Quality improvement techniques: value to improve the timeliness of preoperative chest radiographic reports

AJR Am J Roentgenol. 1993 May;160(5):995-8. doi: 10.2214/ajr.160.5.8470615.


Objective: Continuous quality improvement is being advocated as a process that, if adopted, could lead to greater efficiency and productivity in medical institutions. To determine whether continuous quality improvement techniques could be effective in radiology departments, we undertook a model project that sought to improve our ability to interpret preoperative chest radiographs before surgery. All the preoperative films had been ordered by internists who determined, after seeing the patient, that the radiographic examination was warranted.

Materials and methods: An eight-member team consisting of all persons involved in obtaining and interpreting preoperative chest radiographs was empowered to evaluate the existing process and make appropriate changes. Techniques used included studying and plotting the process, collecting data on the causes of delay, and basic statistical analysis of the data using histograms, Pareto diagrams, and control charts. On the basis of the data analysis, the team instituted changes, which included identifying the preoperative cards with a small flag, placing the processed films in yellow-colored jackets, and collating these jacketed films after their interpretation.

Results: After continuous quality improvement intervention, when the process for obtaining and interpreting preoperative radiographs was modified, the percentage of chest radiographs interpreted before surgery improved from approximately 83% to 98% (p < .001). The average waiting period between patient check-in at the outpatient reception area and interpretation of the preoperative chest radiograph was reduced from 275 to 77 min, a 72% reduction (p < .0302).

Conclusion: Adoption of the quality improvement techniques of analyzing customer-supplier relations, understanding the causes of variation, and using data to solve problems appears to be a desirable management option that should be considered by all medical institutions interested in maximizing the quality of care offered while concurrently minimizing its cost.

MeSH terms

  • Humans
  • Louisiana
  • Management Quality Circles
  • Pilot Projects
  • Preoperative Care
  • Quality Assurance, Health Care / organization & administration*
  • Radiography, Thoracic / standards*
  • Radiology Department, Hospital / standards*
  • Time and Motion Studies*