Presentation on theme: "QUALITY MANAGEMENT University of Sharjah College of Health Sciences"— Presentation transcript:
1 QUALITY MANAGEMENT University of Sharjah College of Health Sciences Medical Diagnostic Imaging Department2nd Quality Assurance & Quality Control Workshop10-11 June 2012QUALITY MANAGEMENTMohamed M Abdelfatah Abuzaid
2 OBJECTIVESDefine 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.
3 Quality AssuranceIs 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.QA consists of activities that provide adequate confidence that a radiology service will render consistently high quality images and services.
4 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.
5 interpretation of examinations, maintenance of equipment, QA includes evaluation activities such asinterpretation of examinations,maintenance of equipment,performance of procedure,filling system,staff development,scheduling of examinations and supply lines
6 Quality Assurance Example Patient Arriving Alert SystemPatient arrived to the front desk, there is a process that is followed to alert the technologist that a patient is waiting.Patients will not complain from long waiting time before starting the procedurePositive patient care
7 Quality ControlDefined 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 safelyThe procedure was appropriate for the patientThe procedure was performed efficientlyThe procedure produced a high-quality image to be read
8 Quality Control Example Check Patient Arriving Alert SystemPatient 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 procedurePatients complain from long waiting time before starting the procedureNegative patient care
9 Quality ControlThree major categories of QC tests are used at various times:Acceptance testingRoutine maintenanceError maintenance
10 Quality Assurance and Quality Control “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”.
11 Acceptance Testing When? Whom? Why? Acceptance testing is performed:Before newly installedorEquipment with major repairs is accepted by the department.Testing may be performed by:A designated technologistA radiation physicistService personnel employed by the hospitalTesting is used to determine whether the equipment is performing within the vendor’s specifications and as promised.
12 Routine MaintenancePerformed to ensure that the equipment is performing as expectedCan catch problems before the problems become radiographically apparentMay be performed by:A designated technologistA radiation physicistService personnel employed by the vendor
13 Error MaintenanceWhen 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.
15 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.
16 Continuous Quality Improvement (CQI) 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.
17 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.
18 Plan ACT Do Check Execute the plan write a policy and standardize the change. If it didn’t workgo through the cycle againDevelop a plan based on what needs to be done.Execute the planStudy the results of the plan to determine whether the plan worked.DoCheck
19 FOCUS PDCA is a process improvement model that is used to identify improvement opportunities and a systematic approach to implementing changes. The original problem solving model was first birthed out of one of the early quality gurus by the name of Walter Shewhard. The model was then adapted by W. Edwards Deming as the Plan-Do-Check-Act (PDCA) cycle.
21 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 acceptableTest 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.
22 RECOMMENDED QUALITY CONTROL TESTS FOR Such FACILITIES FrequencyProcedureWarm-up ProceduresDaily, and If Idle Over 2 Hours1Processor QCDaily, Prior to Developing Films2Darkroom QCDaily and Weekly3System Constancy CheckMonthly and After Service4A, 4BViewboxesMonthly5Visual ChecklistQuarterly and After Service6Repeat AnalysisQuarterly7Film and Chemical Storage8Artifact Evaluation9Cassettes and ScreensQuarterly or Semiannually (As Needed)10Darkroom FogSemiannually*11Screen-Film ContactAnnually and As Needed12Collimation ChecksAnnually13SID Indication14Automatic Collimation Check15Lead Apron Check16Program ReviewForm9Radiation Safety SurveyTwo YearsForm7*Darkroom fog should be evaluated every time you change the filter, bulb, or film type, and at least every 6 months.
23 Total Quality Control System Identification of imaging requirementTotal Quality Control SystemDevelopment of equipment specificationsSelection of equipmentInstallation and acceptance testingContinuing educationMonitoring of equipment performance
24 Identification of imaging requirement Decision should be made by the chief radiologist & administrative technologistsDetermine the basic parameters, impose financial and space restraintsProvide information on patient flow and staffing needs
25 Development of Equipment Specifications Generic equipment specifications should be developedTechnical background is needed to state exactly what is needed to meet the imaging requirementsAn imaging physicist should be involved at this pointDetailed statements of what the equipment should be capable of doing
26 Selection of equipment When the bid arrive they should be compared to meet specifications, cost and servicesA pitfall in the process can occur when radiologists show a preference to a particular vendor, thus weakening the bargaining position of the department administrator
27 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 metSupervising the testing procedures and resultsThe exact methods for acceptance testing be included in the original specificationsThe data from these tests will form the standard for all future quality control monitoring.
28 Continuing EducationIs the responsibility of the vendor to familiarize the users of the equipment with its proper operation.The equipment manual should be availableTraining should be included at the purchase contractContinuing education must be an ongoing procedureA good in-service program will include an orientation procedure as well as periodic updates on all complex equipment
29 Monitoring Equipment Performance Includes routine checks of all radiographic equipmentObjectives for performance monitoring system are to:Monitor the quality of the film processing systemSpecify faults within these systems to allow corrective measures to be taken
30 Monitoring Equipment Performance A properly working quality control system will:-Reduce equipment down-timeThe number of repeated exposuresReduce patient dose,Patient waiting time,Supply costs
31 Monitoring Equipment Performance Responsibility Medical physicists are not required to perform routine quality control proceduresMany procedure must be done dailyRT, who are more available and knowledgeable about potential problems, should do the equipment monitoringTo maintain a program, staff technologists must be given time to perform the procedures and to evaluate them.
32 Monitoring Equipment Performance The tests of x-ray tubes should include:Focal Spot size estimationHalf-value layerCollimator, central ray, and Bucky tray accuracyDistance and centering indicators’ accuracyAngulator or protector accuracyKilovoltage accuracyTimer accuracymR/mAs and miliamperage linearityExposure reproduceability
33 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.
34 Repeat Film Studies Obtaining Data Retain all repeated radiographs, regardless of cause, for analysisFilms labeled as “cause of repeat, the room and tube used should be noted on each film before it is discarded
35 Repeat Film Studies Obtaining Data 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.
36 Repeat Film Studies Analysis of Data Retake Percentage by RoomRoom #ReasonDarkLightPositioningCenteringMotionOtherTotal:Technique exposureChart error?Collimator misaligned?
37 Repeat Film Studies Analysis of Data Retake Percentage by TechnologistTechnologist #ReasonDarkLightPositioningCenteringMotionErrorOtherTotal:Need to be morecarful?Using long exposureTimes?Has difficulty withSome exams?