In an era when more outpatient procedures are being performed with less personnel, patient information documentation may facilitate a smoother tranistion to successful managed-care diagnoses and treatment procedures, and improve communication and patient satisfaction.
Quality assurance initiatives developed for outpatient CT are
discussed in this report. Three user-friendly documents are
described: a patient information sheet, a medical history
questionnaire, and an emergency worksheet. In an era when more
outpatient procedures are being performed with less personnel,
these three documents can enhance patient care and improve
communication among patients, technologists, nurses, and
Dr. Whitman is in the Division of Diagnostic Imaging at the
University of Texas M.D. Anderson Cancer Center, in Houston, TX.
Dr. Whitman and Ms. Newton were previously in the Department of
Radiology at Massachusetts General Hospital and at Harvard
Medical School, both in Boston, MA. Ms. Niziac, Ms. Palumbo,
Mr. Sweeney, and Dr. Saini are in the Department of Radiology at
Massachusetts General Hospital and at Harvard Medical School,
both in Boston, MA.
In the current era of cost containment and managed care, most
medical work-ups are performed on an outpatient basis. Working with
a higher patient volume and a smaller work force (fewer
technologists, nurses, and radiologists), optimizing patient care
is a challenge to medical professionals in CT. The three quality
assurance initiatives for CT described in this report aim to
educate patients and the members of the CT team in the hopes that
this will facilitate a smoother transition to successful
managed-care procedures and diagnostic treatment options. In this
report, CT is addressed as a process, with communication presented
as a key issue from the time of scheduling to the time that a final
report is received.
Quality assurance in outpatient CT
Patients undergoing any medical procedure should be assured of
the standard of quality of the procedure. Three quality assurance
initiatives have been developed for outpatient CT to help further
this goal. A one-page introductory form was designed for patients
to read prior to their CT examinations. This form provides patients
with information on dietary restrictions, examination times, and
image interpretation and reporting. Secondly, a medical history
questionnaire was developed to obtain any information that may be
relevant to a diagnosis or to potential complications, as well as
to enhance patient satisfaction with quality of care. Patients were
asked to complete this questionnaire when they arrived in the
radiology department on the day of their CT. The medical history
form allows technologists, nurses, and radiologists to gain
information about the patient's medical, surgical, and allergy
history. Finally, a one-page emergency worksheet was designed to
help the radiology staff to document any adverse reactions, and to
record the appropriate interventions that followed.
Introductory form: the patient information sheet.
The one-page introductory form shown in figure 1 had been
distributed to patients when they registered at the CT desk on the
day of the examination. In addition, in a pilot project involving
referring physicians whose offices have high CT volumes, the
introductory form was given to patients at the time of exam
scheduling. The dissemination of information about the CT exam has
decreased patient anxiety and confusion. Also, the introductory
form enhanced patients' knowledge of the CT procedure and how the
results would be communicated. Information provided in this
easy-to-read format has also helped to allay some of the worries
and fears of the patients' family and friends. In the pilot
project, where the introductory form was given to the patient at
the time of scheduling, an added benefit was realized: Secretaries,
nurses, and physicians in the referring doctors' offices had
valuable input in how to explain the CT process and discuss
examination preparations with the patients.
Future possibilities for enhancing the effectiveness of the CT
introductory form include:
1. Expanding the distribution of the sheet to include all
offices and clinics where CTs are ordered.
2. Developing information sheets for non-English speaking
3. Changing the format to a videotape or interactive computer
4. Adding relaxation training to the provision of
Medical history questionnaire
Upon arrival in the radiology department on the day of their CT
exam, patients were given a one-page medical history questionnaire
(figure 2) to be completed immediately prior to the scan. The data
helped the CT team to establish the reason for the study and the
patient's risk profile, especially in cases where intravenous
contrast material was administered.2 In addition, the medical
history form served as an introduction of the patient to the CT
team. The provision of information regarding medical and surgical
problems and allergies helped the patient to communicate any
special concerns to the CT staff and, therefore, helped to
personalize patient care in a high-volume outpatient setting.
Future possibilities for enhancing the medical history
1. Changing the format to a computer-based system, wherein
entries would be maintained on a database and updated at the time
of each CT.
2. Linking the data collection process to the referring
physician's office in an attempt to obtain more accurate and
up-to-the-minute medical and surgical information.
Managing contrast reactions:
The emergency worksheet
Allergic reactions to contrast agents used in CT may be
life-threatening. The patient should be monitored closely prior to,
during, and after any CT study.3 Early signs of a contrast reaction
may be subtle, such as reddish skin, itching, sneezing, a warm
sensation, hives, a metallic taste in the mouth, or a tickle in the
throat. More severe reactions, including difficulty swallowing,
difficulty breathing, anaphylaxis, cardiac arrest, and respiratory
arrest, may occur instantly in the CT suite, and they are
potentially fatal. All members of the CT team must be able to
recognize the signs and symptoms of contrast reactions and be able
to initiate proper resuscitative actions, when necessary.
The CT team members should be able to monitor patients, obtain
their vital signs, and record pertinent clinical information and
resuscitative interventions on a flow sheet. The emergency
worksheet shown in figure 3, was designed to help document adverse
reactions, and to record the appropriate treatments.
In the future, the effectiveness of the emergency worksheet may
be enhanced by transferring the documentation of an adverse
reaction from the worksheet to the radiology department's
information system computer. By transferring this document to the
system, information on a patient's adverse reactions would be
readily available to those monitoring that patient during the next
Quality assurance involves the introduction of changes to
improve performance.4 Quality assurance is not meant to be a static
entity; rather, it is an evolving, dynamic process. The three
quality assurance initiatives described in this report grew out of
informal collaborations among physicians, nurses, and
technologists, with an interest in setting a standard of high
quality in patient care. These initiatives place emphasis on the
patient, allowing the patient to learn more about their CT
examination and enabling the CT team to become better acquainted
with the patient's specific needs.5
Quality assurance initiatives such as these questionnaires and
information sheets can help to enhance patient care in an era where
more outpatient procedures are being performed with less personnel.
We feel that initiatives similar to those presented here should be
developed for other modalities and for other organ systems within
The authors thank Joyce Buchanan and Mary Ann Waggoner for
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three psychologic interventions to reduce anxiety during MR
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related to the use of contrast agents. Radiology 175:629-631,
3. Yoshikawa H: Late adverse reactions to nonionic contrast
media. Radiology 183:737-740, 1992.
4. Cascade PN: Quality improvement in diagnostic radiology. AJR
5. Athanasoulis CA, Thrall JH: Standards of radiology practice:
An approach to development. Radiology 173:613-614, 1989.