Case Study in Improving Patient History Reporting for Radiologists

December 2, 2016

How one institution’s initiative improved patient history reporting, from RSNA 2016.

When it comes to improving your practice or department’s performance, informatics is a popular buzzword. But, data gathered using informatics isn’t as impactful without a quality improvement plan in place.

And, how to marry these two factors will determine the success of any initiative you undertake, said David Larson, MD, associate chair for performance improvement in Stanford University’s radiology department, at RSNA 2016. To be successful, he recommended a 9-point for strategy that could maximize your efforts.

“Data is critical. Information is critical,” he said. “There’s a lot more that goes with it. If done right, the results can be rewarding.”

Larson highlighted its efficacy with one of his past efforts at Cincinnati Children’s Hospital to improve patient histories gathered at the time of diagnostic study. Their results were significant. Prior to launching the initiative, only 38% of patient histories were considered adequate. Today, 99% contain sufficient patient data to provide the most appropriate diagnosis and treatment.

1. Define the problem: You can view a problem two ways: something you have to deal with each time it goes wrong or something you can work to solve. Work to solve your problems. In this case, patient histories were incomplete and inadequate to help radiologists make a fully-informed diagnosis. Complete histories should include the nature of symptoms, description of injury or other cause, duration of symptoms, and focal point of any pain or abnormality.[[{"type":"media","view_mode":"media_crop","fid":"54551","attributes":{"alt":"David Larson, MD","class":"media-image media-image-right","id":"media_crop_5716262813436","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6832","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 170px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"David Larson, MD","typeof":"foaf:Image"}}]]

2. Develop Interventions: Design strategies that can help you achieve your objectives and that can be passed along to all your radiologists. In this case, the tactic – always have someone available who can provide a detailed history – was ready-made. Parents or guardians almost always accompany a child to a doctor’s appointment.

3. Anticipate and prepare: Identify the date by which you want your initiative to be fully functional and work backwards to set achievable performance milestones. If your initiative requires others to change their current work habits, be prepared for a level of pushback and craft messages that convey the importance of what you want to do.

With Cincinnati Children’s, technologists were responsible for gathering patient history information, so their workload and time with patients increased. Larson’s group impressed upon any reluctant technologists that collecting better patient histories improved the overall care of children.

4. Get Support: You’ll have varying levels of support from within your organization for any endeavor you undertake: endorsers, fence-sitters, and resisters. And, you should always take a two-prong approach – formal and informal – for building buy-in for your efforts.

For formal efforts, always start two layers up from the group who will be most affected by the change. Coach these individuals to acknowledge any resisters’ concerns and thank them for their efforts to comply with the new initiative. It’s a way to have a dialogue about the initiative rather than dictate to employees.

Fence-sitters are your key group. If you can tip them to your side, the whole organization will follow. If need be, enlist the help of any major influencers within your organization who might be able to sway opinion.

Your endorsers don’t need to be convinced your idea is a good one, but they do deserve your thanks, Larson said.

You’re more likely to get positive responses if you clearly announce what you’re trying to do and why. Offer adequate support through training, coaching, and encouragement. Make ongoing learning available, and provide feedback and recognition for jobs well done. But, remember to be patient. Progress will be slow, he said, and perfection is impossible.

5. Make the Case: Whenever possible, demonstrate to your employees and colleagues why you’re embarking on a new initiative. Provide data that supports your goal, listen to any frustrations and address them publicly, and, if possible, Larson said, play to emotions to win buy-in. For example, he said, technologists at Cincinnati Children’s realized the value of recording detailed patient histories when they saw how knowing a child’s family history could oftentimes accelerate proper care.

6. Clarify Expectations: Your colleagues and staff will perform better if you offer real-world examples that demonstrate your desired outcome. For example, Larson’s group showed technologists’ reports populated with details about injuries or congenital birth defects. In many instances, these data points had been overlooked in previous patient histories.

7. Provide General Feedback: This is your opportunity to give a blanket review of progress on your initiative. Whether it’s written or in a meeting, give everyone periodic updates on how their efforts are moving the needle in the right direction. Discuss performance data, and provide tips and tricks, if appropriate.

In this case, Larson said, Cincinnati saw a marked difference in performance between the main hospital and outlying, associated clinics. Through general feedback, his group was able to provide additional training to bring the main facility in line with other participants.

8. Provide Specific Feedback: In some instances, however, you will need to discuss an individual’s performance. These conversations won’t be easy, Larson said, but the earlier you have the talk, the easier it will be to fix behavior. Before the conversation, arm yourself with the individual’s performance data, have a summary ready, and prepare constructive feedback.

9. Make Your Initiative the New Norm: To maintain your results, you must implement strategies that make improved performance the “new normal” at your facility, he said. Discuss with your colleagues the best avenue for your facility. For Cincinnati, technologists opted to have their behavior in collecting patient histories tied to their annual performance evaluations.