title: Implementation of online radiology quality assurance reporting system for performance improvement: initial evaluation.
abstract: OBJECTIVE
  To evaluate an online system developed and implemented for reporting and managing quality assurance (QA) events occurring in a radiology department.
  
  
  METHODS
  This HIPAA-compliant study had institutional review board approval; informed consent was not required. Using repeated plan-do-study-act cycles, a radiology quality management team applied a 10-step process to implement an online reporting system. The system permits remote submission of cases by staff members. The number of weekly submissions to the system over a 9-month period was evaluated and compared with that for the preceding 6 months by using the Mann-Whitney test. Sources and nature of data, actions initiated, and final outcomes were also analyzed. Recorded data included forum of discussion, dimension of care, action items, monitoring of follow-up and compliance, and notification status.
  
  
  RESULTS
  During the first 9 months of implementation, 605 cases were submitted (mean, 21.4 cases per week), a significant increase (P < .005) compared with the preceding 6 months (mean, 3.2 cases per week). Cases, which were submitted by residents (121 cases [20.0%]), fellows (94 cases [15.5%]), faculty members (319 cases [52.7%]), or technologists (54 cases [8.9%]), reported technical (33.1%) or administrative (8.0%) issues. The 329 clinical cases (54.4%) included 60 errors in communication (18.2%), 67 errors in interpretation (20.4%), 78 diagnostic delays (23.7%), 99 missed diagnoses (30.1%), and 54 procedural complications (16.4%); some cases were in more than one category. Twenty-three cases (3.8%) resulted in submission-related QA projects, and 69 cases (11.4%) resulted in individuals or sections of the hospital undergoing additional training.
  
  
  CONCLUSIONS
  A secure online QA reporting system promotes reporting of QA events and serves as a database for identifying and managing trends, initiating performance improvement projects, and providing feedback to staff members who submit cases.
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215, USA. jkruskal@bidmc.harvard.edu
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Kruskal
authors.forename: Chun S
authors.initials: CS
authors.lastname: Yam
authors.forename: Jacob
authors.initials: J
authors.lastname: Sosna
authors.forename: Donna T
authors.initials: DT
authors.lastname: Hallett
authors.forename: Yolanda J
authors.initials: YJ
authors.lastname: Milliman
authors.forename: Herbert Y
authors.initials: HY
authors.lastname: Kressel
mesh_terms: D006302:Health Services Research; D006801:Humans; D020407:Internet; D017146:Models, Organizational; D009862:Online Systems; D011785:Quality Assurance, Health Care; D011871:Radiology / Q000592:standards*; D018570:Risk Assessment; D012308:Risk Management / Q000458:organization & administration*; D018709:Statistics, Nonparametric