CHICAGO – Quality improvement has been a hot topic in the last couple of years, especially with the passage of the federal stimulus and health reform legislation.

Pre-surgery timeouts, which record procedures from start to finish, got national attention when a surgeon discussed performing the wrong-site surgery in a recent article in the New England Journal of Medicine.

In his Quality Safety Forum presentation at RSNA 2010 on Monday, Nov. 29, at 4:30PM – 6:00PM CT in Room E353A, James Duncan, MD, will discuss how timeouts, the pre-procedure checklist, and scoring how well the team is doing can drive quality improvement and patient safety.

While some may feel timeouts are time-consuming and even not helpful, said Duncan, who is an associate professor at Washington University School of Medicine’s Mallinckrodt Institute of Radiology in St. Louis, Mo. “It’s a terrific team-building exercise because it’s the one time that the team communicates.” The more the exercise is done, the more the team realizes it’s a good investment, he said.

Most timeouts are paper based, but Duncan prefers electronic recording, which he likens to flight data records for pilots in the airline industry, because it records procedures from start to finish and monitors how well the team is doing. Scoring how well people are doing during the pre-procedure is critical, he pointed out.

“So much time is spent recording what was done, when what we really want to know is whether it was actually done,” he said. “We need passive electronic recording rather than scribes during the procedures, which ties up people. They should be used as monitors.”

The recordings are also a “terrific” training tool that surgical teams can refer to when mistakes happen. Duncan and his team are trying to develop what he called “trigger” tools, which identify which recordings to view based on statistical process control involving outliers and small systematic deviations.

While many people think recorders are a form of Big Brother and a major workflow disruption and change, Duncan said, “If you really want to understand what happened, you need a good data source. If we’re really serious about improving, we have to study what we’re doing.”

St. Louis Children’s Hospital implemented the recorded timeouts in its pediatric intervention radiology suite 18 months ago. “Now it’s just a part of doing business,” he said. “The next step is to repeat the process at some other sites.”

Duncan said there’s a small upfront investment to get the system in place to collect and analyze the data. Radiation use has become a good tool for analysis because it’s easy to measure, he said.

Ultimately, quality improvement and patient safety are at the heart of this system. “We’re only going to learn if we step back and say, we could do better,” Duncan said. “It’s pretty comforting to say we’re doing the best we can. But to turn it around and say, could you do it better – the answer is when you watch yourself in these tapes. It has changed us from: We’re doing well to we’re doing better.”

Duncan said the only way to constantly move the bar up is to keep measuring.