Policies and Guidelines for COVID-19 Preparedness: Experiences from the University of Washington.

The coronavirus disease 2019 (COVID-19) pandemic initially manifested in the United States in the greater Seattle area and has rapidly progressed across the nation in the past 2 months, with the United States having the highest number of cases in the world. Radiology departments play a critical role in policy and guideline development both for the department and for the institutions, specifically in planning diagnostic screening, triage, and management of patients. In addition, radiology workflows, volumes, and access must be optimized in preparation for the expected surges in the number of patients with COVID-19. In this article, the authors discuss the processes that have been implemented at the University of Washington in managing the COVID-19 pandemic as well in preparing for patient surges, which may provide important guidance for other radiology departments who are in the early stages of preparation and management.

Rules and Regulations Relating to Roles of Nonphysician Providers in Radiology Practices.

Nonphysician providers (NPPs) in radiology practices include nurse practitioners, physician assistants, and radiologist assistants. The number of NPPs has been increasing both within and outside of radiology departments. In order for leaders in radiology departments to incorporate NPPs effectively into their practice, they require nuanced knowledge of appropriate coding and billing for services these professionals render. Furthermore, the existing body of literature suggests that with a defined and appropriate scope of practice and proper supervision, NPPs can provide care that is at least equivalent to that provided by attending physicians for narrowly defined tasks. A broader understanding of the rapidly evolving NPP workforce both within radiology practices and throughout other health care specialties will inform practice leaders who are adapting to a health care system that is moving rapidly toward value-based incentive payment models. ©RSNA, 2018.

Pediatric radiology malpractice claims - characteristics and comparison to adult radiology claims.

Medical malpractice is the primary method by which people who believe they have suffered an injury in the course of medical care seek compensation in the United States and Canada. An increasing body of research demonstrates that failure to correctly diagnose is the most common allegation made in malpractice claims against radiologists. Since the 1994 survey by the Society of Chairmen of Radiology in Children's Hospitals (SCORCH), no other published studies have specifically examined the frequency or clinical context of malpractice claims against pediatric radiologists or arising from pediatric imaging interpretation. We hypothesize that the frequency, character and outcome of malpractice claims made against pediatric radiologists differ from those seen in general radiology practice. We searched the Controlled Risk Insurance Co. (CRICO) Strategies' Comparative Benchmarking System (CBS), a private repository of approximately 350,000 open and closed medical malpractice claims in the United States, for claims related to pediatric radiology. We further queried these cases for the major allegation, the clinical environment in which the claim arose, the clinical severity of the alleged injury, indemnity paid (if payment was made), primary imaging modality involved (if applicable) and primary International Classification of Diseases, 9th revision (ICD-9) diagnosis underlying the claim. There were a total of 27,056 fully coded claims of medical malpractice in the CBS database in the 5-year period between Jan. 1, 2010, and Dec. 31, 2014. Of these, 1,472 cases (5.4%) involved patients younger than 18 years. Radiology was the primary service responsible for 71/1,472 (4.8%) pediatric cases. There were statistically significant differences in average payout for pediatric radiology claims ($314,671) compared to adult radiology claims ($174,033). The allegations were primarily diagnosis-related in 70% of pediatric radiology claims. The most common imaging modality implicated in pediatric radiology claims was radiography. The highest payouts in pediatric radiology pertained to missed congenital and developmental anomalies (average $1,222,932) such as developmental dysplasia of the hip and congenital central nervous system anomalies. More than half of pediatric radiology claims arose in the ambulatory setting. Pediatric radiology is not immune from claims of medical malpractice and these claims result in high monetary payouts, particularly for missed diagnoses of congenital and developmental anomalies. Our data suggest that efforts to reduce diagnostic error in the outpatient radiology setting, in the interpretation of radiographs, and in the improved diagnosis of fractures and congenital and developmental anomalies would be of particular benefit to the pediatric radiology community.

Autonomía, consentimiento y responsabilidad. Parte II. El consentimiento informado en la medicina asistencial y en la jurisprudencia / Autonomy, consent and responsibility. Part II. Informed consent in medical care and in the law

La consolidación legislativa de los derechos del paciente introdujo modificaciones en la relación clínica y en la lex artis, pero su implantación progresa con dificultades en un entorno sanitario muy condicionado por la escasez de los recursos y la abundancia de las normas. Desde hace algunos años, la autonomía, el consentimiento y la responsabilidad forman uno de los ejes vertebradores de la profesión médica. Sin embargo, son objeto de controversia y causan malestar profesional. En la primera parte de este artículo examinamos las limitaciones conceptuales y normativas del principio de autonomía como fundamento del consentimiento informado, abordadas desde una perspectiva filosófica, histórico-jurídica, bioética, legal, deontológica y profesional. En la segunda parte analizamos la viabilidad del consentimiento informado en la medicina asistencial y su relación con la responsabilidad jurídica (AU)

Legal recognition of patient's rights aspired to change clinical relationship and medical lex artis. However, its implementation has been hampered by the scarcity of resources and the abundance of regulations. For several years, autonomy, consent, and responsibility have formed one of the backbones of the medical profession. However, they have sparked controversy and professional discomfort. In the first part of this article, we examine the conceptual and regulatory limitations of the principle of autonomy as the basis of informed consent. We approach the subject from philosophical, historical, legal, bioethical, deontological, and professional standpoints. In the second part, we cover the viability of informed consent in health care and its relationship with legal responsibility (AU)

[The irradiation process]. / Processus du traitement par irradiation.

The purpose of this article is to describe the regulatory framework of the radiotherapy practice in France, the external irradiation and brachytherapy process and the guidelines for patient follow-up.

US hospital-based direct access with radiology referral: an administrative case report.

BACKGROUND AND PURPOSE: Legislative gains in the US allow physical therapists to function in expanded scopes of practice including direct access and referral to specialists. The combination of direct access with privileges to order imaging studies directly offers a desirable practice status for many physical therapists, especially in musculoskeletal focused settings. Although direct access is legal in all US jurisdictions, institutional-based physical therapy settings have not embraced these practices. Barriers cited to implementing direct access with advanced practice are concerns over medical and administrative opposition, institutional policies, provider qualifications and reimbursement. This administrative case report describes the process taken to allow therapists to see patients without a referral and to order diagnostic imaging studies at an academic medical center. Nine-month implementation results show 66 patients seen via direct access with 15% referred for imaging studies. Claims submitted to 20 different insurance providers were reimbursed at 100%. DISCUSSION: While institutional regulations and reimbursement are reported as barriers to direct access, this report highlights the process one academic medical center used to implement direct access and advanced practice radiology referral by updating policies and procedures, identifying advanced competencies and communicating with necessary stakeholder groups. Favorable reimbursement for services is documented.

Internal Controlling of a Radiology Department.

Caused by legal reform initiatives there is a continuous need to increase effectiveness and efficiency in hospitals and surgeries, and thus to improve processes.Consequently the successful management of radiological departments and surgeries requires suitable structures and optimization processes to make optimization in the fields of medical quality, service quality and efficiency possible.In future in the DRG System it is necessary that the organisation of processes must focus on the whole clinical treatment of the patients (Clinical Pathways). Therefore the functions of controlling must be more established and adjusted. On the basis of select Controlling instruments like budgeting, performance indicators, process optimization, staff controlling and benchmarking the target-based and efficient control of radiological surgeries and departments is shown.

Defining Population Health and Implications for Radiology.

Most definitions of population health include improved patient health, reduced inpatient stays and proce- dures, holistic care of the entire population of a country, and a general approach to improve the quality of healthcare. However, there seems to be no mention of payment for services and resources for reimbursement. The term population health can be considered a philosophy of a new model of healthcare based upon future expectations from current laws and studies from the federal government, most notably through the ACA, and healthcare organizations. Radiology departments may perform fewer procedures in the future and receive less money for these complet- ed procedures. Management will need to adjust budgets and staffing to reflect changes. Radiology departments will need to continue the current trend of doing more with less.

Risk management in radiology.

Recent US nationwide research on malpractice lawsuits shows that the most common cause of medical malpractice suits against radiologists was error in diagnosis (mainly failure to diagnose instead of delay); the category next in frequency was procedural complications, followed by inadequate communication with either patient or referring physician. Risk management is a fundamental instrument to prevent and limit errors and adverse events. This article analyzes risk management in radiology addressing the most common ethical-legal issues on appropriateness of prescriptions, informed consent, and management of adverse events. Effective remedial actions are proposed to avoid malpractice claims that would help physicians in preventing malpractice stress syndrome, leading to defensive medicine.

The need for an effective compliance program.

Recent healthcare related law, and more importantly, government enforcement activity of the law is increasing at an exponential rate. Many imaging exams are quite expensive and represent a significant portion of claims paid to beneficiaries of Medicare and Medicaid programs. While many large healthcare organizations have well-honed compliance and ethics programs and infrastructures, small to medium sized organizations are especially at risk for ethical misconduct and subsequent sanction by the Federal Sentencing Guidelines for Organizations. Creating of a culture of compliance starts at the highest level of an organization and is disseminated via a well defined executive document and communicated during new hire orientation and continual management through staff meetings and training.

[Quality management systems are compulsory: clinics have the choice. Comparison of the systems DIN EN ISO 9000 ff, KTQ and EFQM]. / Qualitätsmanagementsysteme sind Pflichtprogramm: die Kliniken haben die Wahl. Ein Vergleich der QM-Systeme DIN EN ISO 9000 ff, KTQ® und EFQM.

According to §§135-137 SGB V (German Civil Code), German hospitals are required to introduce and develop an institutional quality management (QM) system. They are, however, currently not obliged to undergo a certification. The prime responsibility to introduce a QM system lies with the top management. The aim is to continuously monitor and improve the quality of the processes and practices in the hospital. QM systems are one of the major constituents which influence the prosperity of an enterprise. Hospitals are able to improve the quality of their processes without significantly increasing the costs. The Excellence Barometer® Health Care (ExBa) of the Fraunhofer Institute has shown that deficits are usually not identified in the professional competence of the medical personnel but rather in respect to leadership abilities, communication and motivation. The introduction of QM in a hospital requires an in-depth familiarity with the various QM systems to select an appropriate model for the own institution. The systems most commonly in use in German hospitals are DIN EN ISO ff, EFQM and KTQ®. The article illustrates and compares the layout, requirements and assessment criteria of the various systems.

[Practical implementation of a quality management system in a radiological department]. / Praktische Umsetzung von Qualitätsmanagement in einer radiologischen Abteilung.

This article describes the architecture of a project aiming to implement a DIN EN ISO 9001 quality management system in a radiological department. It is intended to be a practical guide to demonstrate each step of the project leading to certification of the system. In a planning phase resources for the implementation of the project have to be identified and a quality management (QM) group as core team has to be formed. In the first project phase all available documents have to be checked and compiled in the QM manual. Moreover all relevant processes of the department have to be described in so-called process descriptions. In a second step responsibilities for the project are identified. Customer and employee surveys have to be carried out and a nonconformity management system has to be implemented. In this phase internal audits are also needed to check the new QM system, which is finally tested in the external certification audit with reference to its conformity with the standards.

Level of compliance with the radiation protection regulation--a survey among Norwegian hospitals and X-ray institutes.

To identify the level of compliance with the new radiation protection regulation among Norwegian health care enterprises (HCEs). Totally, 41 HCEs were authorised to use advanced X-ray equipment for medical purposes during 2005-07. Follow-up inspections with 14 HCEs were carried out during 2007-09. Main topics for the inspections were those requirements identified as most challenging to implement in the authorisation process. Totally, 192 non-conformities with the regulation were revealed during the authorisation process. The inspections revealed that 93 % of the inspected HCEs had non-conformities with the regulation. Most common non-conformities dealt with skills in radiation protection, establishment of local diagnostic reference levels, access to medical physicists and performance of quality control of X-ray equipment. Inspections are an effective tool for implementation of regulation the requirements at the HCEs, thus improving radiation protection awareness.