of a comprehensive quality improvement program that incorporated real-time reminders. These findings underscore the effectiveness of such initiatives and suggest that they may be beneficial in other healthcare settings.”
The QI initiative was broken up into several different phases, with the initial period focused on email-based education. A practice medical director sent messages to all radiologists, stressing the importance of reporting ASPECTS for stroke protocol of noncontrast head CT scans. These messages also included a link to a peer-reviewed article and an online educational primer with a visual guide for calculating stroke scores.
In the second phase, vRad created a new feature to check radiologists’ stroke protocol reports for the use of ASPECTS. An internally developed software called Report Facilitator would scan reports, with options to identify missing text and send notifications to radiologists. IT experts in the practice also wrote coding to search reports, verifying if they referenced ASPECTS in some form. Additionally, vRad implemented a real-time reminder for rads to use the stroke score just before signing and submitting their diagnostic findings. This consisted of a text banner that appeared at the top of the field for stroke protocol exams, when a reference to ASPECTS was not detected.
Phase 3 led to the development of a related quality measure through a Qualified Clinical Data Registry (QCDR), a government-approved entity that collects information and reports on its successes to the Medicare program. An audit from this effort showed that email communication and educational materials did not result in significant improvements. VRad further created an auto-populated ASPECTS statement in rad reports. This paused the report-signing process, with rads having the chance to either verbally or manually enter the corresponding score into designated brackets. Further QI phases deployed a follow-up email communication and required radiologist training module, a “soft-stop feature” to enhance reminder alerts, and another small-scale audit to gauge progress.
Compliance improved after the auto-populated statement, the authors noted, which enabled rads to manually or verbally insert a stroke score. However, ASPECTS reporting didn’t increase significantly after introducing the “soft stop” feature, requiring rads to choose whether to modify a report.
“This suggests that a single reminder with active participation suffices to change behavior,” the authors noted.
Reporting of ASPECTS leapt from just 6% to 95% between the first and second audits. A two-year, large-scale analysis, involving 73,599 reports from 218 radiologists, denoted measurable progress. Results showed an increase in ASPECTS reporting from 1.4% in September 2017 to 94.4% by September 2019. In the study’s discussion section, Lamoureux and co-authors emphasized the importance of effective leadership in shaping an organization’s culture, including shared goals and fostering learning, innovation and quality improvement.
“Identifying and removing barriers is crucial for implementing a QI program,” the authors emphasized. “There was a significant increase in ASPECTS reporting adherence when radiologists completed the [continuing medical education] activity with a quiz during the later phase of our QI project,” they added later. “Active CME and comprehensive strategies may be more effective than passive methods in encouraging guideline adherence and improving physician performance.”
Read much more, including potential study limitations and how the program has evolved further, in the official journal of the New York Roentgen Society here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.