How the clinical audit in Belgium will be shaped by the Quality System B-QUAADRIL [Interview]

Conducting internal and external clinical audits will be obligatory for every European radiology department from February 2018 onwards. However, the concrete implementation in Belgium is less clear and raises questions in many radiology departments. We spoke about this topic with Nils Reynders-Frederix, secretary of the Belgian Medical Imaging Platform (BELMIP). They have a better handle on the situation as they are currently developing best practices on how to conduct clinical audits in Belgium. Read the complete interview here.

Can you explain to us what BELMIP does, and what they stand for?

BELMIP is a collaborative platform of multiple stakeholders, that was founded by the Federal Public Service (FPS) public health, in collaboration with the Federal Agency for Nuclear Control (FANC), the National Institute for Health and Disability Insurance (RIZIV/INAMI), the Belgian Society of Radiology and the Belgian Society of Nuclear Medicine.

Our mission is to promote the good use of medical imaging and to avoid unnecessary examinations and unneeded exposure to ionising radiation. In order to achieve these goals, we organize various initiatives in multiple domains. The first domain is justification. We promote the good use of medical imaging using published guidelines. These assist the referring physicians in choosing the most appropriate examination for their patient. Creating awareness in the sector and in the general public is also part of our work. You’ve certainly heard of the awareness campaigns “medische beelden zijn geen vakantiekiekjes”, or “medical images aren’t holiday pictures.”

In addition, we also focus on optimization. We provide services that aim at quality improvement, the most important of which is the Quality System B-QUAADRIL.

In BELMIP we involve as many relevant Belgian stakeholders as possible: radiologists and nuclear medicine physicians, radiographers, as well as physicists and general practitioners, all delegated by their representative professional organizations. In other words, we work with a fairly large group of stakeholders. The platform structure of BELMIP assures that all initiatives start from a certain well-organized strategy that is supported by the broader community on the one hand, but on the other hand also succeeds in successfully channelling the great engagement, effort and time that our wonderful members invest in our platform on a voluntary basis.

How does BELMIP define a Quality System?

A Quality System contains criteria that imaging services can use to test their performance in various stages: including the preparatory process, self-evaluation during the internal audit and the external audit.

BELMIP based its system on a method proposed by the International Atomic Energy Agency (IAEA) in its handbook “Quality Improvement Quality Assurance Audit for Diagnostic Radiology Improvement and Learning (QUAADRIL)”. The handbook contains almost 300 quality criteria with which radiology departments can test their processes, in order to determine those domains that run smoothly and others that need improvement. In order to help the Belgian sector to evaluate and optimize quality inside their services, BELMIP developed a Belgian variant of the QUAADRIL, the B-QUAADRIL.

And why does BELMIP think that a Belgian variant of the Quality System, B-QUAADRIL, is necessary?

Well, all European Member States are required to comply with the EURATOM ‘97 and 2013 directives before 6/02/2018. These directives will be introduced into the Belgian legal framework as FANC regulation, containing standards to introduce clinical audits according to national procedures. Accordingly, BELMIP has been working on a Belgian version of QUAADRIL since 2011. It took the complexity of the original away by simplifying several criteria and made a selection based on the Belgian landscape: we classified them into three categories, A, B, and C.

• Category A: criteria that are already part of the Belgian law, or that are considered as crucial by BELMIP experts .
  
  
• Category B: desirable criteria that every radiological department should be able to achieve.
  
  
• Category C: criteria that focus on research or education centres.

In this way, smaller centres can comply with levels A & B but don’t necessarily have to meet all criteria originally contained in the QUAADRIL document. The purpose is to offer the sector a tool that is as user-friendly, expedient and efficient as possible.

We discussed what a Quality System is according to BELMIP, but what is a clinical audit? And what is the relationship between both?

The criteria of the B-QUAADRIL allow services to assess their actual performance, where they score well, and where there is room for improvement. This Quality System facilitates internal and external audits.

First, a multidisciplinary team - I would like to highlight the importance of teamwork - makes a step-by-step self-evaluation of the service using the B-QUAADRIL criteria. During a second phase, audits by peers will allow an objective performance evaluation of the audited service. This method covers all operational aspects of the service and hence promotes the process of quality improvement.

So, the Quality System is necessary in Belgium in order to attain the necessary standards for clinical audits and to continuously improve quality. But how will this be implemented?

The next few months will be pivotal in deciding how internal and external audits will be organized. We are planning preliminary tests at pilot sites in order to explore how user-friendly, clear and effective the current B-QUAADRIL is, to observe how services actually use the system and whether they need further clarifications. Because Quality Systems always entail a certain workload, it is important to get a clear impression of their efficacy and user-friendliness. After the pilot phase, we will adapt the document and adjust the criteria as needed based on the feedback we collected.

So, the upcoming months will be extremely important in the development of the final version of the B-QUAADRIL. We aim at offering the sector a Quality System that will be considered as a useful working tool assisting radiology departments in mapping their quality, to learn about strengths and weaknesses, and to strive for improvement.

Nils Reynders-Frederix, Secretary of BELMIP