Lane F. Donnelly MD is currently Chief Quality Officer and Christopher G. Dawes Endowed Director of Quality at Lucile Packard Children’s Hospital and Stanford Children’s Health. He is also a Professor of Radiology and Pediatrics and the Associate Dean, Maternal and Child Health (Quality and Safety) in the School of Medicine at Stanford University. He also serves as the Co-Executive Director of Stanford Medicine Center for Improvement.

Dr. Donnelly has been an NIH funded researcher, has published 278 peer review manuscripts that have been cited over 10,000 times and has authored multiple textbooks, including Pediatric Imaging: The Fundamentals, a lead selling text book on pediatric imaging. Many improvement projects for which he was a contributor have received multiple national recognitions including International Quality Radiology Network’s Quality-Improvement in Radiology Practices Paper Competition: Annual Award 2008 (Paper of the Year); Caffey Award – for Outstanding Presented Paper, Society for Pediatric Radiology (2001, 2009, 2011); 2012 British Medical Association Book Awards; Singleton–Taybi Award for Lifetime Achievements in Education, Society for Pediatric Radiology (2009); Journal of the America College of Radiology 2018 Paper of the Year Award; and the 2009 Best Scientific Paper Award - Institute for Healthcare Improvement (IHI) and the RSNA Honored Educator Award (2019). Dr. Donnelly has served on the Board of Trustees for both the American Board of Radiology and the Society for Pediatric Radiology.

Former Leadership positions include Radiologist-in-Chief and Frederic N. Silverman Chair of Pediatric Radiology as well as Executive Cabinet member at Cincinnati Children’s Hospital Medical Center (2002-2011); Inaugural Chief Medical Officer / Physician-in-Chief at the Nemours Children’s Hospital (helping plan, staff, and open the greenfield hospital in 2012) and Enterprise Vice President as well as Enterprise Radiologist-in-Chief for the Nemours Foundation (2011-2015); and Chief Quality Officer for Hospital Based Services at Texas Children’s Hospital (2015-2017). He was educated at The Ohio State University and the University of Cincinnati College of Medicine.

Clinical Focus

  • Diagnostic Radiology

Academic Appointments

Administrative Appointments

  • Associate Dean, Maternal and Child Health (Quality and Safety), Stanford University School of Medicine (2018 - Present)
  • Christopher G. Dawes Endowed Director of Quality, Lucile Packard Children's Hospital / Stanford Children's Health (2018 - Present)
  • Chief Quality Officer, Lucile Packard Children's Hospital at Stanford (2017 - Present)
  • Professor, Stanford University School of Medicine (2017 - Present)

Professional Education

  • Board Certification: American Board of Radiology, Diagnostic Radiology (1994)
  • Board Certification: American Board of Radiology, Pediatric Radiology (1996)
  • Fellowship: Cincinnati Children's Hospital Medical Center (1995) OH
  • Residency: University of Cincinnati College of Medicine (1994) OH
  • Medical Education: University of Cincinnati College of Medicine (1990) OH
  • Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Pediatric Radiology (1995)
  • Radiology, University of Cincinnati, Radiology (1994)
  • MD, University of Cincinnati College of Medicine, Medicine (1990)
  • BS, Ohio State University, Biology (1986)


All Publications

  • Development and Implementation of a Real-time Bundle-adherence Dashboard for Central Line-associated Bloodstream Infections. Pediatric quality & safety Chemparathy, A., Seneviratne, M. G., Ward, A., Mirchandani, S., Li, R., Mathew, R., Wood, M., Shin, A. Y., Donnelly, L. F., Scheinker, D., Lee, G. M. 2021; 6 (4): e431


    Introduction: Central line-associated bloodstream infections (CLABSIs) are the most common hospital-acquired infection in pediatric patients. High adherence to the CLABSI bundle mitigates CLABSIs. At our institution, there did not exist a hospital-wide system to measure bundle-adherence. We developed an electronic dashboard to monitor CLABSI bundle-adherence across the hospital and in real time.Methods: Institutional stakeholders and areas of opportunity were identified through interviews and data analyses. We created a data pipeline to pull adherence data from twice-daily bundle checks and populate a dashboard in the electronic health record. The dashboard was developed to allow visualization of overall and individual element bundle-adherence across units. Monthly dashboard accesses and element-level bundle-adherence were recorded, and the nursing staff's feedback about the dashboard was obtained.Results: Following deployment in September 2018, the dashboard was primarily accessed by quality improvement, clinical effectiveness and analytics, and infection prevention and control. Quality improvement and infection prevention and control specialists presented dashboard data at improvement meetings to inform unit-level accountability initiatives. All-element adherence across the hospital increased from 25% in September 2018 to 44% in December 2019, and average adherence to each bundle element increased between 2018 and 2019.Conclusions: CLABSI bundle-adherence, overall and by element, increased across the hospital following the deployment of a real-time electronic data dashboard. The dashboard enabled population-level surveillance of CLABSI bundle-adherence that informed bundle accountability initiatives. Data transparency enabled by electronic dashboards promises to be a useful tool for infectious disease control.

    View details for DOI 10.1097/pq9.0000000000000431

    View details for PubMedID 34235355

  • Healthcare Worker Serious Safety Events: Applying Concepts from Patient Safety to Improve Healthcare Worker Safety. Pediatric quality & safety Foster, C., Doud, L., Palangyo, T., Wood, M., Majzun, R., Bargmann-Losche, J., Donnelly, L. F. 2021; 6 (4): e434


    Introduction: Patient safety has improved pediatric healthcare by defining when patient safety events meet criteria as serious safety events (SSEs). Similar concepts apply to healthcare worker (HCW) safety. We describe the newly designed process for HCW injury reporting, the process for evaluating HCW SSEs, and early experience with the new systems.Methods: The work to redesign our approach to HCW safety included 2 parts: (1) process flow mapping and redesigning the work for HCW injury reporting; and (2) creating a process to categorize HCW injuries and determine when such injuries rise to a HCW SSE level. We evaluated the mean time per month from HCW injury to reporting and compared those values during the postimplementation time. We also evaluated the team's experience with the first 4 potential HCW SSEs.Results: By improving the process flow, the mean time to reporting decreased significantly from 28 days implementation time-period (September-October 2019) to 9 days during the postimplementation time-period (November 2019-May 2020) (P = 0.0002). Of the first 4 HCW events identified and reviewed as possible HCW SSE events, there were 2 defined as HCW SSE level 4, one defined as a precursor event, and one defined as a nonsafety event.Conclusion: Adapting infrastructure and definitions used previously to improve patient safety can improve HCW safety.

    View details for DOI 10.1097/pq9.0000000000000434

    View details for PubMedID 34179676

  • Correlation of an Independent Electronic Health Record & External Ranking of Children’s Hospitals Health Donnelly, L. F., Scheinker , D., Pageler, N. M., Shin, A. Y. 2021; 13: 81-89
  • Optimizing Professional Practice Evaluation to Enable a Nonpunitive Learning Health System Approach to Peer Review. Pediatric quality & safety Sandborg, C. I., Hartman, G. E., Su, F., Williams, G., Teufe, B., Wixson, N., Larson, D. B., Donnelly, L. F. 2021; 6 (1): e375


    Healthcare organizations are focused on 2 different and sometimes conflicting tasks; (1) accelerate the improvement of clinical care delivery and (2) collect provider-specific data to determine the competency of providers. We describe creating a process to meet both of these aims while maintaining a culture that fosters improvement and teamwork.Methods: We created a new process to sequester activities related to learning and improvement from those focused on individual provider performance. We describe this process, including data on the number and type of cases reviewed and survey results of the participant's perception of the new process.Results: In the new model, professional practice evaluation committees evaluate events purely to identify system issues and human factors related to medical decision-making, resulting in actional improvements. There are separate and sequestered processes that evaluate concerns around an individual provider's clinical competence or behavior. During the first 5 years of this process, 207 of 217 activities (99.5%) related to system issues rather than issues concerning individual provider competence or behavior. Participants perceived the new process as focused on identifying system errors (4.3/5), nonpunitive (4.2/5), an improvement (4.0/5), and helped with engagement in our system and contributed to wellness (4.0/5).Conclusion: We believe this sequestered approach has enabled us to achieve both the oversight mandates to ensure provider competence while enabling a learning health systems approach to build the cultural aspects of trust and teamwork that are essential to driving continuous improvement in our system of care.

    View details for DOI 10.1097/pq9.0000000000000375

    View details for PubMedID 33409427

  • Transitioning From Peer Review to Peer Learning: Report of the 2020 Peer Learning Summit. Journal of the American College of Radiology : JACR Larson, D. B., Broder, J. C., Bhargavan-Chatfield, M., Donnelly, L. F., Kadom, N., Khorasani, R., Sharpe, R. E., Pahade, J. K., Moriarity, A. K., Tan, N., Siewert, B., Kruskal, J. B. 2020


    Since its introduction nearly 20 years ago, score-based peer review has not been shown to have meaningful impact on improving radiologist performance or to be a valid measurement instrument of radiologist performance. A new paradigm has emerged, peer learning, which is a group activity in which expert professionals review one another's work, actively give and receive feedback in a constructive manner, teach and learn from one another, and mutually commit to improving performance as individuals, as a group, and as a system. Many radiology practices are beginning to transition from score-based peer review to peer learning. To address challenges faced by these practices, a 1-day summit was convened at Harvard Medical School in January 2020, sponsored by the ACR. Several key themes emerged. Elements considered key to a peer-learning program include broad group participation, active identification of learning opportunities, individual feedback, peer-learning conferences, link with process and system improvement activities, preservation of organizational culture, sequestration of peer-learning activities, and program management. Radiologists and practice leaders are encouraged to develop peer-learning programs tailored to their local practice environment and foster a positive organizational culture. Health system administrators should support active peer-learning programs in the place of score-based peer review. Accrediting organizations should formally recognize it as an acceptable form of peer review and specify minimum criteria for peer-learning programs. IT system vendors should actively collaborate with radiology organizations to develop solutions that support the efficient and effective management of local peer-learning programs.

    View details for DOI 10.1016/j.jacr.2020.07.016

    View details for PubMedID 32771491

  • Reduction of Central Line-associated Bloodstream Infection Through Focus on the Mesosystem: Standardization, Data, and Accountability. Pediatric quality & safety Mathew, R., Simms, A., Wood, M., Taylor, K., Ferrari, S., Rhein, M., Margallo, D., Bain, L. C., Valencia, A. K., Bargmann-Losche, J., Donnelly, L. F., Lee, G. M. 2020; 5 (2): e272


    Introduction: Efforts to reduce central line-associated bloodstream infection (CLABSI) rates require strong microsystems for success. However, variation in practices across units leads to challenges in ensuring accountability. We redesigned the organization's mesosystem to provide oversight and alignment of microsystem efforts and ensure accountability in the context of the macrosystem. We implemented an A3 framework to achieve reductions in CLABSI through adherence to known evidence-based bundles.Methods: We conducted this CLABSI reduction improvement initiative at a 395-bed freestanding, academic, university-affiliated children's hospital. A mesosystem-focused A3 emphasized bundle adherence through 3 key drivers (1) practice standardization, (2) data transparency, and (3) accountability. We evaluated the impact of this intervention on CLABSI rates during the pre-intervention (01/15-09/17) and post-intervention (07/18-06/19) periods using a Poisson model controlling for baseline trends.Results: Our quarterly CLABSI rates during the pre-intervention period ranged from 1.0 to 2.3 CLABSIs per 1,000 central line-days. With the mesosystem in place, CLABSI rates ranged from 0.4 to 0.7 per 1,000 central line days during the post-intervention period. Adjusting for secular trends, we observed a statistically significant decrease in the post versus pre-intervention CLABSI rate of 71%.Conclusion: Our hospital-wide CLABSI rate declined for the first time in many years after the redesign of the mesosystem and a focus on practice standardization, data transparency, and accountability. Our approach highlights the importance of alignment across unit-level microsystems to ensure high-fidelity implementation of practice standards throughout the healthcare-delivery system.

    View details for DOI 10.1097/pq9.0000000000000272

    View details for PubMedID 32426638

  • Key Drivers in Reducing Hospital-acquired Pressure Injury at a Quaternary Children's Hospital. Pediatric quality & safety Johnson, A. K., Kruger, J. F., Ferrari, S., Weisse, M. B., Hamilton, M., Loh, L., Chapman, A. M., Taylor, K., Bargmann-Losche, J., Donnelly, L. F. 2020; 5 (2): e289


    Introduction: Despite being a participating Solutions for Patient Safety (SPS) children's hospital and having attempted implementation of the SPS hospital-acquired pressure injuries (HAPIs) prevention bundle, our hospital remained at a HAPI rate that was 3 times the mean for SPS participating children's hospitals. This performance led to the launch of an enterprise-wide HAPI reduction initiative in our organization. The purpose of this article is to describe the improvement initiative, the key drivers, and the resulting decrease in the SPS-reportable HAPI rate.Methods: We designed a hospital-wide HAPI reduction initiative with actions grouped into 3 key driver areas: standardization, data transparency, and accountability. We paused all individual hospital unit-based HAPI reduction initiatives. We calculated the rate of SPS-reportable HAPIs per 1,000 patient days during both the pre- and postimplementation phases and compared mean rates using a 2-sided t test assuming unequal variances.Results: The mean SPS-reportable HAPI rate for the preimplementation phase was 0.3489, and the postimplementation phase was 0.0609. The difference in rates was statistically significant (P < 0.00032). This result equates to an 82.5% reduction in HAPI rate.Conclusions: Having an institutional pause and retooled initiative to reduce HAPI with key drivers in the areas of standardization, data transparency, and accountability had a statistically significant reduction in our organization's SPS-reportable HAPI rate.

    View details for DOI 10.1097/pq9.0000000000000289

    View details for PubMedID 32426646

  • Differences in Central Line-Associated Bloodstream Infection Rates Based on the Criteria Used to Count Central Line Days. JAMA Scheinker, D., Ward, A., Shin, A. Y., Lee, G. M., Mathew, R., Donnelly, L. F. 2020; 323 (2): 183–85

    View details for DOI 10.1001/jama.2019.18616

    View details for PubMedID 31935018

  • Book Review: Imaging in Pediatric Pulmonology, 2nd Edition. Robert H. Cleveland, Edward Y. Lee - Editors. Pediatric pulmonology Donnelly, L. F. 2020


    It was my pleasure to review Imaging in Pediatric Pulmonology 2nd Edition. Dr. Robert H. Cleveland, the sole editor of the first edition, is back as a co-editor. Dr. Cleveland is a Professor Emeritus at Harvard Medical School and Boston Children's Hospital. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1002/ppul.24955

    View details for PubMedID 32652871

  • Innovations for improving the patient experience in pediatric radiology. Pediatric radiology Donnelly, L. F. 2020; 50 (11): 1481

    View details for DOI 10.1007/s00247-020-04723-z

    View details for PubMedID 32935238

  • The approach to improving patient experience at children's hospitals: a primer for pediatric radiologists. Pediatric radiology Bomher, S. T., Munguia, J. M., Albert, M. S., Nelson, K. W., Bargmann-Losche, J. n., Platchek, T. S., Donnelly, L. F. 2020; 50 (11): 1482–91


    Increasing attention is being given to improving patient experience in health care. Most children's hospitals have a patient experience office or team that champions and measures patient experience and partners with operations to optimize performance in this area. We outline the activities that our patient experience team undertakes at our pediatric health system to advocate for, measure and improve the experience of our patients and families. The framework we propose for such activities includes those that are proactive in improving patient experience as well as those that are reactive to when patients and families have had a poor experience. Those reactive practices are often centered on the management of patient complaints and grievances and early intervention into patient complaints so that they do not become grievances.

    View details for DOI 10.1007/s00247-020-04781-3

    View details for PubMedID 32935239

  • The Importance of both the Technical and Social Domains in Creating a Culture that Accelerates Improvement in Healthcare. Health Donnelly, L. F., Frush, K., Shook, J., Schein, P. A., Schein, E. H. 2020; 12: 1575-1582
  • Practical Application of the International Neuroblastoma Risk Group Staging System: A Pictorial Review CURRENT PROBLEMS IN DIAGNOSTIC RADIOLOGY Braojos, F., Donnelly, L. F. 2019; 48 (5): 509–18
  • Review of learning opportunity rates: correlation with radiologist assignment, patient type and exam priority. Pediatric radiology Sammer, M. B., Sammer, M. D., Donnelly, L. F. 2019


    BACKGROUND: Common cause analysis of learning opportunities identified in a peer collaborative improvement process can gauge the potential risk to patients and opportunities to improve.OBJECTIVE: To study rates of learning opportunities based on radiologist assignment, patient type and exam priority at an academic children's hospital with 24/7 in-house attending coverage.MATERIALS AND METHODS: Actively submitted peer collaborative improvement learning opportunities from July 2, 2016, to July 31, 2018, were identified. Learning opportunity rates (number of learning opportunities divided by number of exams in each category) were calculated based on the following variables: radiologist assignment at the time of dictation (daytime weekday, daytime weekend and holiday, evening, and night) patient type (inpatient, outpatient or emergency center) and exam priority (stat, urgent or routine). A statistical analysis of rate differences was performed using a chi-square test. Pairwise comparisons were made with Bonferroni method adjusted P-values.RESULTS: There were 1,370 learning opportunities submitted on 559,584 studies (overall rate: 0.25%). The differences in rates by assignment were statistically significant (P<0.0001), with the highest rates on exams dictated in the evenings (0.31%) and lowest on those on nights (0.19%). Weekend and holiday daytime (0.26%) and weekday daytime (0.24%) rates fell in between. There were significantly higher rates on inpatients (0.33%) than on outpatients (0.22%, P<0.0001) or emergency center patients (0.16%, P<0.0001). There were no significant differences based on exam priority (stat 0.24%, urgent 0.26% and routine 0.24%, P=0.55).CONCLUSION: In this study, the highest learning opportunity rates occurred on the evening rotation and inpatient studies, which could indicate an increased risk for patient harm and potential opportunities for improvement.

    View details for DOI 10.1007/s00247-019-04466-6

    View details for PubMedID 31317241

  • Janet L. Strife, MD (1942-2019). Pediatric radiology Donnelly, L. F., Coley, B. D., Koch, B. L. 2019

    View details for DOI 10.1007/s00247-019-04451-z

    View details for PubMedID 31222444

  • The American Board of Radiology B. Leonard Holman Research Pathway to Initial Certification: Opportunities Lost for Diagnostic Radiology AMERICAN JOURNAL OF ROENTGENOLOGY Wallner, P. E., Alektiar, K. M., Donnelly, L. F., Kaufman, J. A. 2019; 212 (2): 245–47
  • Efficient Auditing of Standardized Reporting in Radiology Reply JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY Guimaraes, C. V., Grzezczuk, R., Bisset, G. S., Donnelly, L. F. 2019; 16 (1): 6–7
  • Creating a Defined Process to Improve the Timeliness of Serious Safety Event Determination and Root Cause Analysis. Pediatric quality & safety Donnelly, L. F., Palangyo, T. n., Bargmann-Losche, J. n., Rogers, K. n., Wood, M. n., Shin, A. Y. 2019; 4 (5): e200


    Serious Safety Events (SSEs) are defined as events in which there is a deviation from clinically accepted performance standards, causation, and significant patient harm or death. Given the nature of SSEs, it is important that the processes for declaration of SSEs, the performance of a root cause analysis (RCA), and action plan formation occur quickly, such that the window for potential recurrence of similar events is as small as possible. This manuscript describes a process put in place to improve the timeliness of SSE determination and RCA conduction and evaluates the effect of the process change on these parameters.A causal analysis was performed of the baseline process to determine factors contributing to long process times. A new process was created and implemented both for the SSE determination process and the RCA completion process. We calculated the mean time for the pre-implementation phase (April 2016-December 2017) and the post-implementation phase (March 2018-January 2019) for both SSE determination and RCA completion. We evaluated differences with a two-sided t test assuming unequal variances.Comparing pre- versus post- implementation phases, the mean time for SSE determination for events that met the SSE criteria decreased from 38.4 to 4.8 days (P < 0.0001), determination for events that did not meet the SSE criteria decreased from 38.4 to 3.8 days (P < 0.0001), and RCA completion time dropped from 118.0 to 26.2 days (P < 0.0001).A targeted intervention can significantly reduce SSE determination and RCA conduction times.

    View details for DOI 10.1097/pq9.0000000000000200

    View details for PubMedID 31745504

    View details for PubMedCentralID PMC6831051

  • Author's Reply. Journal of the American College of Radiology : JACR Guimaraes, C. V., Grzezczuk, R., Bisset, G. S., Donnelly, L. F. 2019; 16 (1): 6–7

    View details for PubMedID 30611384

  • Gauging potential risk for patients in pediatric radiology by review of over 2,000 incident reports PEDIATRIC RADIOLOGY Snyder, E. J., Zhang, W., Jasmin, K., Thankachan, S., Donnelly, L. F. 2018; 48 (13): 1867–74


    Incident reporting can be used to inform imaging departments about adverse events and near misses.To study incident reports submitted during a 5-year period at a large pediatric imaging system to evaluate which imaging modalities and other factors were associated with a greater rate of filed incident reports.All incident reports filed between 2013 and 2017 were reviewed and categorized by modality, patient type (inpatient, outpatient or emergency center) and use of sedation/anesthesia. The number of incident reports was compared to the number of imaging studies performed during that time period to calculate an incident report rate for each factor. Statistical analysis of whether there were differences in these rates between factors was performed.During the study period, there were 2,009 incident reports filed and 1,071,809 imaging studies performed for an incident report rate of 0.19%. The differences in rates by modality were statistically significant (P=0.0001). There was a greater rate of incident reports in interventional radiology (1.54%) (P=0.0001) and in magnetic resonance imaging (MRI) (0.62%) (P=0.001) as compared to other imaging modalities. There was a higher incident report rate for inpatients (0.34%) as compared to outpatient (0.1%) or emergency center (0.14%) (P=0.0001). There was a higher rate of incident reports for patients under sedation (1.27%) as compared to non-sedated (0.12%) (P=0.0001).Using incident report rates as a proxy for potential patient harm, the areas of our pediatric radiology service that are associated with the greatest potential for issues are interventional radiology, sedated patients, and inpatients. The areas associated with the least risk are ultrasound (US) and radiography. Safety improvement efforts should be focused on the high-risk areas.

    View details for PubMedID 30159593

  • Impact on Quality When Pediatric Urgent Care Centers Are Staffed With Radiology Technologists JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY Kan, J., Orth, R. C., Yen, T. A., Schallert, E. K., Zhang, W., Donnelly, L. F. 2018; 15 (12): 1717–22
  • The American Board of Radiology B. Leonard Holman Research Pathway to Initial Certification: Opportunities Lost for Diagnostic Radiology. AJR. American journal of roentgenology Wallner, P. E., Alektiar, K. M., Donnelly, L. F., Kaufman, J. A. 2018: 1–3


    OBJECTIVE: In 1998, the American Board of Radiology introduced the B. Leonard Holman Research Pathway (HRP) to initial certification for trainees in diagnostic radiology (DR) and radiation oncology (RO) motivated to pursue research-oriented careers in academic DR and RO.CONCLUSION: The HRP Committee anticipated that there would be a relatively even distribution between DR and RO participants, but with 18 years of experience that has not been the case. This article focuses on the HRP and DR.

    View details for PubMedID 30476455

  • Using a Natural Language Processing and Machine Learning Algorithm Program to Analyze Inter-Radiologist Report Style Variation and Compare Variation Between Radiologists When Using Highly Structured Versus More Free Text Reporting. Current problems in diagnostic radiology Donnelly, L. F., Grzeszczuk, R., Guimaraes, C. V., Zhang, W., Bisset Iii, G. S. 2018


    PURPOSE: To use a natural language processing and machine learning algorithm to evaluate inter-radiologist report variation and compare variation between radiologists using highly structured versus more free text reporting.MATERIALS AND METHODS: 28,615 radiology reports were analyzed for 4 metrics: verbosity, observational terms only, unwarranted negative findings, and repeated language in different sections. Radiology reports for two imaging examinations were analyzed and compared - one which was more templated (ultrasound - appendicitis) and one which relied on more free text (chest radiograph - single view). For each metric, the mean and standard deviation for defined outlier results for all dictations (individual and group mean) was calculated. The mean number of outlier metrics per reader per study was calculated and compared between radiologists and between the two report types. Wilcoxon rank test and paired Wilcoxon signed rank test were applied. The radiologists were also ranked based on the number of outlier metrics identified per study.RESULTS: There was great variability in radiologist dictation styles - outlier metrics per report varied greatly between radiologists with the maximum 10 times higher than the minimum score. Metric values were greater (P < 0.0001) on the standardized reports using free text than the more structured reports.CONCLUSIONS: The algorithm successfully evaluated metrics showing variability in reporting profiles particularly when there is free text. This variability can be an obstacle to providing effective communication and reliability of care.

    View details for PubMedID 30391224

  • Radiographic appearance and clinical significance of fidget spinner ingestions PEDIATRIC RADIOLOGY Sammer, M. K., Kan, J., Sammer, M. D., Donnelly, L. F. 2018; 48 (11): 1584–92


    According to anecdotal press reports, there have been medically significant ingestions of fidget spinner toys, including ingestions that required endoscopic intervention. Fidget spinners have been marketed to improve attention and have been suggested as a therapeutic alternative to medications in children with attention deficit hyperactivity disorder (ADHD).To describe the radiographic appearance and features of ingested fidget spinner components. To evaluate clinical significance via rates of endoscopic intervention, incidence in patients on ADHD medications, and mean age compared to other accidental foreign body ingestions.A nested retrospective case control study analyzed pediatric accidental foreign body ingestions identified via electronic medical record search between March 1, 2017, and Feb. 28, 2018. Radiographic identifiability, component type and maximum diameter of ingested fidget spinner components were described. A nested cohort of non-fidget spinner ingestions between May 1 and Aug. 31, 2017, was compared with the fidget spinner ingestions for rates of endoscopic intervention (a), concomitant use of ADHD medication (b) and mean age (c) using the Fisher exact test (a and b) and independent samples t-test (c).There were 1,095 unintentional foreign body ingestions. Ten were ingested fidget spinner component ingestions. Eight of the 10 ingested components were radiographically identifiable. Compared with the nested cohort of non-fidget spinner ingestions, fidget spinner ingestions were more likely to undergo endoscopic intervention (P=0.009, 5/10 fidget spinner ingestions vs. 54/383 other ingestions). Fidget spinner patients were more likely to be on ADHD medication (P=0.011, 2/10 fidget spinners vs. 5/383 other). Fidget spinner mean patient age was significantly older than other ingestions (P=0.015, mean: 7.1 years fidget spinner ingestions vs. 4.0 years for other ingestions).Compared with other foreign body ingestions, patients who ingested fidget spinner components were more likely to undergo endoscopic intervention, had a higher rate of ADHD medication use and were older. Familiarity with the radiographic appearance of ingested fidget spinner components is important for patient management.

    View details for PubMedID 29955903

  • Optimizing Performance by Preventing Disruptive Behavior in Radiology. Radiographics : a review publication of the Radiological Society of North America, Inc Willis, M. H., Friedman, E. M., Donnelly, L. F. 2018; 38 (6): 1639–50


    Disruptive behaviors impede delivery of high-value health care by negatively impacting patient outcomes and increasing costs. Health care is brimming with potential triggers of disruptive behavior. Given omnipresent environmental and cultural factors such as constrained resources, stressful environments, commercialization, fatigue, unrealistic expectation of perfectionism, and burdensome documentation, a burnout epidemic is raging, and medical providers are understandably at tremendous risk to succumb and manifest these unprofessional behaviors. Each medical specialty has its own unique challenges. Radiology is not exempt; these issues do not respect specialty or professional boundaries. Unfortunately, preventive measures are too frequently overlooked, provider support programs rarely exist, and often organizations either tolerate or ineffectively manage the downstream disruptive behaviors. This review summarizes the background, key definitions, contributing factors, impact, prevention, and management of disruptive behavior. Every member of the health care team can gain from an improved understanding and awareness of the contributing factors and preventive measures. Application of these principles can foster a just culture of understanding, trust, support, respect, and teamwork balanced with accountability. The authors discuss these general topics along with specific issues for radiologists in the current medical environment. Patients, providers, health care organizations, and society all stand to benefit from better prevention of these behaviors. There is a strong moral, ethical, and business case to address this issue head-on. ©RSNA, 2018.

    View details for DOI 10.1148/rg.2018180019

    View details for PubMedID 30303780

  • Costs of Quality and Safety in Radiology. Radiographics : a review publication of the Radiological Society of North America, Inc Donnelly, L. F., Lee, G. M., Sharek, P. J. 2018; 38 (6): 1682–87


    With the movement toward at-risk population health management-related payment models, a core factor for the success and survival of health care organizations has become understanding and decreasing costs. In medical specialties such as radiology, understanding models for procedure-based costing will become increasingly important. Using bottom-up models for procedure-based costing, such as time-driven activity-based costing, is more advantageous than using the inaccurate ratio of costs to charges approach; however, these approaches are more resource intensive when compared to top-down approaches. Understanding the costs of quality is also important for creating an accounting and budgeting process that reflects the total cost of quality. The costs of quality are divided into two main categories: the cost of control (also referred to as the costs of conformance) and the costs of failure of control (also referred to as the costs of nonconformance). The costs of control are the expenditures that occur to ensure quality. The costs of noncontrol are the expenses that arise from the lack of quality and safety. The cost of control has two subcategories: prevention costs and appraisal costs. The cost of noncontrol also has two subcategories: internal failure costs and external failure costs. Adopting a mind-set that takes into account the costs of control, or the costs to ensure high-quality care, and the costs of noncontrol, or the hidden costs of poor-quality care, will be essential for successful health care organizations in the future. ©RSNA, 2018.

    View details for PubMedID 30303806

  • Costs of Quality and Safety in Radiology RADIOGRAPHICS Donnelly, L. F., Lee, G. M., Sharek, P. J. 2018; 38 (6): 1682–87
  • Practical Application of the International Neuroblastoma Risk Group Staging System: A Pictorial Review. Current problems in diagnostic radiology Del Campo Braojos, F., Donnelly, L. F. 2018


    Because of issues with the previous staging system, the International Neuroblastoma Risk Group Staging System (INRG-SS) was created in 2009. The INRG-SS is based on preoperative imaging, rather than surgical, staging and emphasizes Imaging-Defined Risk Factors as the determining factors between L1 and L2 stages. Like with the introduction of any new tool, based on the authors' experience, there has been a time-lag related to adoption of the INRG-SS staging system by radiologists. This pictorial essay offers a practical approach to learning and utilizing the INRG system, emphasizing use of the descriptive terms which determine the presence or absence of imaging-defined risk factors.

    View details for PubMedID 30268582

  • Magnetic resonance imaging of obstructive sleep apnea in children PEDIATRIC RADIOLOGY Fleck, R. J., Shott, S. R., Mahmoud, M., Ishman, S. L., Amin, R. S., Donnelly, L. F. 2018; 48 (9): 1223–33


    Sleep-disordered breathing has a spectrum of severity that spans from snoring and partial airway collapse with increased upper airway resistance, to complete upper airway obstruction with obstructive sleep apnea during sleeping. While snoring occurs in up to 20% of children, obstructive sleep apnea affects approximately 1-5% of children. The obstruction that occurs in obstructive sleep apnea is the result of the airway collapsing during sleep, which causes arousal and impairs restful sleep. Adenotonsillectomy is the first-line treatment of obstructive sleep apnea and is usually effective in otherwise healthy nonsyndromic children. However, there are subgroups in which this surgery is less effective. These subgroups include children with obesity, severe obstructive sleep apnea preoperatively, Down syndrome, craniofacial anomalies and polycystic ovarian disease. Continuous positive airway pressure (CPAP) is the first-line therapy for persistent obstructive sleep apnea despite previous adenotonsillectomy, but it is often poorly tolerated by children. When CPAP is not tolerated or preferred by the family, surgical options beyond adenotonsillectomy are discussed with the parent and child. Dynamic MRI of the airway provides a means to identify and localize the site or sites of obstruction for these children. In this review the authors address clinical indications for imaging, ideal team members to involve in an effective multidisciplinary program, basic anesthesia requirements, MRI protocol techniques and interpretation of the findings on MRI that help guide surgery.

    View details for PubMedID 30078047

  • Practical Suggestions on How to Move From Peer Review to Peer Learning AMERICAN JOURNAL OF ROENTGENOLOGY Donnelly, L. F., Larson, D. B., Heller, R. E., Kruskal, J. B. 2018; 210 (3): 578–82


    The purpose of this article is to outline practical steps that a department can take to transition to a peer learning model.The 2015 Institute of Medicine report on improving diagnosis emphasized that organizations and industries that embrace error as an opportunity to learn tend to outperform those that do not. To meet this charge, radiology must transition from a peer review to a peer learning approach.

    View details for PubMedID 29323555

  • Comparison Between Manual Auditing and a Natural Language Process With Machine Learning Algorithm to Evaluate Faculty Use of Standardized Reports in Radiology JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY Guimaraes, C. V., Grzeszczuk, R., Bisset, G. S., Donnelly, L. F. 2018; 15 (3): 550–53


    When implementing or monitoring department-sanctioned standardized radiology reports, feedback about individual faculty performance has been shown to be a useful driver of faculty compliance. Most commonly, these data are derived from manual audit, which can be both time-consuming and subject to sampling error. The purpose of this study was to evaluate whether a software program using natural language processing and machine learning could accurately audit radiologist compliance with the use of standardized reports compared with performed manual audits.Radiology reports from a 1-month period were loaded into such a software program, and faculty compliance with use of standardized reports was calculated. For that same period, manual audits were performed (25 reports audited for each of 42 faculty members). The mean compliance rates calculated by automated auditing were then compared with the confidence interval of the mean rate by manual audit.The mean compliance rate for use of standardized reports as determined by manual audit was 91.2% with a confidence interval between 89.3% and 92.8%. The mean compliance rate calculated by automated auditing was 92.0%, within that confidence interval.This study shows that by use of natural language processing and machine learning algorithms, an automated analysis can accurately define whether reports are compliant with use of standardized report templates and language, compared with manual audits. This may avoid significant labor costs related to conducting the manual auditing process.

    View details for PubMedID 29269244

  • The Daily Operational Brief: Fostering Daily Readiness, Care Coordination, and Problem-Solving Accountability in a Large Pediatric Health Care System JOINT COMMISSION JOURNAL ON QUALITY AND PATIENT SAFETY Donnelly, L. F., Basta, K. C., Dykes, A. M., Zhang, W., Shook, J. E. 2018; 44 (1): 43–51


    At a pediatric health system, the Daily Operational Brief (DOB) was updated in 2015 after three years of operation. Quality and safety metrics, the patient volume and staffing assessment, and the readiness assessment are all presented. In addition, in the problem-solving accountability system, problematic issues are categorized as Quick Hits or Complex Issues. Walk-the-Wall, a biweekly meeting attended by hospital senior administrative leadership and quality and safety leaders, is conducted to chart current progress on Complex Issues. The DOB provides a daily standardized approach to evaluate readiness to provide care to current patients and improvement in the care to be provided for future patients.

    View details for DOI 10.1016/j.jcjq.2017.04.010

    View details for Web of Science ID 000418892600006

    View details for PubMedID 29290246

Latest information on COVID-19