QA – The Independent Sector Perspective Stephen Davies Consultant Radiologist Cwm Taf Health Board Medical Director and Responsible Officer Medica

Declaration  Medical Director Medica Reporting

Overview  Consider a framework for QA of Imaging Services  Relate this to the Independent Sector  Examine one area in detail – radiology reporting  Relate this to UK radiology practice

ISAS and Independent Sector  ISAS: ‘patients have the reassurance that the imaging services central to their core pathway are operating to a high quality standard’  Quality systems underpin good business practice; manage risk  Required in Tendering process

QA of Radiology Reporting  Quality Assurance – ‘assurance’  Audit should inform a change in practice

Audit  10% cross-sectional imaging  2% plain film  Scoring – binary?  Scoring in Independent Sector

Report Content and Discrepancy Scoring The Independent Sector or ‘GMC’ scoring  Grade 1: Unequivocal potential for serious morbidity or threat to life  Grade 2: Moderate morbidity but not threat to life  Grade 3: clinical significance is debatable or likelihood of harm is low  Grade 4: Disagreement over style &/or presentation  Grade 5: No disagreement

Radpeer – American College of Radiology  1 – Concur with interpretation  2 - Difficult diagnosis, not ordinarily expected to be made  3 - Difficult diagnosis should be made most of the time  4 - Diagnosis should be made almost every time – misinterpretation of findings

Medica ‘In House’ system  Patient outcome score 1-5  Observation score  Interpretation score  Communication score

Teleradiology context  Rapid feedback – through Insight™  Virtual – unlike departmental consensus – so arbitration  Intelligent management of process - AWT  Large database  Otherwise much is common with real departments

QA data: change in practice  Organisation – client  Organisation – provider  Individual – radiologist  Group - radiologists

Learning Organisation  Individual Learning – reflective review of discrepancies  Group Learning – monthly discrepancy briefings  Organisation – e.g. Nighthawk process; image quality

Individual Learning  Single case – perception, interpretation; knowledge  Trends – reflective review  Feedback:  ‘I realise that I have not looked at the bone windows in every case’  ‘I have learnt from these cases and my search pattern for acute abdominal imaging will include…..’  ‘I think that I should take more time checking reports for typos’  ‘This was a really useful exercise and I will apply it to my NHS practice’

GMC and Revalidation  GMC Revalidation requires doctors to show continuing fitness to practice – outcome audit data of reporting performance can be used. e.g. Domain 2  A Designated Body needs to demonstrate good clinical governance  A positive audit report reassures the patient and importantly also the radiologist.

Final Thoughts  Independent Sector is focused on quality assurance of imaging services in a number of domains  There are opportunities for the Independent Sector to share practice with the NHS for the benefit of patients  ISAS provides a framework for developing audit relating to imaging services in both sectors – linkage with CQC  QA should be used as a development tool for individuals and organisations

Reference: Is Yours a Learning Organization? Garvin DA et al (2008). Harvard Business Review March Reprint R0803H.