Bluth E I, Havrilla M, Blakeman C
Department of Radiology, Ochsner Clinic, New Orleans, LA 70121.
AJR Am J Roentgenol. 1993 May;160(5):995-8. doi: 10.2214/ajr.160.5.8470615.
Continuous quality improvement is being advocated as a process that, if adopted, could lead to greater efficiency and productivity in medical institutions. To determine whether continuous quality improvement techniques could be effective in radiology departments, we undertook a model project that sought to improve our ability to interpret preoperative chest radiographs before surgery. All the preoperative films had been ordered by internists who determined, after seeing the patient, that the radiographic examination was warranted.
An eight-member team consisting of all persons involved in obtaining and interpreting preoperative chest radiographs was empowered to evaluate the existing process and make appropriate changes. Techniques used included studying and plotting the process, collecting data on the causes of delay, and basic statistical analysis of the data using histograms, Pareto diagrams, and control charts. On the basis of the data analysis, the team instituted changes, which included identifying the preoperative cards with a small flag, placing the processed films in yellow-colored jackets, and collating these jacketed films after their interpretation.
After continuous quality improvement intervention, when the process for obtaining and interpreting preoperative radiographs was modified, the percentage of chest radiographs interpreted before surgery improved from approximately 83% to 98% (p < .001). The average waiting period between patient check-in at the outpatient reception area and interpretation of the preoperative chest radiograph was reduced from 275 to 77 min, a 72% reduction (p < .0302).
Adoption of the quality improvement techniques of analyzing customer-supplier relations, understanding the causes of variation, and using data to solve problems appears to be a desirable management option that should be considered by all medical institutions interested in maximizing the quality of care offered while concurrently minimizing its cost.
持续质量改进作为一种流程正在得到倡导，若采用该流程，有望提高医疗机构的效率和生产力。为确定持续质量改进技术在放射科是否有效，我们开展了一个示范项目，旨在提高术前解读胸部X光片的能力。所有术前X光片均由内科医生开具，他们在看过患者后判定有必要进行X光检查。
一个由八名成员组成的团队，包括所有参与获取和解读术前胸部X光片的人员，被授权评估现有流程并做出适当改变。所采用的技术包括研究和绘制流程、收集延误原因的数据，以及使用直方图、帕累托图和控制图对数据进行基本统计分析。基于数据分析，团队进行了改进，包括用小旗标识术前卡片、将处理后的X光片放入黄色封套，并在解读后整理这些装在封套里的片子。
经过持续质量改进干预，当获取和解读术前X光片的流程得到改进后，术前解读的胸部X光片百分比从约83%提高到了98%（p <.001）。从患者在门诊接待区登记到术前胸部X光片解读的平均等待时间从275分钟减少到了77分钟，减少了72%（p <.0302）。
采用分析客户 - 供应商关系、理解变异原因并利用数据解决问题的质量改进技术，似乎是一种理想的管理选择，所有有意在最大限度提高医疗质量的同时尽量降低成本的医疗机构都应予以考虑。
