Abstract
We hypothesized that clinical process improvement strategies can reduce frequency of motion artifacts and expiratory phase scanning in chest CT. We reviewed 826 chest CT to establish the baseline frequency. Per clinical process improvement guidelines, we brainstormed corrective measures and priority-pay-off matrix. The first intervention involved education of CT technologists, following which 795 chest CT were reviewed. For the second intervention, instructional videos on optimal breath-hold were shown to 245 adult patients just before their chest CT. Presence of motion artifacts and expiratory phase scanning was assessed. We also reviewed 311 chest CT scans belonging to a control group of patients who did not see the instructional videos. Pareto and percentage run charts were created for baseline and post-intervention data. Baseline incidence of motion artifacts and expiratory phase scanning in chest CT was 35% (292/826). There was no change in the corresponding incidence following the first intervention (36%; 283/795). Respiratory motion and expiratory phase chest CT with the second intervention decreased (8%, 20/245 patients). Instructional videos for patients (and not education and training of CT technologists) reduce the frequency of motion artifacts and expiratory phase scanning in chest CT.
Highlights
To address these concerns, we applied clinical process improvement strategies to reduce the frequency of motion artifacts and expiratory phase scanning in chest CT by 50% compared to the baseline prevalence
The most common cause of suboptimal chest CT was expiratory phase scanning, respiratory motion artifacts, patient intubation leading to expiratory phase scanning or motion www.nature.com/scientificreports
The magnitude of motion artifacts and expiratory phase scanning in patients who viewed the instructional videos during the PDSA cycle 2 (PDSA-2) was 8.2% (20/245 patients)
Summary
Close to a third of the patients (35%; 292/826) in the baseline chest CT data had motion artifacts or were expiratory Both the inpatients (60%, 152/252) and the outpatients (24%, 140/574) had respiratory motion artifacts or expiratory phase scanning on chest CT. The magnitude of motion artifacts and expiratory phase scanning in patients who viewed the instructional videos during the PDSA-2 was 8.2% (20/245 patients) Both inpatients (18%, 3/17) and outpatients (7%, 17/228) experienced a reduction in motion artifacts and expiratory phase scanning during the PDSA-2. Lower than the baseline and the PDSA-1 data, the frequency of motion artifacts and expiratory phase scanning in the control group patients (15%, 46/311) was significantly greater than those scanned following the instructional videos in the PDSA-2 (p = 0.016). Most patients said that they had undergone a CT before (98%, 239/245) which may explain why they were not less anxious after they saw the video (82%, 200/245)
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Published Version
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