Transcript Quality Management

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
• 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.
• QA consists of activities that provide adequate
confidence that a radiology service will render consistently
high quality images and services.
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.
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• QA includes evaluation activities such as
•interpretation of examinations,
• maintenance of equipment,
• performance of procedure,
• filling system,
• staff development,
• scheduling of examinations and supply lines
Quality Assurance Example
Patient Arriving Alert System
 Patient 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 procedure
Positive
patient care
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
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Quality Control Example
Check Patient Arriving Alert System
 Patient arrived to the front desk,
 Is there a process that is followed to alert the
technologist that a patient is waiting.
Patients complain from long
waiting time before starting the
procedure
Negative
patient care
Quality Control
 Three major categories of QC tests are used at
various times:
 Acceptance testing
 Routine maintenance
 Error maintenance
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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”.
Acceptance Testing
When? Whom? Why?
 Acceptance testing is performed:
 Before newly installed
or
 Equipment with major repairs is accepted by the department.
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.
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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
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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.
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Continuous Quality Improvement (CQI)
Vs
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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.
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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.
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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.
• write a policy
and
standardize
the change. If
it didn’t work
•go through
the cycle again
•Study the
results of the
plan to
determine
whether the
plan worked.
• Develop a plan
based on what
needs to be
done.
• Execute the
plan
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
Test
Frequency
Procedure
Warm-up Procedures
Processor QC
Darkroom QC
System Constancy Check
Viewboxes
Visual Checklist
Repeat Analysis
Film and Chemical Storage
Artifact Evaluation
Cassettes and Screens
Darkroom Fog
Screen-Film Contact
Collimation Checks
SID Indication
Automatic Collimation Check
Lead Apron Check
Program Review
Radiation Safety Survey
Daily, and If Idle Over 2 Hours
Daily, Prior to Developing Films
Daily and Weekly
Monthly and After Service
Monthly
Quarterly and After Service
Quarterly
Quarterly
Quarterly
Quarterly or Semiannually (As Needed)
Semiannually*
Annually and As Needed
Annually
Annually
Annually
Annually
Annually
Two Years
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2
3
4A, 4B
5
6
7
8
9
10
11
12
13
14
15
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Form9
Form7
*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
Development of Equipment Specifications
 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
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
A properly working quality control system will:-
• Reduce equipment down-time
• The number of repeated exposures
• Reduce patient dose,
• Patient waiting time,
• Supply costs
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.
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
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.
Repeat Film Studies
Analysis of Data
Retake Percentage by Room
Reason
1
2
Room #
3
4
Dark
Light
Positioning
Centering
Motion
Other
Total:
29
45
20
10
6
8
118
37
31
18
11
7
6
110
36
32
18
20
6
7
119
Technique exposure
Chart error?
33
32
19
9
5
7
105
5
33
37
17
9
5
6
107
Collimator misaligned?
Repeat Film Studies
Analysis of Data
Retake Percentage by Technologist
Technologist #
2
3
4
Reason
1
Dark
Light
Positioning
Centering
Motion
Error
Other
Total:
35
32
20
13
5
10
5
120
Need to be more
carful?
31
31
18
12
11
4
7
112
32
31
18
11
4
5
6
107
Using long exposure
Times?
5
30
34
30
12
4
3
6
119
43
30
17
11
4
3
7
115
Has difficulty with
Some exams?