1. FOCUS Voluntary Community, May 2011 IMAGING IN FOCUS

2. Goal #1: To Increase Appropriate Testing Rates Reduce the number of low risk RNI procedures ordered Turn more uncertain studies into appropriate studies Decrease testing for patients with normal ECGS’s and normal exercise capacity Track inappropriateness rates every quarter and watch for reduction Reduce inappropriate testing for asymptomatic patient Goal #2: Physician Meetings to Review and Discuss Data Create documentation for each physician and review their progress with them Report findings at dept meeting. Look for patterns and report them to appropriate referring physicians Review group results monthly Include discussion at quarterly meetings and get feedback from nurse tech and physician

3. Goal #3: To Increase Education and Awareness Continuously educate ordering physicians Inform and educate MD’s about Appropriate Use Criteria Educate patients about radiation burn and decrease patient demand for imaging Educate physicians about the relevant risk factors of nuclear imaging Goal #4: Increase communication among physicians Meet with chief of echo lab, and cardiology Increase communication with the patient and the ordering physician regarding appropriate/inappropriate/uncertain testing Physician interaction with nuclear medicine department director

4. Goal #5: To Educate PCP’s/referring physicians and Simplify Referrals Spread knowledge of AUC to referring physicians Evaluate referring orders Improve communication with referring physicians Help referring physicians to order the appropriate test and adhere to AUC Provide flowchart and table for AUC to referring physicians, review all orders Closer study of orders from referrals Send letters to referring physicians Talk to referring physicians and help them understand AUC Identify PCP’s with most inappropriate referrals

5. Goal #6: To Determine Current Ordering Patterns and Identify Areas to Improve Assess past MPI for appropriate, uncertain & inappropriate use, quantify results and compare with updated criteria. Determine our AUC areas of concern Determine if there is a pattern within groups for the ordering of RNI on patients who are considered inappropriate according to AUC Develop a system, by which AUC is evaluated during the scheduling process. Goal #7: Review data and compare with other measure (i.e. outcomes) See the effects of appropriate imaging on patient outcomes Determine if nuclear tests are correlating with high risk Document appropriate diagnosis for ordering nuclear studies within the practice

6. Goal #8: Learn More About the FOCUS Initiative Become proficient using the AUC RNI tool Obtain education from ACC/FOCUS website to further improve the practice role in quality improvement standards Goal #9: Participate in webinars, listserv, and the FOCUS program Keep up with the standards for appropriate use through webinars/seminars Joining the ListServ community. Participating in discussions and seeking guidance from the community to put the tool in practice at our office. Create a protocol; utilize the RNI tool, set-up interoffice tools to collect data for ongoing use.

7. Goal #10: Acquire Greater Knowledge and Implementation of Guidelines and AUC Document AUC as justification for MPI on patient test results and EMR during patient office visits Gaining doctor recognition/acceptance of the value of AUC. Develop practice guidelines for staff utilization when a nuclear study is ordered with a inappropriate diagnosis Make staff and physicians aware of criteria that should be met in order minimize completion of inappropriate studies. Goal #11: Increase use of AUC Keep up with recommended guidelines Utilize published ACC AUC guidelines, document in patient records & also inform patients of AUC during office visits. Educate physicians and staff about AUC and encourage adherence to guidelines