Continuous Quality Improvement Cycle Research Articles

Quality assessment in radiology: value of a portable bar-code scanner integrated with a computer workstation.

Radiographs are typically processed by several employees of a radiology department before being interpreted by a radiologist. A technologist acquires and labels the radiograph(s), and file room employees match the radiograph(s) with prior examinations and prepare them for interpretation by the radiologist. Every radiologist has encountered radiologic examinations in which the image quality, presentation, or associated clinical or technical information is suboptimal. In small departments, the process of immediately tracking the problem to its source and correcting it might be straightforward, albeit an annoying interruption to the radiologist's focus on clinical care. However, in larger departments, trends of human error or machine malfunction may be overlooked or untraceable because no effective method exists to track the quality of images and associated information. A feedback loop from radiologists to the department's ancillary personnel can result in a cycle of continuous quality improvement that enhances the quality of radiographic examinations and also decreases waste. To achieve this, we designed and implemented a computerized process that involves a portable bar-code scanner, a personal computer workstation, and our existing radiology information system.

A continuous quality improvement cycle for teaching the identification of psychosocial problems to general internal medicine residents.

To study a continuous quality improvement (CQI) cycle intended to enhance general internal medicine residents' identification of psychosocial problems in an ambulatory-care setting. From 1986 through 1990, the authors compared two groups of comprehensive examinations of patients by 34 residents at the University of Vermont College of Medicine before and after the implementation of a CQI cycle. After data on the first group of 17 residents' examinations of patients had been retrospectively audited by a clinical social worker, the CQI cycle was developed for the next group of 17 residents' examinations to reinforce the importance of psychosocial problems in primary care and the use of diagnostic case-finding instruments, flow sheets, and real-time feedback from social workers to the residents on their performances, according to accepted predefined specifications. The t-test was then used to measure the difference in the residents' performances between the two groups of examinations. The CQI intervention resulted in a statistically significant (p < .05) improvement in performance: an increased rate of residents' identifications of patients with psychosocial problems, from 72% (36 of 50 patients) to 85% (140 of 165 patients). That the CQI cycle resulted in improved performance suggests that an effective psychosocial training program for residents in ambulatory primary-care general internal medicine can be organized around CQI and a problem-oriented system of care.