The use of a patient advocate to improve the experience in pediatric radiology.

There is increasing emphasis on improving the patient experience with a shift to patient- and family-centered care throughout all areas of health care. In 2013, the American College of Radiology launched Imaging 3.0, an initiative aimed at encouraging and enabling radiologists to work on culture change to increase focus on appropriateness, efficiency, quality, safety and patient satisfaction. Many groups have subsequently used these and other tools to improve the overall patient experience, focusing on the entire imaging journey to include initial order placement, registration in the department, image acquisition, departure from the department, and how and when the patient and family receive the imaging results. In our department we have used multiple strategies and have applied quality-improvement methods and patient/family-centered care models to improve quality, safety and the patient experience. Most of these efforts have included team members across the department, including radiologists, technologists, quality-improvement personnel, managers and nurses. In addition, for the last 12 years, a key member of these teams has been our patient and family advocate (PFA). We describe the important role that a PFA can play in improving the patient and family experience in pediatric radiology.

Using informatics to engage patients.

As a specialty, radiology has spent much of the last two decades implementing information systems that improve departmental efficiency and the ordering provider's access to information. While our patients have realized benefits such as improved access to care and reduced turnaround times, there has been little focus on using these information systems to improve patient engagement. In the last decade, society has shifted. Now, consumers in every industry expect to be able to use technology to help them accomplish different tasks from scheduling to communicating. Medicine, in general, has been slow to respond to the concept of the patient as a consumer. In this manuscript we describe some of the informatics efforts we have employed in our department to improve patient engagement. We present these initiatives, corresponding to each aspect of the radiology value stream, from the patient's point of view.

Improving Communication, Collaboration, and Faculty Comfort in Communicating Difficult News in the Pediatric Radiology Department.

OBJECTIVE: When an unexpected or significant diagnosis is made while imaging a child, the pediatric radiologist and support staff are placed in the middle of a life-changing event for the patient and family. The process by which this situation is handled can be quite variable in part because of the lack of a preexisting relationship between the pediatric radiologist and the patient and family. Therefore, we developed a program to improve effective communication of unexpected or significant diagnoses to families called the Difficult News Program. CONCLUSION: By defining and coordinating roles, the Difficult News Program improves communication between radiology staff and other health professionals and families and optimizes the patient and family experience during an emotional and difficult time. The defined roles and teamwork approach allow timely, compassionate, and accurate information to be shared with families.

Improving health literacy: use of an informational brochure improves parents' understanding of their child's fluoroscopic examination.

OBJECTIVE: The purpose of this study was to determine parents' knowledge about pediatric fluoroscopic procedures and potential risk from ionizing radiation before and after being given an informational brochure. SUBJECTS AND METHODS: We reviewed responses from 120 randomly selected participants who were parents or guardians of pediatric patients undergoing diagnostic fluoroscopic examinations. A questionnaire assessed participants' knowledge of the procedure, radiation exposure, and whether their child had a prior examination before and after receiving an informational brochure. In a feedback survey, participants rated the brochure. A repeated measures mixed model was used to evaluate the effect of the brochure on the participants' knowledge. RESULTS: Participant demographics were women (79%), English speaking (99%), white (90%), and education higher than 12th grade (76%). The median age of patients undergoing the fluoroscopic examination was 4 years. Participant knowledge increased (p < 0.0001) between pre- and postbrochure (least-squares means) for those without a previous examination from 38.3 to 63.4 (total test score) and from 46.3 to 61.8 for those with a prior examination. The proportion of correct answers was higher (p < 0.0001) postbrochure compared with pre-brochure in areas of examination name (99% vs 93%), procedure details (97% vs 87%); use of radiation (100% vs 68%), and radiation dose comparison (79% vs 25%). Overall, 99% (119/120) rated the brochure "good" or "great" (p < 0.0001). CONCLUSION: An informational brochure given to participants before their child's fluoroscopic procedure improved their knowledge of the examination and radiation exposure. No participants refused their child's examination.