We are working on a new program at our hospital regarding "quality control" of reports. I am interested in how it is done elsewhere. Currently we have 2.5% of our work checked every two weeks. Would like to know what's being done elsewhere. Any comments appreciated.

Judy Hinickle wrote an article on ways of doing QA. It may have been printed in Perspectives Magazine. You could call HPI....209, 551-2112.

The more feedback the better! I have trained MTs who had made simple mistakes for 30 years because they never got feedback. In fact, it would be better, I think, to give them more feedback for learning and less rating for judgment! :) There are zillions of ways we can err everyday in this detailed work, and like writers and artists, corrections with grades can be hard to take, corrections are hard enough, after all...but we get plenty of practice at this grace when we do get supportive feedback! :)

Well, after 30+ years of doing this, I know I still make mistakes. I typed "discreet" when I should have typed "discrete" for probably 20+ years. The problem with QC of this type of work is that people feel they are being attacked rather than offered constructive criticism. I'm careful to say something like "Gee, I've typed that thus-and-such for years, let's look it up cause I may be wrong" people still get upset. I try to respond in kind when I'm on the other end also--like saying "Oh, let's look that up, I could easily be wrong" but if I turn out to be right, the other person has gotten really upset. So when you implement a QC thing, you need to be sure people understand that it is NOT an attack forum, simply a means to make sure that reports are as accurate as possible and a means of learning where we may be making those simple errors. Sometimes, it is just a matter of a typo--if you've been doing hips all day, you might suddenly get an abdomen and type "iliocecal" rather than "ileocecal." Anyway, I would appreciate more feedback than I get at home or even that I got at hospitals. The best feedback I have ever gotten has been doing radiology. Radiolgist's read their stuff and send it back pronto for the most part. I worked 8 years for one doc and he was pretty easy. But when he went on vacation, he got an Argentine gentleman to sub for him and he was hard and picky and I learned something new most every day he was there. Later, he would get 3rd year residents and they were wordy and picky and I learned a lot from them also. Mostly, because they were just in the next office, I was able to ask them before I printed a report and have it correct by the time they saw it--but that is feedback of the best sort. I often got a little anatomy and physiology lessen thrown in and that was a help! Good luck in getting something implemented! Hope these comments help.
Carol

Some QA people seem to take things personally, as though you made the mistake just to be mean to them. :)

It's humiliating enough to be given the correction; it's a lot easier to keep learning and producing if reassurance is given with the feedback.

Giving the "benefit of the doubt" is wonderful, like you mentioned, Carol. I love it when our QA head, an M.D., says, "Your spellchecker failed you here," as though it wasn't our fault at all. :)

We never outgrow our ability to make errors! And it can be difficult when the shoe is on the other foot and the QA person is wrong...then WE have to be kind!

Mary

Someone mentioned being humiliated by having an error pointed out or being corrected. Maybe I am weird, but I have never been humiliated; I have been furious at myself if it was truly an error on my part. On the other hand, if the "corrector" was in error, I ended up with glossal lacerations from biting my tongue. For example, a certain huge clinic insists that murmurs be typed as II/VI, and other stupid stuff. As long as they pay me, I will do it their way, but when I am alone, I will DO IT MY WAY. There is no shame in learning that you have made a mistake. The shame is in not learning from from your mistake.

I've done this for years -- typing glibly along making the same mistakes over and over without a clue that I was doing anything wrong. We NEED feedback (read correction) or we never fix those little glitches that make us look stupid.

I took on a summer intern last year who was so good for me. Each of us is certain she learned more than the other did. She had a wonderful way of pointing out my errors -- I, the teacher! She's soft-spoken and poised anyway, so what she said never sounded picky or critical.

I'm going to confess a "sin" that I've been committing for years that I just learned about from a colleague: One doctor that we've both done in the past constantly says something about infected wounds that sounded exactly, and I'm not kidding, like "no fluctuance." Fluctuance isn't a word in my dictionary, but it was clear as day that that's what she was saying. When my colleague heard it and asked me what the doctor was saying, I confidently told her, "It's fluctuance. I know that's not a real word but that's what she's saying." My friend didn't argue, but did what I should have done in the first place and called the doctor, who answered, "It's fluctuance. F-l-o-c-c-u-l-e-n-c-e, fluctuance."

Boy do I feel stupid.

Maria Stahl

Look up flocculent and fluctuant (I use Dorland's). Is she talking about a flaky solution (literally flakes in a solution, not a crazy one) or a wavelike motion on palpation because of liquid content? I have been caught on the horns of this dilemma also. When I go to Webster's, although more forms of the first word are listed, neither has a form ending in "ence" or "ance." So where do we go with this one? There are others like that out there too. Like crepitant. They insist on saying crepitance which is not a correct form of the word. Look that one up also. We know what they mean, but they are not using it according to Webster/Dorland's/etc. And don't feel stupid. We are given wrong input sometimes. However, one doc I worked for an I agreed that my job was to keep both of us from looking stupid AS MUCH AS POSSIBLE and it is not always possible!
Regular English words can be just as bad!
Bye for now,
Carol

I also am stumped on the "crepitance" that they dictate, and since that is not really a word, I either reword it to say, "I heard no crepitation.", or change it to "There was no crepitus." In Tabers, crepitus can mean (1) noise of gas in the intestine, or (2) crepitation - either joint or redux. I have never gotten any feedback from supervisors or docs on this one, but always wondered if I WAS doing it right.

Dr. John Dirckx, the wonderful "word man" who writes for both JAAMT and Perspectives, has commented in the past on both "crepitance" and "fluctuance." He has, of course, advised that references to "crepitance" be changed to "crepitation" for the simple reason that crepitance is not correct. In the case of fluctuance, he admits to hearing his colleagues' frequent incorrect usage of this term and says that this usage may eventually make "fluctuance" acceptable, even though "fluctuation" is the correct term. Don't be shy about showing your client the dictionary page that documents correct usage of a term. If, after seeing the documentation, he/she still insists on using the word incorrectly, you may want to point out that you are anxious for his/her documentation to reflect the high quality of his/her patient care. A little flattery may go a long way! As for working in a vacuum, line that vacuum with as many current reference books as you can, and don't be afraid to consult your colleagues on line or by phone when you need more information. The patient deserves the best documentation you can provide.

I also pick the correct form of crepitus acording to what they are talking about. And also have never gotten any feedback on it. As my radio-ologist (his term) said, an MT's job is to keep us both from looking stupid. But since so many misuse these terms, how many know we are looking stupid? Well, enuff is enuff on this topic. We all can use QC type feedback and I don't think any of us get much of it, so we get sensitive when we do get it even when it isn't meant to be an attack! So let's all just do our best to do it right and be kind when correcting/being corrected!
Carol

The impression I get is that most of you feel you don't get enough feedback. We feel we get too much and it is too "picky." I feel we all do the best that we can. We do not make errors on purpose. Our reports are pulled and checked after they have gone out into the hospital system so the error is still out there. A big problem, we feel, is that we all trained different places, we educated at different places and learned different styles - especially regarding punctuation. We are not writing the "great American novel." What do supervisors in your workplace look for?

The supervisors who hire our graduates are tough. They want 100% accuracy, but on the employment test, they will go down as far as 99% if they think the applicant has potential. It's rough out there, isn't it?

Ruth,
I think it helps if an institution has their own style guide with details about style, including punctuation. Then everyone knows the standards by which the work is corrected. That way you are not just subject to the style of the proofreader. Of course, there are optional matters where we have some choices, like that last comma in a series of units.

Without feedback, you can feel uneasy about your work, even guilty and that can be paralyzing; with harsh correction, you can feel totally condemned and demoralized and that can be paralyzing. That combination of feeling respect for your work and allowance for your humanness is the best!

Generous carefulness...supportive coaching.

Mary

I think Mary's comments apply for sure. I have been forunate in that I have never worked at a place that was so picky as to style. Punctuation is a matter of style and that can vary a lot. Some docs put commas all over, some never say comma, period, etc. As EDITORS, we have to do this. However, if your QA people are picking on punctuation, maybe they aren't finding any real errors and just feel like they need to find ANYTHING. If they aren't getting these corrected in the final copies, then I wouldn't be overly concerned. Hope these comments help!
Carol

A truly good quality program involves the MTs in a way that results in people looking forward to seeing how well they have done, or if there is any new information they they can learn. While transcribing they will constantly be checking the latest references, or the procedure manuals developed for each account or dictator, eager to be doing their best...
Sound impossible? I see it at our service each day.
-Judy

My thoughts on QA are that basically we just do the very best we can with the tools at hand (and there are lots of those!) and help each other out. If Dorland's can make a mistake in the "bible" on Stimson's method (printed it Stinson's) and then admit it, I would hope that we can all be as gracious in admitting and/or calling attention to our own mistakes. Also, as we have seen, styles and preferences change. Used to be that "calix" was defined as "calyx" in the dictionaries but now it is the other way around. (The root word is the Greek kalyx.) At any rate, the bottom line is documentation that is as correct as possible to benefit the patient and I am sure that is what we are all after.

I am having controversy with another employee at work, is it 2/6 or II/VI systolic murmur. I have seen it both ways, and have been using 2/6, but a coworker says I am doing it wrong. Any input?

Current Medical Terminology by Vera Pyle say murmurs can be either Roman or Arabic, but her examples are Arabic.