A Simple QI Project to Improve Practice Quality in Neuroradiological CT Angiography

The purpose of this study was continuous quality improvement (CQI) of head and neck CT angiography (CTA) in the neuroradiology practice of a tertiary care medical center.

We conducted baseline quality audits of 50 consecutive head or neck CTAs, including referrals for a variety of indications from emergency department, ambulatory, and inpatient settings. Neuroradiologists as a group used Likert-type questionnaire items to assess scan quality. Based on identified opportunities for CQI, the group evaluated alternative scanning methods, proposed action items, and implemented changes in scanning methods. After implementing the changes, the group performed follow-up quality audits of 61 consecutive CTAs. Quality of scans was compared for baseline and postimplementation patients using chi-square or McNemar tests.

Several key opportunities for CQI were identified, namely related to coverage levels and timing. These opportunities were translated into protocol changes, standardization of methods, and in-service sessions to implement specific process changes. Using a Likert-type scale with 1 anchored at "excellent" and 5 at "poor," the overall quality of CTAs improved from 2.46 at baseline to 1.64 after implementation of QI measures (P < .01). There were significant improvements in timing and coverage, and fewer scans required quality disclaimers after CQI implementation.

Using basic CQI techniques of assessment, analysis, change implementation, and reassessment, the quality of CTA scans in a busy neuroradiology clinical practice can be improved. These techniques are amenable to repeated use, so that CQI can be a routine practice to help optimize the quality of care in radiology.