3.METHODS
Case study developed with the radiologists of the Radiology Service and physicists of the Medical Physics Service of the HCPA.
These professionals,
along with the nursing and radiology technicians,
work directly with the performance of imaging examinations through the evaluation of the clinical information provided,
adequacy of the protocols of acquisition of images and control of the norms of safety in the use of the ionizing radiations.
Radiologists interpret and release the results.
In order to achieve the objective of this study,
a Dynamic Systems Analysis Model adapted to four stages of Forrester (1971) and Guo (2016) containing the objectives and tools presented in the following table (table1) will be used:
Table 1 - Dynamic system analysis model adapted
phases
|
goals
|
tools
|
1
|
Problem identification
|
- contextualization
|
2
|
Formulation of the model
|
- causal loop diagram
|
3
|
Validation
|
- causal loop diagram
- qualitative research with specialists
|
4
|
results achieved
|
- improvement propositions
|
Source: adapted from Forrester (1963) an Guo (2016)
This model of qualitative system dynamics is often referred to as a "Causal Loop Diagram" (CLD) because it uses a "cause and effect diagram" to illustrate the factors or causes of the problem.
To represent the cause and effect relationships between variables (factors),
arrows (GUO,
2016) and positive or negative signaling are used according to the interference in the factors in the direction of the arrow.
4.RESULTS
The results presented were the construction of a cause and effect diagram (CDL) where the knowledge factor by the attending physician of the importance of providing adequate clinical information in the request of imaging tests can impact the choice of the image protocols,
the time of release of the report,
the quality of the report,
the reduction of radiation dose with adequacy of the investigation and reduction of additional tests Fig. 1
Fig. 1: Diagram Loop Causal, criated VENSIM PLE 7.2
References: VENSIM PLE 7.2
Were identified 14 factors that interfere with the provision of clinical information in the request for imaging tests,
shown in table 2.
Table 2.
Factors that interfere with the provision of clinical information in the request for imaging tests
Factors
|
Definitions
|
Factor 1.
Provision of clinical information - Justification
|
-Justification to submit the patient to examination with ionizing radiation.
Provision of data on the patient's disease and the diagnostic hypothesis
|
Factor 2.
Result release time
|
-Elapsed time between the request of the imaging exam until delivery of the result in the patient's chart
|
Factor 3.
Complementary imaging test
|
-Need to perform another exam or other examination modality for diagnostic resolution
|
Factor 4.
Adequacy of the image protocols
|
-The orientation of the choice of the image acquisition protocol depends on the clinical suspicion of the patient
|
Factor 5.
Repeating or completing exams
|
-The need to repeat the exam or to complement images with protocol different from the one initially chosen.
|
Factor6.
Trained assistant physician
|
-Clinical experience,
knowledge of the importance of providing clinical information,
interaction with imaging staff
|
Factor 7.
Search of information in the medical record
|
-Repository of clinical information and evolution of patients,
with diagnostic impressions and results of previous exams.
|
Factor 8.
Complexity of the clinical case
|
-More complex diseases present greater diagnostic challenges.
|
Factor 9.
Operation of the imaging systems
|
-Electronic digital image acquisition systems,
interaction with a diagnostic evaluation tool system and patient information systems (electronic medical record).
Hardware and software.
|
Factor 10.
Quality of the report
|
-Reliable result,
delivered in a timely manner for consultation,
with description of the changes and diagnostic hypothesis.
|
Factor 11.
Double reading of Exams
|
-Quality program with re-reading of medical peer examinations and statistical evaluation of concordances and discrepancies between the results.
|
Factor 12.
Experience of radiologist
|
-Technical knowledge and ability to correlate clinical data with images obtained in image evaluations and interaction with clinical teams.
|
Factor 13.
Motivation
|
-Search for continuous improvement in work processes,
openness and participation in the implementation of new techniques,
routines or procedures.
|
Factor 14.
Economic crisis
|
-Limitation of health care due to economic and health policies,
with delay and delay in care and consequent greater severity of the pathologies presented by the patients.
|
The analysis of the cause and effect diagram shows that the qualification of the attending physician in providing adequate clinical information in the request for imaging tests can impact the choice of the imaging protocols,
the time of release of the report,
the quality of the report,
the reduction of the radiation dose with adequacy of the investigation and reduction of additional tests.
Thus,
improvements are proposed in the diagnostic imaging service that can be used by the hospital institution,
producing results in a timely,
reliable,
with the aid of appropriate techniques,
reducing wait times and rework and improving the interrelationships between multidisciplinary teams.