A patient journey audit tool (PJAT) to assess quality indicators in a nuclear medicine service

Abstract

Purpose: To develop a nuclear medicine specific patient journey audit tool (PJAT) to survey and audit patient journeys in a nuclear medicine department such as staff interaction with patients, equipment, quality of imaging and laboratory procedures, patient protection, infection control and radiation safety, with a view to optimising patient care and providing a high-quality nuclear medicine service.

Methods: The PJAT was developed specifically for use in nuclear medicine practices. Thirty-two questions were formulated in the PJAT to test the department's compliance to the Australian National Safety and Quality Health Service Standards, namely clinical governance, partnering with consumers, preventing and controlling health care infection, medication safety, comprehensive care, communicating for safety, blood management and recognising and responding to acute deterioration. The PJAT was also designed to test our department's adherence to diagnostic reference levels (DRL). A total of 60 patient journey audits were completed for patients presenting for nuclear medicine, positron emission tomography and bone mineral density procedures during a consecutive 4-week period to audit the range of procedures performed. A further 120 audits were captured for common procedures in nuclear medicine and positron emission tomography during the same period. Thus, a total of 180 audits were completed. A subset of 12 patients who presented for blood labelling procedures were audited to solely assess the blood management standard.

Results: The audits demonstrated over 85% compliance for the Australian national health standards. One hundred percent compliance was noted for critical aspects such as correct patient identification for the correct procedure prior to radiopharmaceutical administration, adherence to prescribed dose limits and distribution of the report within 24 h of completion of the imaging procedure.

Conclusion: This PJAT can be applied in nuclear medicine departments to enhance quality programmes and patient care. Austin Health has collaborated with the IAEA to formulate the IAEA PJAT, which is now available globally for nuclear medicine departments to survey patient journeys.

Keywords: Clinical governance; Nuclear medicine; PET; Patient journey audit tool; Quality indicators.

Fig. 1

Standard 1 clinical governance. Ensuring safety and quality systems are followed to maintain reliability, safety and quality of health care. The n value is smaller for the first set of data because inpatients do not report to the department reception, they report directly to the nursing station

Fig. 2

Standard 2 partnering with consumers. Survey responses from patients who attended the department during the audit period

Fig. 3

Standard 4 medication safety. High compliance was observed for all aspects of medication safety in NM and PET. BMD was not included since no medication/radiopharmaceutical is administered for DXA scans

Fig. 4

Patient safety. Diagnostic reference levels for administered radiopharmaceutical dose. The chart demonstrates the average administered dose for each of the common procedures in the subset of 120 patients, where 100% depicts the maximum allowed dose as stipulated by ARPANSA

Fig. 5

The time spent by patients in the department from arrival to completion of the study and time taken from scan completion to report generation