Resources address the QA challenge

It is axiomatic in healthcare that what gets measured gets done. While many in medicine believe that the quality of healthcare can be assessed and quantified, it can be difficult to develop and apply valid quality assurance measures.

A new book (see below) attempts to answer a number of quality assurance questions, from the dispute over exactly what QA means to the step-by-step measures needed to make quality assurance an ongoing and integrated part of the practice setting.

"The ultimate goal for any quality assurance program is improved diagnosis, and this is certainly true in a filmless imaging department," said Dr. Bruce Reiner, one of the book's editors. "But QA is far more complex than simply understanding equipment physics and calibrating the image to a given standard."

QA is more than a clinical desire. It is mandated by the American College of Radiology in a position statement ( Quality Control and Improvement, Safety, Infection Control, and Patient Education - available at http://www.acr.org ).

With the stakes higher than ever, the challenge is to effectively use new digital technologies to their greatest potential. The book, the third document to appear in the Society for Computer Applications in Radiology University Primer Series, offers 12 chapters contributed by industry experts ranging from attorneys to radiologists.

No commercial PACS are designed to support comprehensive QA activities, even for routine practices such as reject analysis, according to the opening chapter by Charles Willis, Ph.D., PACS Coordinator at Texas Children's Hospital.

Several factors contribute to this:

?QA costs time and money
?QA features are not required to obtain FDA approval of PACS products
?ISO 9000 standards address manufacturing QA rather than operational QA activities

"The end user bears the responsibility for developing and implementing QA, because the end user is the one who suffers the consequences of the absence of QA," Willis said.

Many of these consequences are related to human error. The human/machine interface creates a synergism that can aggravate the weaknesses of both human and computer.

"Increasing the complexity of the user interface increases human error exponentially," he said.

Knowledge of the consequences of errors, nonjudgmental reporting systems, and a sense of personal responsibility for timely and accurate delivery of images are keys to effective improvement in digital services, Willis said.

All three books in the SCAR primer series are available online ( http://www.scarnet.org ), or can be examined at the May SCAR meeting in Cleveland.