Mammography Form – Conversion to Electronic Form
The history form created patient dissatisfaction due to the redundant nature of being completed annually on paper. The manual process of scanning forms was cumbersome and prone to errors; resulting in mammograms being put on a hold list until history was obtained and re-entered for the radiologist to view. Turnaround times (TAT) were being negatively impacted and patient’s results were delayed.
With conversion to digital forms, turnaround times and patient result delays have significantly decreased, resulting in increased patient and provider satisfaction. Once the electronic data is captured, a check of previously answered questions allows for a quick history review. Efficiency and accuracy have been achieved with future mammography visits.
Radiology Specimen – Lab Rejections
The process for specimen collection and transportation of specimens was prone to human error. We utilized a handwritten format that proved to cause major and minor rejections including identification errors, incorrect demographics and absent demographics. We were in an upward trend for rejected specimens during submission. Rejected specimens delayed pathology results and also decreased quality patient care. In September 2019 we began the journey to implement electronic requisitions and patient labels for specimen containers.
Specimen rejections show a reversing trend. The electronic requisitions are now exclusively used. The Fern Hill Biopsy Procedures graph shows the increase in specimen volume.
Over the past year, the data demonstrates not only the overall specimen rejections are decreasing, but more importantly, the severity score is decreasing even with the increase in specimen volume. This was a collaborative effort on the part of the PennChart analysts and the lab.
Decrease the DXA Backlog (Continuity of Care)
Description of improvement opportunity: Over seven days to first available appointment.
Actions Implemented: Added evening and weekend appointments. Hired additional staff. Changed patient schedule to be more effective.
Outcome: Consistently less than seven days for seven months in a row for FY21.
Creating a database for high risk screening patients to assist staff with scheduling of breast imaging (mammography and MRI) (Patient Engagement)
Description of improvement opportunity: Difficult for patients to keep track of alternating appointments.
Outcome: Better patient and physician satisfaction. Increased compliance with recommended follow up.
Baseline: Patients rescheduled or missing interval appointments.
Target: No missed appointments.
Standardizing process for Therasphere therapy dosage ordering and recording
Description of improvement opportunity: When ordering the dose technologists had to review two separate documents.
Actions Implemented: Therasphere ordering procedure reviewed. Radiation Physicist sends an illustrator and now includes both the “week of” and dose in the free text field. Developed a second check process of the Therasphere order form prior to ordering and upon receipt of the dose.
Outcome: Streamlined process eliminating the need to check two documents prior to ordering the dose.
Project: Patient Falls Initiative
Improvement Opportunity: Develop a process to identify and support patients who are at risk of falling.
Actions Implemented:
- Screen all outpatients at patient access point of entry via EPIC documentation.
- Documentation will be flagged for technologist to review and prepare accordingly.
- Provide YELLOW wristband (FALL RISK) to qualifying patient.
- Purchase staxi chairs to transport patients from waiting room to exam area.
Follow Up:
All sections (X-ray, CT, US, NM, MRI, Mammo) assessed patients and encounter documentation for compliance.
Outcome:
-
70% compliance for screening encounter
- 82% compliance for wrist band distribution
- 45% compliance for technologist FYI notification
Next Steps:
- Data presentation with Patient Access Manager
- Additional education and training
- Re-implement departmental assessments
- Immediate goal is to achieve >95% compliance
- End goal = 100%
Understanding the Safe Use of Gadolinium Contrast: Performance Improvement Effort via Dialogue with Our MRI Technologists
Improvement Opportunity: Determine if a teaching effort led by a radiologist can improve the knowledge of our MRI technologists in adhering to the guidelines in the safe use of gadolinium-based contrast agents.
Actions Implemented:
- Pre-intervention - 10 multiple choice questions sent to MR techs in March 2020 90% technologists participated
- Intervention - Two virtual sessions going over the document in April 2020 100% technologists attended
- Post-intervention - 10 multiple choice questions, two weeks later – 60% techs participated, three months later – 100% techs participated
Correct Aggregate Response Rate:
- Pre-intervention – 80%
- Intervention (Two weeks) – 95%
- Post-intervention (Three months) – 91%
Outcome: Reviewing department guidelines as a group in an organized manner helped improve engagement and better understanding of guidelines.