Transcript Turnaround Time - Diagnostic Radiology

DIAGNOSTIC
RADIOLOGY
PQI - Turnaround Time
C. Merritt & M. Mauro, Moderators
P. Alderson, Trustee
Breakout:
Turnaround Time - 12:30-2:15 PM
12:45- 1:00
Comments and feedback on AM session
1:00 - 1:15
Overview of turnaround time activity
1:15 - 2:15
Questions and Discussion
Participants
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ACR – Lawrence P. Davis, MD
SIR – Hilary Bilkowski – staff
AUR – Beth McFarland, MD
ISMRM – Martin Prince,
RBMA – Mike Mabry
ASNR – Robert Zimmerman, MD
Daniel I Rosenthal, MD – speaker
Turnaround Time
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Time from request to schedule
Time from scheduled to completed
Time fromm completed to dictated
Time from dictated from transcribed
Time from transcribed to approved
Time from approved to distribution
Turnaround Time
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Measurement / Benchmarking
Individual
 Departmental
 Regional
 National
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ABMS Guidelines
In preparing its application to the ABMS for
approval of its MOC program, the ABR was
required to respond in detail to a number of
ABMS requirements regarding the practice
performance component (Part IV) of MOC.
ABMS requirements and ABR responses related to
turnaround time are presented in the following
slides:
MOC Part IV
ABMS:
1. A program of practice assessment should be
phased in, periodically evaluated for its
effectiveness, and systematically improved.
Diplomates should be kept informed of the
development of practice performance
assessment.
MOC Part IV
ABR:
The monitoring of report turnaround times for
physicians participating in MOC will be
implemented. Effective assessment tools are
currently available and will be improved over
time by the generation of local, regional, and
national performance benchmarks.
MOC Part IV
ABMS:
2. The assessment process should reflect the
activities of a diplomate related to patients or
patient care.
MOC Part IV
ABR:
The radiology report is the definitive product of the
diagnostic radiologist, and its prompt transmission to
the referring physician and/or patient is an important
determinant of quality patient care. Measurement of
report turnaround time is therefore an appropriate
practice performance parameter to monitor and
improve, as it has a direct effect on patient care.
Measures of improvement will be specific to practice
settings and referring physician needs.
MOC Part IV
ABMS:
3. Standards for measurement of clinical practice
performance should be based on evidence-based
guidelines, explicit expert consensus, or
normative peer comparison.
MOC Part IV
ABR:
National guidelines for reporting turnaround times
have been developed by national organizations,
largely through a process of expert consensus.
MOC Part IV
ABMS:
4. The assessment process should compare the
diplomate’s practice performance to evidencebased guidelines or explicit expert consensus,
where available, and to peers.
MOC Part IV
ABMS:
(4.) After an initial baseline assessment, diplomates should
be asked to develop an implementation plan for how
they would improve performance. Diplomates should
submit a follow-up assessment of the effect of the
improvement plan. Each board should have a plan for
what to do with diplomates whose performance does
not meet acceptable expectations.
MOC Part IV
ABR:
In addition to use of national guidelines
referenced above, targets for mean report
turnaround performance will be established at a
local or institutional level. Performance of
individual physicians will be compared to local,
regional, and national benchmarks, permitting
normative peer comparison.
MOC Part IV
ABMS:
5. Initially each of the six general competencies
should be assessed at least once during a board’s
repeating maintenance of certification cycle. It is
expected that by the end of the second cycle,
this should be a continuous process.
MOC Part IV
ABR:
Report turnaround times address competency in
- communication
- systems-based practice
- practice-based learning.
MOC Part IV
ABMS:
6. Assessment of patient care initially should focus
on a sampling of patients in a practice with a
key disease or clinical process (such as asthma,
diabetes, pregnancy, immunizations, surgical
procedure or processes central to that specialty)
at least once per cycle.
MOC Part IV
ABMS:
(6.) By the end of the second cycle, each board should
move to a more continuous sampling of patients that
will enable diplomates to demonstrate, at any point in
time, the quality of his/her care for a defined number
of consecutive patients or specialty-related key
activities.
MOC Part IV
ABR:
Assessment of report turnaround times is not
restricted to a specific class of diseases, but
involves a process of continuous monitoring.
MOC Part IV
ABMS:
7. An effective method for boards to consider for
assessment and improvement of clinical
performance is to be part of a collaborative
effort with other practices using shared
databases.
MOC Part IV
ABR:
Report turnaround time performance for departments
and individuals can be easily shared and compared
through the use of standardized measurement
procedures.
MOC Part IV
ABMS:
8. The measurement of practice performance
should use proven educational and assessment
methodology.
MOC Part IV
ABR:
Measurement of turnaround time is objective and
can be standardized to permit benchmarking at
local, regional, and national levels.
MOC Part IV
ABMS:
9. Practice assessment should provide
performance feedback, improve workflow,
improve efficiency of practice, and should not
duplicate other assessment efforts.
MOC Part IV
ABR:
Individual performance is measured and will be
used to monitor and improve reporting
performance. This will result in improved
workflow and efficiency.
MOC Part IV
ABMS:
10. Practice assessment should include appropriate
collaboration with specialty societies and other
organizations with relevant education and
assessment expertise.
MOC Part IV
ABR:
National guidelines can serve as a valuable basis
for establishing individual targets.
MOC Part IV
ABMS:
11. Boards should develop a consistent approach
regarding the status of Maintenance of
Certification© for diplomates who are not
involved in direct patient care.
ABR:
The ABR will review guidelines developed by Dr.
Stockman and the ABMS Group.
MOC Part IV
ABMS:
12. The assessment of physician performance
should begin during residency and continue
throughout practice. The board’s evaluation of
physician performance during residency should
be linked to the six general competencies
described by the ABMS-ACGME.
MOC Part IV
ABR:
The ABR is collaborating with the Radiology Residency
Review Committee of the ACGME in a joint
workgroup to develop definitions, and to eventually link
resident performance with diplomate performance. The
use of satisfaction surveys is a tool that has relevance
during both training and practice.
Discussion / Action
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Review currently available assessment tools and
develop a process to improved these over time
by the generation of local, regional, and national
performance benchmarks.
Develop standards for measurement of clinical
practice performance based on evidence-based
guidelines, explicit expert consensus, or
normative peer comparison
Discussion / Action
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Explore opportunities for collaboration among
practices using shared databases.
Apply proven educational and assessment
methodology to measurement.
Explore opportunities for benchmarking at
local, regional, and national levels.
Discussion / Action
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Develop and / or provide tools to measure and
monitor performance.
Explore collaboration with specialty societies
and other organizations with relevant education
and assessment expertise.
Develop methods for assessment of
performance during residency.
Discussion / Action
Departmental, institutional, and society projects.
 Database development for future benchmarking
(societies instrumental).
 Communicating accurate information about how
Part IV requirements may be met (societies
instrumental)
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Implementaion
Year
1
Select topic (and sub-topic if appropriate); identify
specific objectives, metrics; collect baseline data;
develop improvement plan +/- add’l metrics
2
Implement plan; begin collecting 1st set of
improvement plan data
3
Complete collecting 1st set of improvement plan
data; analyze; summarize results
4
Modify improvement plan; begin collecting 2nd set of
improvement plan data
PQI Steps
Year
5
Continue collecting data
6
Complete collecting 2nd set of improvement plan data
7
Refine improvement plan; implement; begin collecting
3rd set of improvement plan data
8
Continue collecting data
PQI Steps
Year
9
Complete collecting 3rd set of improvement plan data;
analyze; summarize results
10
Final report of results and conclusions
11
Sustain gain of PPP; select next topic