Daniel I Glazer1, Pamela J DiPiro2, Atul B Shinagare3, Raymond Y Huang4, Aijia Wang5, Giles W Boland4, Ramin Khorasani6. 1. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: dglazer@bwh.harvard.edu. 2. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. 3. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 4. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 5. Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 6. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Abstract
PURPOSE: To reduce CT and MRI protocol variation across a multisite radiology practice at an academic medical center so that patients with similar clinical presentations are examined the same way. MATERIALS AND METHODS: This study was performed at a large academic radiology practice performing ∼800,000 radiology examinations annually. To diminish variability across the enterprise (2 general radiology divisions; 10 subspecialty imaging divisions), a Harmonization Oversight Committee was created and tasked with ensuring patients with similar clinical presentations undergo the same CT or MRI protocol, regardless of where they are imaged. A process for decision making and conflict resolution was established, supported by the department chair. Primary outcome measure was standardization of CT and MRI protocols across all sites. Secondary outcome was percent reduction of CT and MRI protocols postharmonization. RESULTS: Over the 5-month harmonization process, most conflicts arose for abdominal imaging protocols because they are performed in four distinct subspecialty divisions, but all were addressed effectively through the conflict resolution process. Overall, there was a 31% reduction in the total number of CT and MRI protocols (before harmonization 481, after harmonization 331). There was significant variation in reduction of protocols per workgroup (multiple P values; range <.0001 to .9) with largest reduction in workgroups that overlapped multiple divisions. CONCLUSION: A structured, organ system- and consensus-based quality improvement process with unambiguous decision-making and conflict resolution processes can be used to harmonize imaging protocols across complex, matrixed, multisite radiology practices so that patients with similar clinical presentations are imaged with the same imaging protocol.
PURPOSE: To reduce CT and MRI protocol variation across a multisite radiology practice at an academic medical center so that patients with similar clinical presentations are examined the same way. MATERIALS AND METHODS: This study was performed at a large academic radiology practice performing ∼800,000 radiology examinations annually. To diminish variability across the enterprise (2 general radiology divisions; 10 subspecialty imaging divisions), a Harmonization Oversight Committee was created and tasked with ensuring patients with similar clinical presentations undergo the same CT or MRI protocol, regardless of where they are imaged. A process for decision making and conflict resolution was established, supported by the department chair. Primary outcome measure was standardization of CT and MRI protocols across all sites. Secondary outcome was percent reduction of CT and MRI protocols postharmonization. RESULTS: Over the 5-month harmonization process, most conflicts arose for abdominal imaging protocols because they are performed in four distinct subspecialty divisions, but all were addressed effectively through the conflict resolution process. Overall, there was a 31% reduction in the total number of CT and MRI protocols (before harmonization 481, after harmonization 331). There was significant variation in reduction of protocols per workgroup (multiple P values; range <.0001 to .9) with largest reduction in workgroups that overlapped multiple divisions. CONCLUSION: A structured, organ system- and consensus-based quality improvement process with unambiguous decision-making and conflict resolution processes can be used to harmonize imaging protocols across complex, matrixed, multisite radiology practices so that patients with similar clinical presentations are imaged with the same imaging protocol.