Medical Imaging (MI) services are provided at high volume throughout our healthcare system and are considered pertinent to clinical decision-making in a variety of healthcare settings. Due to the extreme complexity of MI, these services are also considered high-risk for adverse events and poor patient outcomes. This case provides an interesting example of how a large geographically diverse healthcare organization improved MI processes and patient safety across the region.
Medical Imaging (MI) includes various forms of medical images for the purpose of providing appropriate patient care (e.g. x-ray, CT scan and bone density scan). Timeliness of MI test results can be critical, but services are often provided in silos and patients are required to move between these silos to receive care. These transition points are where breakdowns in communication, gaps in information sharing and bottlenecks can occur, resulting in unintended adverse outcomes for patients.
In addition, Northern Health (NH) is British Columbia’s largest health authority by land mass with MI services spread across a vast geographical area and multiple facilities in remote locations, making timely workflow and quality assurance even more challenging.
MI results in NH normally take only a few days to process. Review of events recorded in the BC Patient Safety & Learning System (BCPSLS), however, indicated that there was an issue with the timeliness of some MI reports. Delays in reporting results could delay diagnosis and treatment, so NH decided to identify and solve this problem through a prospective analysis of the MI process from end-to-end.
The analysis was led by Chief Operating Officer, Penny Anguish, and involved staff members from multiple departments including Medical Imaging, Information Technology, Health Records, Finance, Risk Management, Planning and Performance Improvement. The analysis uncovered several key findings:
- More than 99% of the MI test results had been reported in a timely manner. Fortunately, there was no patient harm resulting from the less than 1% where there were delays in reporting.
- One site was performing exceptionally well. This site was conducting regular audits to ensure timely turnaround of test results, a task that is not a generally applied practice in BC healthcare.
- There were multiple legacy systems in use, which contributed to the problem since the information-handling processes were different within each of the legacy systems.
- The end-to end-process analysis revealed that there was not a standard process across all sites and the results showed that the problem was not confined to any single site.
- BCPSLS was instrumental in identifying and quantifying the problem.
Follow-up and solution
A formal auditing process was put in place across NH to ensure that any delayed test results would be identified early and any issues with the reporting would be resolved.
“Because there are so many people involved in MI it was highly effective to review processes from end-to-end to see where the delays were occurring,” says Bonnie Urqhuart, Regional Director. “And we’re so spread out at Northern Health – we have radiologists who review cases outside of our physical boundaries – so we’re very reliant on technology. This is a great example of how PSLS can be used to identify a problem in one area and how it affects other areas down the line.”
“I agree, that’s the strength of PSLS. If you’re working in a small unit and don’t normally speak with your colleagues in another area it’s a way of communicating and addressing bigger problems to ensure patient safety across the entire system,” says Dr. Shyr Chui, Radiologist.
In recent years, business management models have been finding their way into healthcare to improve efficiency and patient safety. NH has adopted this approach in MI and is looking for opportunities to apply it in other care areas.
Bonnie Urquhart is Regional Director for Planning and Performance Improvement at Northern Health. She has a background in business management and has been with Northern Health for over 20 years. To learn more about this quality improvement initiative, please contact Bonnie at firstname.lastname@example.org
Bonnie Urquhart is Regional Director for Planning and Performance Improvement at Northern Health. She has a background in business management and has been with Northern Health for over 20 years.
To learn more about this quality improvement initiative, please contact Bonnie at email@example.com
- Penny Anguish
- Bindy Bains
- Shawna Boyd
- Blaine Curry
- Linda Dodd
- Mary Gendron
- Linda Gordon
- Shavown Gulka
- Cheryl Howard
- Ken Maggs
- Chad McDowell
- Valoree Regner
- Shawn Smith
- Gayle Swerdfeger
- Kirsten Thomson
- Laura Vanderlee
- Ken Winnig
BCPSLS Central Office would like to thank Northern Health for sharing this quality improvement story with us!