Online Error Reporting for Managing Quality Control Within Radiology

Abstract

Information technology systems within health care, such as picture archiving and communication system (PACS) in radiology, can have a positive impact on production but can also risk compromising quality. The widespread use of PACS has removed the previous feedback loop between radiologists and technologists. Instead of direct communication of quality discrepancies found for an examination, the radiologist submitted a paper-based quality-control report. A web-based issue-reporting tool can help restore some of the feedback loop and also provide possibilities for more detailed analysis of submitted errors. The purpose of this study was to evaluate the hypothesis that data from use of an online error reporting software for quality control can focus our efforts within our department. For the 372,258 radiologic examinations conducted during the 6-month period study, 930 errors (390 exam protocol, 390 exam validation, and 150 exam technique) were submitted, corresponding to an error rate of 0.25 %. Within the category exam protocol, technologist documentation had the highest number of submitted errors in ultrasonography (77 errors [44 %]), while imaging protocol errors were the highest subtype error for computed tomography modality (35 errors [18 %]). Positioning and incorrect accession had the highest errors in the exam technique and exam validation error category, respectively, for nearly all of the modalities. An error rate less than 1 % could signify a system with a very high quality; however, a more likely explanation is that not all errors were detected or reported. Furthermore, staff reception of the error reporting system could also affect the reporting rate.

Keywords: PACS; Quality assurance; Web technology.

Fig. 1

Percent of exams with submitted quality report, per modality (mean and range from 6 months of data). CR computed radiography, CT computed tomography, MG mammography, MR magnetic resonance imaging, NM nuclear medicine, PT physical therapy, US ultrasonography, XA X-ray angiography

Fig. 2

Distribution of errors by modality. CR computed radiography, CT computed tomography, MG mammography, MR magnetic resonance imaging, NM nuclear medicine, PT physical therapy, US ultrasonography, XA X-ray angiography

Fig. 3

Number of exam protocol subtype errors per modality (threshold = 15). CR computed radiography, CT computed tomography, MR magnetic resonance imaging, US ultrasonography

Fig. 4

Number of exam technique subtype errors per modality (threshold = 8). CR computed radiography, CT computed tomography, MG mammography, MR magnetic resonance imaging, US ultrasonography, FOV field of view

Fig. 5

Number of exam validation subtype errors per modality (threshold = 15). CR computed radiography, CT computed tomography, MR magnetic resonance imaging, NM nuclear medicine

Fig. 6

Percent of exams with submitted quality report, per center type (mean and range from 6 months of data)

Fig. 7

Number of exam protocol subtype errors per center (threshold = 30)

Fig. 8

Number of exam technique subtype errors per center (threshold = 15). FOV field of view

Fig. 9

Number of exam validation subtype errors per center (threshold = 30)