Presentation on theme: "QUALITY MANAGEMENT Mohamed M Abdelfatah Abuzaid. OBJECTIVES Define quality assurance and control and discuss their relationship to excellence in radiography."— Presentation transcript:
QUALITY MANAGEMENT Mohamed M Abdelfatah Abuzaid
OBJECTIVES Define quality assurance and control and discuss their relationship to excellence in radiography. Describe the process of identifying imaging requirements, developing equipment specifications, selecting equipment, installing and testing equipment, and training the technical staff. Describe the objectives and responsibilities of monitoring equipment performance. Explain the rationale behind the data collection process and the basic analysis of a radiographic repeats rate study.
Quality Assurance QA consists of activities that provide adequate confidence that a radiology service will render consistently high quality images and services. Is a program designed by management to assure quality of a product or service. Such a program can include customer feedback, employee empowerment, and quality control.
Quality Assurance Activities Activities are focused around people and service. Most quality assurance activities produce quantitative data that can be analyzed. These data can be used to monitor the processes and determine whether the process is working as it should and whether the standard of quality has been met. 4
interpretation of examinations, maintenance of equipment, performance of procedure, filling system, staff development, scheduling of examinations and supply lines QA includes evaluation activities such as
Quality Assurance Example Patient arrived to the front desk, there is a process that is followed to alert the technologist that a patient is waiting. Positive patient care Patients will not complain from long waiting time before starting the procedure Patient Arriving Alert System
Quality Control Defined as a comprehensive set of activities designed to monitor and maintain systems that produce a product. In a radiology department, QC activities are performed to ensure that: The procedure was performed safely The procedure was appropriate for the patient The procedure was performed efficiently The procedure produced a high-quality image to be read 7
Quality Control Example Patient arrived to the front desk, Is there a process that is followed to alert the technologist that a patient is waiting. Waiting Time for the RT to start the procedure Negative patient care Patients complain from long waiting time before starting the procedure Check Patient Arriving Alert System
Quality Control Three major categories of QC tests are used at various times: Acceptance testing Routine maintenance Error maintenance 9
“A quality assurance program maximizes the possibility that the image will every time provide adequate diagnostic information for the least possible radiation exposure and cost to the patient”. Quality Assurance and Quality Control
Acceptance Testing When? Whom? Why? Acceptance testing is performed: Before newly installed or Equipment with major repairs is accepted by the department. 11 Testing may be performed by: A designated technologist A radiation physicist Service personnel employed by the hospital Testing is used to determine whether the equipment is performing within the vendor’s specifications and as promised.
Routine Maintenance Performed to ensure that the equipment is performing as expected Can catch problems before the problems become radiographically apparent May be performed by: A designated technologist A radiation physicist Service personnel employed by the vendor 12
Error Maintenance When errors occur in equipment performance, corrective action must occur. Errors are detected by poor equipment performance or poor-quality outcomes. Corrections generally are made by service personnel employed by the vendor. 13
Continuous Quality Improvement (CQI) 14 Vs
Continuous Quality Improvement (CQI) CQI tends to focus on the process rather than the people or the service. Belief is that if the process is good, the people will follow it and the service will then be good. CQI does not replace the quality assurance/QC programs but comes alongside as a higher level of thinking. 15
Quality assurance/QC programs focus on maintaining a certain level of quality, not necessarily improving to a higher quality. CQI focuses on improving the process or system in which the people function as team members rather than focusing on the individual’s work. 16 Continuous Quality Improvement (CQI)
FOCUS-PDCA method Find and define a problem. Organize a team to work on improvement. Clarify the problem with current knowledge. Understand the problem and its causes. Select a method to improve the process. Plan implementation. Do the implementation and measure change. Check the results. Act to continue improvements.
Develop a plan based on what needs to be done. Study the results of the plan to determine whether the plan worked. Execute the plan write a policy and standardize the change. If it didn’t work go through the cycle again
Why QA & QC? The three Ds: Dose Diagnosis Dollars
QUALITY CONTROL MANUAL A QC Manual should be created and reviewed at least annually. The manual should include the facility’s objectives, QC instructions, QC results, and personnel responsibility. Items that should be included in a QC Manual are: A list of the tests to be performed and the frequency for each test, including acceptable Test limits, test procedures, maintenance, and service records. A list of equipment to be used for testing. Policy and procedures for QC tests as well as for the facility. Sample forms.
RECOMMENDED QUALITY CONTROL TESTS FOR Such FACILITIES TestFrequencyProcedure Warm-up ProceduresDaily, and If Idle Over 2 Hours1 Processor QCDaily, Prior to Developing Films2 Darkroom QCDaily and Weekly3 System Constancy CheckMonthly and After Service4A, 4B ViewboxesMonthly5 Visual ChecklistQuarterly and After Service6 Repeat AnalysisQuarterly7 Film and Chemical StorageQuarterly8 Artifact EvaluationQuarterly9 Cassettes and ScreensQuarterly or Semiannually (As Needed)10 Darkroom FogSemiannually*11 Screen-Film ContactAnnually and As Needed12 Collimation ChecksAnnually13 SID IndicationAnnually14 Automatic Collimation CheckAnnually15 Lead Apron CheckAnnually16 Program ReviewAnnuallyForm9 Radiation Safety SurveyTwo YearsForm7 *Darkroom fog should be evaluated every time you change the filter, bulb, or film type, and at least every 6 months.
Total Quality Control System Identification of imaging requirement Development of equipment specifications Selection of equipment Installation and acceptance testing Continuing education Monitoring of equipment performance
Identification of imaging requirement Decision should be made by the chief radiologist & administrative technologists Determine the basic parameters, impose financial and space restraints Provide information on patient flow and staffing needs
Generic equipment specifications should be developed Technical background is needed to state exactly what is needed to meet the imaging requirements An imaging physicist should be involved at this point Detailed statements of what the equipment should be capable of doing Development of Equipment Specifications
Selection of equipment When the bid arrive they should be compared to meet specifications, cost and services A pitfall in the process can occur when radiologists show a preference to a particular vendor, thus weakening the bargaining position of the department administrator
Installing and Acceptance Testing of Equipment Is the responsibility of the vendor and/or manufacturer. Quality Control technologists must verify that the equipment specifications have been met Supervising the testing procedures and results The exact methods for acceptance testing be included in the original specifications The data from these tests will form the standard for all future quality control monitoring.
Continuing Education Is the responsibility of the vendor to familiarize the users of the equipment with its proper operation. The equipment manual should be available Training should be included at the purchase contract Continuing education must be an ongoing procedure A good in-service program will include an orientation procedure as well as periodic updates on all complex equipment
Monitoring Equipment Performance Includes routine checks of all radiographic equipment Objectives for performance monitoring system are to: Monitor the quality of the film processing system Specify faults within these systems to allow corrective measures to be taken
Monitoring Equipment Performance Reduce equipment down-time The number of repeated exposures Reduce patient dose, Patient waiting time, Supply costs A properly working quality control system will:-
Monitoring Equipment Performance Responsibility Medical physicists are not required to perform routine quality control procedures Many procedure must be done daily RT, who are more available and knowledgeable about potential problems, should do the equipment monitoring To maintain a program, staff technologists must be given time to perform the procedures and to evaluate them.
Monitoring Equipment Performance The tests of x-ray tubes should include: Focal Spot size estimation Half-value layer Collimator, central ray, and Bucky tray accuracy Distance and centering indicators’ accuracy Angulator or protector accuracy Kilovoltage accuracy Timer accuracy mR/mAs and miliamperage linearity Exposure reproduceability
Repeat Film Studies as a part of QA & QC Why we need it? Significant reductions in patient dose, radiographers time and effort and supply costs can be achieved.
Obtaining Data Repeat Film Studies Obtaining Data Retain all repeated radiographs, regardless of cause, for analysis Films labeled as “cause of repeat, the room and tube used should be noted on each film before it is discarded
RT must be informed of the purpose of the study and asked to cooperate in a positive manner to improve patient care and working condition. Incompetent radiographers should be disciplined through normal administrative procedures based on actual performance, not as a result of repeat film study. Obtaining Data Repeat Film Studies Obtaining Data
Retake Percentage by Room Room # Reason 12345 Dark2937363333 Light4531323237 Positioning2018181917 Centering10112099 Motion67655 Other86776 Total:118110119105107 Technique exposure Chart error? Collimator misaligned? Analysis of Data Repeat Film Studies Analysis of Data
Retake Percentage by Technologist Technologist # Reason12345 Dark3531323043 Light3231313430 Positioning2018183017 Centering1312111211 Motion511444 Error104533 Other57667 Total:120112107119115 Need to be more carful? Has difficulty with Some exams? Using long exposure Times? Analysis of Data Repeat Film Studies Analysis of Data