Telluride Alumni Protecting Peds Patients via Good Imaging Decisions

Following is a Guest Post by Telluride Scholar and Alumni, Matthew Starr, MSIII, Saint Louis University School of Medicine.

Better imaging starts with better decisions.  The goal of the 100K Children campaign is 100,000 good decisions when imaging children by June 30, 2015–

The 100K Children Initiative began with a summit series convened by the American Board of Radiology Foundation. The goal of the meetings was to develop a national strategy for safe, appropriate and patient-centered imaging. The meetings brought together a broad group of stakeholders, including patient advocates, medical professionals, and oversight agencies.  I had the opportunity to attend two of the three summit meetings. Out of these meetings came several goals and objectives for optimizing medical imaging, a few of which are being addressed by this campaign.

My role in this campaign began with developing a series of process maps for the summit series. The maps highlighted the many pathways patients could take through routine healthcare scenarios. It became quickly apparent that a patient might receive unnecessary imaging studies because of the variations along the process pathways. As the campaign progressed, my role became focused on promoting our program to medical students, building a grass-roots effort to expand the reach of the campaign.

One of the things I found very interesting during my time in Telluride, were the discussion around how the IHI used medical students to promote the surgical checklist. The movement spread nationally mainly using the work of medical students. Then as a group in Telluride, we were able to develop a project of our own that focused on improving hand-washing practices at our various home hospitals.  I was able to use these discussions in Telluride as inspiration as I try to promote the optimization of medical imaging in children to healthcare workers across the country. My biggest message for students is that now is our time to take responsibility for the safety of patients. This movement is a way to get involved at your own hospital and community by informing both physicians and parents about the importance of appropriate medical imaging in children.

In summary, the 100K Children Initiative asks sites to report how often they make good imaging decisions for children.  In essence, we are celebrating the small wins that frontline teams achieve every day.  The structure comes from Chuck Denham/Steve Swensen’s 5 Rights of Imaging.  Focus will be the front end (Right study, Right order, Right way).5_Rights_Imaging

Measure Primary Target Secondary Targets Simple Tally*
1.  Right study:Observation instead of head CTs for children with minor head trauma ER Physicians Pediatricians, family practice physicians, and families ER nurses provide a count of the number of patients who don’t get a head CT but rather are given instructions for signs to watch for after head trauma
2.  Right order:Single phase CT studies (head and chest) Radiologists Referring physicians (ER, pediatricians, family practice) and families Techs count number of single phase head and chest CT exams that they perform
3.  Right way:How often was a child sized CT protocol used Technologists Radiologists, referring physicians, and families Techs count number of times they use a pediatric protocol
*Simple tally offers quick data turnaround and is based on the honor system.  Can use administrative data to verify each site’s progress with measures 1 and 2.  Can use dose reports to monitor each site’s progress with measure #3.

Enrolling sites

  1. An easy sell for the pediatric specialty centers since they are already following these recommendations.  They will become the key nodes in the local networks that prompt community hospitals to follow suit.  Children’s Hospital Association will likely be a key partner.
  2. Each site identifies staff in ER and radiology who will be responsible for collecting data on a weekly basis and submitting it.  How they collect the data is up to them.  We will learn as we go.
  3. Each week, sites submit their weekly count in each category.  Data is due each week by Monday afternoon.  Results are reviewed on a Tuesday morning conference call.

100K_Children_SLU_MapFor more information and how to get involved, check out the website — Follow us on Facebook (100K Children) and Twitter @100KChildren #ImproveImaging

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