NightHawk Radiology Services QA at Belleville Memorial: Case Study

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Since the first of the year, radiologists at Advanced Diagnostic Imaging (ADI), Belleville, Ill, have been using a new outcomes-based quality assurance program from NightHawk Radiology Services, Scottsdale, Ariz. NightHawk developed the program to realign quality assurance with patient care, focusing first on the effect a discrepancy may have on clinical outcomes and making the subjective visibility of a finding a secondary concern. ADI’s 10 radiologists use the teleradiology provider’s Quality Assurance Program to track potential discrepancies in nighttime preliminary interpretations done by NightHawk radiologists, explains Linde Flanders, MHA, MBA; Flanders is business services director for the group, which provides radiology services for Belleville’s Memorial Hospital. Flanders says that current program has yielded significant improvements in both the submission and resolution processes for potential discrepancies. “NightHawk’s QA program is incredibly fast and responsive,” Flanders says. “We have them back and everything is all cleaned up in a matter of a few days. Our patient care is better just on the time issue alone.” She adds that the program is more time-efficient for ADI staff, making compliance easier: “I get on the NightHawk website and type in everything electronically,” she says. “I think it will be a huge timesaver for us, and using the service has given us the ability to give the radiologists their lives back.” NightHawkNightHawk worked closely with ADI to ensure they understood the new focus of the QA program and how to leverage it, Flanders says. The teleradiology provider sent the head of its quality assurance section to Memorial to explain it, then followed up with webinars “on the nuts and bolts of how to work the program.” She gives the teleradiology provider high marks for the program’s outcomes-based focus. “It shows that NightHawk is very interested in our mission of good patient care,” she says. Patient-centric The new QA program uses a category 0-4 rating system to characterize discrepancies between the preliminary reports that teleradiologists complete at night and the final reports that radiologists complete the next day. Unlike traditional QA ratings, however, NightHawk’s are based on patient outcomes. A Category 0 means that the client radiologist, or later NightHawk, has scored the discrepancy as merely a comment on the night read. It could be as innocuous as “nice job,” or it could call attention to an interesting pathology. A Category 1 rating on the scale means that the client radiologist agrees with the preliminary interpretation and report and that patient care is not affected. A Category 2 means the client radiologist interpretation varies slightly from the prelim, but the discrepancy is minor and unlikely to affect patient care. A Category 3 means the final interpretation varies and would likely affect patient care or require follow up. Finally, a category 4 means the interpretation varies and would immediately affect patient care. Flanders says Advanced Diagnostic Imaging does its own internal review of all reported discrepancies. NightHawk, for its part, refers all discrepancies to QA analysts who collect additional data such as operative reports, pathology reports, information found on subsequent studies and other facts that impact the effect of the discrepancy on patient care. From there the case is sent to radiologists on NightHawk's internal review board. Once the IRB review is complete, the case is sent back to the original reader for comment. NightHawk’s chief medical officer may also review the case, or it can be sent to an external review board composed of academic radiologists. Actionable results In addition to being faster and more patient-centric, NightHawk’s new electronic QA program automatically compiles data that can be retrieved and analyzed by the customer on a monthly basis. “A doctor might come in and say, ‘What about that discrepancy I gave you last week, have you heard anything?’ Now,” Flanders says, “I can show them the response and tell them our doctor here has reviewed it." Flanders says she can scan the teleradiology provider’s QA site for all reports on any given Memorial patient. She can look for information about the NightHawk radiologists that provide interpretations for ADI and Memorial. She can also review the reported discrepancies and follow the numbers over time. “It gives us a lot more flexibility and the ability to do more in-depth analysis,” Flanders says. “I can generate a monthly report that gives me all the information I need." As an example of data that can be generated by the QA program, Flanders says that in the six months from January through June of this year, NightHawk radiologists completed 4,399 reports. In Category 0 through Category 2, categories which do not affect patient care, the discrepancy rate was 1.3%. In Category 3, the rate was 1.5%, while in Category 4 the rate was 0.8%, making the total rate for cases that could or would require follow-up or affect patient care 2.3%. While there are no comparable QA programs looking at the type of outcomes-based data NightHawk reviews, there are other programs and reports from literature that discuss typical discrepancy rates; for example, in a 2004 Journal of the American College of Radiology: JACR report¹, Soffa et al reported a discrepancy rate of 3.48%, and a 2009 JACR article² discussing the ACR’s RADPEER program reported a 2.91% discrepancy rate. Timothy Myers, MD, CMO of NightHawk, was pleased with ADI’s results but felt there was more to do. "NightHawk, like radiology in general, needs to continue to improve both the accuracy and the effectiveness of the information we give the clinicians that depend on our interpretations,” Myers says. "Patient care should be at the center of our focus when it comes to QA, and we cannot rest even on these promising results. We have to try continually to do more."