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RAD CH 15 and CH16

Radiology CH 15 and CH 16

QuestionAnswer
DRGs Diagnosis-related groups, payments are limited to the set amount allocated to the specific diagnosis
life-cycle cost+Life cycle cost purchase cost + cost of maintenance through useful life
quality assurance Monitoring/testing of imaging equipment and control of variables to minimize unnecessary duplication of radiographic exams & maximize the quality of diagnostic info
in-service education program All radiology personnel should receive instruction about safety precautions & management of radiation-related accidents/emergencies Training provided by hospital to improve the quality of services
functions of hospital administrator operation of hospital ,planning, developing, and maintaining programs that implement policies & achieve the goals established by govn body Organizes administrative functions of hospital, delegates duties, establishes formal meetings & provides direction
radiologic compliance evaluations Include inspection & testing of x-ray units Should be performed at required intervals & must be documented Exposure rate measurements; half-value layer determinations; scatter surveys; timer & collimator accuracy checks
factors attributing to rising health costs Primarily due to lack of incentives to control costs in the past – government simply reimbursed hospitals for whatever procedure/treatment was performed malpractice, more tests (CYA) & more liberal benefits for employees
hospital revenue-producing departments Radiology, laboratory, and pharmacy
factors that contribute to the cost of retakes Film, chemicals, staff time, equipment usage and room occupancy Additional radiation exposure to staff and patients
guidelines for staffing all radiology personnel Guideline is 1 productive hr/procedure
radiology equipment purchasing considerations based on how many rooms and what types of equipment are necessary Availability of equipment maintenance is prime consideration (loss of revenue; bypass)
management of periodic occupational exposure notice Exposure reports should be posted in high visibility area and reviewed/verified monthly by staff & management Occupational exposure documents should also be placed in employee’s personnel file
What radiology staffing numbers and function are based on Number & functions of staff are based on volume & type of procedures performed
frequency of radiologic tests performed (and percentages of each) 30% CXRs; 10 % fluoro; 9% pyelo, 51% bone, spine, abd & skull
who is responsible for verifying radiology personnel qualifications Radiology administrator
primary considerations when purchasing new radiology equipment Needs of the department, economic factors & equipment maintenance
number of procedures used to determining number of x-ray rooms needed 18 exams per day, per room 6500 radiographic procedures should performed in each unit
Prospective payment system government’s policy of reimbursing hospitals for tests and treatments for Medicare and Medicaid Hospitals now contracting with doctors/corporations to provide services at a fixed fee
what shift in medical services has resulted from prospective payment system Certain medical services are moving out of hospital care and into less costly facilities Freestanding urgent care Imaging centers outreach clinics Physical rehab facilities Sports medicine clinics
OSHA Occupational Safety and Health Administration concerned with safety in the workplace, primarily radiation-emitting materials and equipment (CALOSHA)
silver reclamation in procedure manual silver in the x-ray film itself Fixer solution washes undeveloped silver off film should never go down the drain Hospital pays for silver when purchased;reclamation from fixer helps recover some cost Scrap film saved/salvaged
Cost of silver 1 gal fixer=3 troy oz silver 4,000 gal/yr > 2,400 troy oz = @ $18K (at about $8/oz)
organizational chart Organizational charts & departmental flowcharts establish clear lines of authority, responsibility & accountability to provide spans of control create operational independence & define administrative (record-keeping) responsibilities
CON (and from who to who is it issued) Certificate of need Review committee issue to purchaser after need for equipment /expansion established Regulates major capital expenditures and changes in service
relentless attention to entire x-ray exam process Ultimate objective to aid physicians in diagnosing/treatment of diseases by providing timely/reliable info To ensure reliability careful attention must be given to performance of every exam, from ordering to point where results are returned
X-ray process Effective patient care depends upon cooperation between all hospital departments Staff must be familiar with procedures within and outside of radiology, i.e. admissions, medical records, personnel (HR) and business services (billing/ coding) departments
a radiology department Determined by the roles/ functions of the hospital & the needs of the community No typical or average department /certain characteristics are common Org. affects internal structure, disposition & mgmt of people and fiscal resources.
Radoliogy special areas devoted to; diagnostic rad, nuclear medicine, and sonography Large hospitals, sections devoted to rad oncology, rad biology, radiation physics If hospital only has a diagn. rad called: imaging dept, dept of imaging or diagnostic rad dept (x-ray)
a procedures manual to provide radiology information to other departments/institutions or physicians Generally designed to meet accreditation standards, state regs and hospital codes,helpful to new hires/student
General Info contained in procedure manual instructions for visiting patients appropriate gowning transport isolation & precautions to observe authorization forms
Radiology procedure manual exams & preps prep contrast studies sequencing contrast procedure & which exams can be performed on same day outside referrals /film loans silver recovery dated film disposal microfilmed records disaster drills
Reasons for reducing retakes Increase costs to the hospital/economics Increase dosage and exposure to the patient and staff
OEM, T&M and ISO contracts Important to negotiate contract prior to purchase to obtain lowest price and lowest possible life cycle cost More complex systems (CT, MRI, Angio)-usually prepaid OEM or ISO
OEM Original equipment manufacturer prepaid, usually long-term w/ glassware options
T&M Tim and materials payment made only for these items used in repair on a case-by-case basis usually lowest cost for less sophisticated equipment
ISO Independent service organization third-party contract providing both prepaid maintenance and T&M
Radiology director/manager responsibilities Participate in staff activities Establish effective working relationship with staff admin & other depts Develop/approve all P&P for rad dept Verify qualifications/capabilities of all technical personnel
Radiology director/manager responsibilities Develop comprehensive safety rules in coop.w/ hospital safety committee Review/evaluate quality & appropriateness of radiology services Advise medical staff & administration of equipment needs, modification and utilization
infection control program Accrediting body for hospital recommends a hospital-wide program Include mechanisms for reporting & identifying infections, maintaining records of infections & reviewing/evaluating aseptic isolation & sanitation techniques
Who recommends radiation safety precautions JCAHO recommends safety precautions be established by radiologist or radiation safety committee Recommendations of NCRP are standard that should be known & applied
Radiation safety precaution Rules for safe use, handling, storage & disposal of radioactive elements established and enforced Occupational exposure documents placed in personnel file Lead gloves, aprons & beam r devices monitored on scheduled basis
electrical safety considerations Policy is usually hospital-wide but is of particular concern for radiology because of high-voltage equipment used Awareness of use of electrical equipment is essential for all personnel; written policies are usually available
radiologic compliance evaluations inspection & testing of x-ray units performed at required intervals & documented measure exposure rate half-value layer determinations scatter surveys timer/collimator structural shielding Electrical & mechanical safety
Organizational charts & departmental flowcharts establish clear lines of authority responsibility & accountability to provide spans of control create operational independence & define administrative (record-keeping) responsibilities
radiologic equipment requirements that must be met The accrediting agency recommends that Diagnostic & therapeutic equipment should be calibrated IAW US, state & local requirements
Created by: juaire30