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Safe radiology for junior doctors: closed-loop audit
Abstract / Clinical Radiology 71 (2016) S11eS25
Methodology: A retrospective audit of all patients who underwent skeletal survey for suspected NAI in the Oxford University Hospitals (OUH) NHS Trust between January 2007 and April 2011 was performed. Patients were identified by a computerised radiology information system (CRIS) search. Each skeletal survey was assessed against guidelines from the above standards for technical quality and the radiology report. After an intervention a re-audit was performed from May 2011 to January 2015. Results of 1st audit round: At least 97% compliance with the radiographic guidelines. Fracture aging was performed in 62% of cases. Only 2.5% of cases were verbally communicated to the referrer. 1st action plan: Implementation of trust-wide policy to verbally communicate and document all important findings. Results of 2nd audit round: 30% of cases were verbally communicated and documented in the report. This increased to 43% for non post-mortem skeletal surveys. 85% of fractures were aged. 87e97% compliance with the radiographic guidelines. 2nd action plan: Reaffirm importance of documentation of communication with referrers. Ensure all skeletal surveys are booked correctly onto CRIS. All images to be reviewed by a radiologist and repeated if necessary. References: 1. The Royal College of Radiologists and the Royal College of Paediatrics and Child Health. Standards for radiological investigations of suspected nonaccidental injury. London: The Royal College of Radiologists and the Royal College of Paediatrics and Child Health, 2008. Compliance with imaging guidelines for paediatric major trauma: results of second audit cycle Authors: Tharunniya Vamadevan, T. Sarvananthan, J. Kho, D. Sander, I. Moorthy Background to the audit: UK paediatric major trauma imaging guidelines were adapted for local use in 2014, aiming to reduce radiation dose1. Standard: The local guideline must be followed for all patients presenting with major trauma before their 17th birthday. Indicator: 1. Adequacy of clinical details on request form. 2. Dose reduction by: e Targeted computed tomography (CT) instead of full-body traumagrams e Fewer X-rays before chest and pelvic CT e Correct arm position and removing scoop during CT. 3. Immediate communication of life-threatening findings to clinical teams and a verified report on the picture archiving and communication system (PACS) within an hour. Target: 100% compliance. Methodology: Data retrospectively acquired for 37 months before guideline implementation and 12 months after. Results of 1st audit round: Number of patients¼43 Traumagrams¼30 (70%) Targeted CT¼0 Adequate clinical details¼93% Pre-CT chest X-ray (CXR)¼49% Pre-CT pelvic X-ray¼33% Correct (arms up) position during CT¼49% 1st action plan: Raise awareness of guidelines (presentation at clinical governance meeting). Results of 2nd audit round: Number of patients¼10 Traumagrams¼3 (30%) Targeted CT¼7 (70%) Adequate clinical details¼60% Pre-CT CXR¼40% Pre-CT pelvic X-ray¼10% Arms up position¼67% Improvements noted in report verification, scoop usage and traumagram doses but adequacy of clinical information declined. 2nd action plan: 100% compliance with: 1) Clinical information on request forms 2) ‘Arms up’ in CT 3) Report verified within one hour, with consultant input within 24 hours. References: 1. The Royal College of Radiologists. Paediatric trauma protocols. London: The Royal College of Radiologists, 2014.
S19
Safe radiology for junior doctors: closed-loop audit Authors: Mahmud Saedon, Hussein Kaderbhai, Sally Lewis, Akashdeep Nijjar Background to the audit: Despite being the largest imaging requesting cohort, junior doctors’ awareness of the Ionising Radiation (Medical Exposure) Regulations (IR[ME]R) 2000 regulations and their relevance to radiology requesting is unclear.1 We aim to investigate knowledge of these regulations using a questionnaire.2 Standard: RCR IR(ME)R 2000 regulations awareness questionnaire. 2 Indicator: Foundation Year doctors’ working at St Helier Hospital understanding of the IR(ME)R guidelines. Target: 100% positive response to each questionnaire. Methodology: The ‘Foundation Doctors e Radiation Legislation Awareness Questionnaire’ was distributed within a two-week period in December 2015. An intervention was put in place and a re-audit was completed in March 2016. Results of 1st audit round: Question e % Yes Q1 Are you aware of any governmental regulations on radiation? 18% Q2 Are you aware of any legal obligation to provide accurate information when requesting imaging? 27% Q3 Are you aware that the department of radiology has the right to withdraw radiology ‘ordering’ rights? 45% Q4 Are you aware of the book ‘Making the best use of clinical radiology services’? 9% Q6 Are you able to estimate the correct radiation dose of chest X-ray? Q7 Have you been asked by a senior colleague to request imaging and been unsure of the indication? 55% Q8 Do you feel you have had adequate teaching regarding appropriate radiology referrals? 36% 1st action plan: We developed a condensed teaching resource and incorporated this into the local Foundation Doctors teaching programme Results of 2nd audit round: Question e % Yes Q1 e 80% Q2 e 80% Q3 e 80% Q4 e 20% Q6 e 40% Q7 e 60% Q8 e 40% 2nd action plan: We continue to ensure the radiology resource is being used as part of the foundation doctors’ teaching programme. Our plan is to re-audit in one year to ensure standards are maintained as junior doctors rotate through the hospital References: 1. Ionising Radiation (Medical Exposure) Regulations 2000 (IRMER). London: Department of Health, 2012 2. www.rcr.ac.uk/audit/foundation-doctors%E2%80%99-knowledgeradiation-legislation-and-exposure (last accessed 27/05/2016) The Royal College of Radiologists. iRefer: making the best use of clinical radiology. London: The Royal College of Radiologists, 2012. The Royal College of Radiologists. Recommendations for cross-sectional imaging in cancer management, second edition. London: The Royal College of Radiologists, 2014. Can I report chest X-rays? The General Medical Council may want to know... Authors: John Laurence Oakes Background to the audit: Measuring outcomes is difficult in diagnostic radiology, but potentially important in the current climate of appraisal and revalidation. Aim is to assess strategies for assessing diagnostic accuracy in plain chest reporting. Standard: No accepted error rate for diagnostic radiology. Published data suggests a wide potential error incidence rate of 2e20%.1
Methodology: A retrospective audit of all patients who underwent skeletal survey for suspected NAI in the Oxford University Hospitals (OUH) NHS Trust between January 2007 and April 2011 was performed. Patients were identified by a computerised radiology information system (CRIS) search. Each skeletal survey was assessed against guidelines from the above standards for technical quality and the radiology report. After an intervention a re-audit was performed from May 2011 to January 2015. Results of 1st audit round: At least 97% compliance with the radiographic guidelines. Fracture aging was performed in 62% of cases. Only 2.5% of cases were verbally communicated to the referrer. 1st action plan: Implementation of trust-wide policy to verbally communicate and document all important findings. Results of 2nd audit round: 30% of cases were verbally communicated and documented in the report. This increased to 43% for non post-mortem skeletal surveys. 85% of fractures were aged. 87e97% compliance with the radiographic guidelines. 2nd action plan: Reaffirm importance of documentation of communication with referrers. Ensure all skeletal surveys are booked correctly onto CRIS. All images to be reviewed by a radiologist and repeated if necessary. References: 1. The Royal College of Radiologists and the Royal College of Paediatrics and Child Health. Standards for radiological investigations of suspected nonaccidental injury. London: The Royal College of Radiologists and the Royal College of Paediatrics and Child Health, 2008. Compliance with imaging guidelines for paediatric major trauma: results of second audit cycle Authors: Tharunniya Vamadevan, T. Sarvananthan, J. Kho, D. Sander, I. Moorthy Background to the audit: UK paediatric major trauma imaging guidelines were adapted for local use in 2014, aiming to reduce radiation dose1. Standard: The local guideline must be followed for all patients presenting with major trauma before their 17th birthday. Indicator: 1. Adequacy of clinical details on request form. 2. Dose reduction by: e Targeted computed tomography (CT) instead of full-body traumagrams e Fewer X-rays before chest and pelvic CT e Correct arm position and removing scoop during CT. 3. Immediate communication of life-threatening findings to clinical teams and a verified report on the picture archiving and communication system (PACS) within an hour. Target: 100% compliance. Methodology: Data retrospectively acquired for 37 months before guideline implementation and 12 months after. Results of 1st audit round: Number of patients¼43 Traumagrams¼30 (70%) Targeted CT¼0 Adequate clinical details¼93% Pre-CT chest X-ray (CXR)¼49% Pre-CT pelvic X-ray¼33% Correct (arms up) position during CT¼49% 1st action plan: Raise awareness of guidelines (presentation at clinical governance meeting). Results of 2nd audit round: Number of patients¼10 Traumagrams¼3 (30%) Targeted CT¼7 (70%) Adequate clinical details¼60% Pre-CT CXR¼40% Pre-CT pelvic X-ray¼10% Arms up position¼67% Improvements noted in report verification, scoop usage and traumagram doses but adequacy of clinical information declined. 2nd action plan: 100% compliance with: 1) Clinical information on request forms 2) ‘Arms up’ in CT 3) Report verified within one hour, with consultant input within 24 hours. References: 1. The Royal College of Radiologists. Paediatric trauma protocols. London: The Royal College of Radiologists, 2014.
S19
Safe radiology for junior doctors: closed-loop audit Authors: Mahmud Saedon, Hussein Kaderbhai, Sally Lewis, Akashdeep Nijjar Background to the audit: Despite being the largest imaging requesting cohort, junior doctors’ awareness of the Ionising Radiation (Medical Exposure) Regulations (IR[ME]R) 2000 regulations and their relevance to radiology requesting is unclear.1 We aim to investigate knowledge of these regulations using a questionnaire.2 Standard: RCR IR(ME)R 2000 regulations awareness questionnaire. 2 Indicator: Foundation Year doctors’ working at St Helier Hospital understanding of the IR(ME)R guidelines. Target: 100% positive response to each questionnaire. Methodology: The ‘Foundation Doctors e Radiation Legislation Awareness Questionnaire’ was distributed within a two-week period in December 2015. An intervention was put in place and a re-audit was completed in March 2016. Results of 1st audit round: Question e % Yes Q1 Are you aware of any governmental regulations on radiation? 18% Q2 Are you aware of any legal obligation to provide accurate information when requesting imaging? 27% Q3 Are you aware that the department of radiology has the right to withdraw radiology ‘ordering’ rights? 45% Q4 Are you aware of the book ‘Making the best use of clinical radiology services’? 9% Q6 Are you able to estimate the correct radiation dose of chest X-ray? Q7 Have you been asked by a senior colleague to request imaging and been unsure of the indication? 55% Q8 Do you feel you have had adequate teaching regarding appropriate radiology referrals? 36% 1st action plan: We developed a condensed teaching resource and incorporated this into the local Foundation Doctors teaching programme Results of 2nd audit round: Question e % Yes Q1 e 80% Q2 e 80% Q3 e 80% Q4 e 20% Q6 e 40% Q7 e 60% Q8 e 40% 2nd action plan: We continue to ensure the radiology resource is being used as part of the foundation doctors’ teaching programme. Our plan is to re-audit in one year to ensure standards are maintained as junior doctors rotate through the hospital References: 1. Ionising Radiation (Medical Exposure) Regulations 2000 (IRMER). London: Department of Health, 2012 2. www.rcr.ac.uk/audit/foundation-doctors%E2%80%99-knowledgeradiation-legislation-and-exposure (last accessed 27/05/2016) The Royal College of Radiologists. iRefer: making the best use of clinical radiology. London: The Royal College of Radiologists, 2012. The Royal College of Radiologists. Recommendations for cross-sectional imaging in cancer management, second edition. London: The Royal College of Radiologists, 2014. Can I report chest X-rays? The General Medical Council may want to know... Authors: John Laurence Oakes Background to the audit: Measuring outcomes is difficult in diagnostic radiology, but potentially important in the current climate of appraisal and revalidation. Aim is to assess strategies for assessing diagnostic accuracy in plain chest reporting. Standard: No accepted error rate for diagnostic radiology. Published data suggests a wide potential error incidence rate of 2e20%.1