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Integrated communication: workflow enhancement in the digital diagnostic radiology department
International Congress Series 1268 (2004) 357 – 360
www.ics-elsevier.com
Integrated communication: workflow enhancement in the digital diagnostic radiology department G.R. Aben a,*, M. Morita b, S. Fors b, M. Switzer a a
Department of Radiology, Switzer Michigan State University, 185 Radiology Building, East Lansing, MI 48823-1303, USA b Fors GE Medical, USA
Abstract. Numerous factors have an impact on the workflow efficiency in a typical Diagnostic Radiology Department. Enhancing workflow efficiency is especially critical given the current staffing levels of radiologists and radiology technical personnel. Our observation is that one factor that plays an increasingly important role in the adverse effect on technologist productivity is the availability of the supervising radiologist for consultation. Communication patterns were evaluated in our department. Based on our observation, it was determined that a more efficient mechanism of communication was necessary in order to reduce radiologists and technologists time commitments. It was determined that an online, internet-based communication system would be more valuable than a telephony-based system. An integrated communication system was identified and installed in the digital mammography setting. The time required for completion of diagnostic digital mammograms both without and with the communication system was evaluated. Technologist travel time was also evaluated. The impact of the integrated communication system was immediately noted by the technologists. A time saving of between 1.2 and 2.1 min was noted. An annual saving in technologist time of between 3 and 5 days could be realized. An improvement in patient care was noted. D 2004 CARS and Elsevier B.V. All rights reserved. Keywords: Communication; Mammography; Efficiency
1. Introduction Numerous factors have an impact on the workflow efficiency in a typical diagnostic radiology department. Enhancing workflow efficiency is especially critical given the current lean staffing levels of radiologists and radiology technical personnel. Saketkhoo et al. [3] comment that the continued shortage of radiologists can compromise patient care. A recent article by Reiner et al. [2], pertaining to the evaluation of 112 facilities, noted that, on average, the facilities were short two FTEs in general radiology technical positions. They also note that the introduction of digital modalities have done little to reduce that
* Corresponding author. Tel.: +1-517-355-0120x265; fax: +1-517-432-2849. E-mail address: [email protected] (G.R. Aben). 0531-5131/ D 2004 CARS and Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2004.03.099
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shortage. Reiner et al. [1], in 2002, also evaluated technologist workflow and identified multiple factors that impact that work flow. Their observations indicated that transition to filmless operations enhanced workflow. They as well suggested the need to evaluate other variables that might lead to workflow gains. Our observation is that one factor that plays an increasingly important role in the adverse effect on technologist productivity is the availability of the supervising radiologist for consultation. This is especially noted in three distinct areas: (1) patients are delayed while waiting for radiologist review of examinations prior to patient release, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasound (US), and Digital Mammography (DM); (2) the productivity of technologists is reduced when they are required to travel from the imaging area to the radiologist reading area to consult with the radiologist (DM and US); and (3) time is consumed during radiologist feedback to technologist on technical issues using current communication modes (all areas). The cumulative impact of these inefficiencies on the day-to-day management of a radiology department can be substantial. Communication patterns between radiologists and technologists were evaluated in our department. It was determined that significant roadblocks existed in the communication between the radiologist and the technologist when diagnostic imaging modalities required physician ‘‘sign off’’ prior to patient discharge from the unit. This was especially significant in MRI, CT and US. It was also noted that the digital mammography technologist, who was performing diagnostic mammography, spent considerable time traveling between the digital mammography suite and the digital mammography reading areas to consult with the radiologist regarding the need for additional views or maneuvers. On many occasions, several trips between the areas became necessary before the case could be resolved. To some extent, a similar problem was noted in the ultrasound suite. On many occasions, it was observed that the radiologist would direct the technologist to return to the US suite for additional imaging prior to the radiologist actually proceeding to the suite to observe/perform real-time evaluation. In our facility, general radiology reading is centralized. During the course of our evaluation, we noted that the reading radiologist(s) would spend considerable time on the telephone searching for various technologists to discuss quality control issues or to request patient-specific information. Each call would necessitate the involvement of a departmental clerk who would consequently become unavailable for patient calls while locating the technologist for the calling radiologists. In addition, the technologist was frequently interrupted during an ongoing procedure leading to additional delays to the patient and referring physician. Based on our observation, it was determined that a more efficient mechanism of communication was necessary in order to reduce this time commitment, representing a human capital loss, in part caused by the existing communication systems. 2. Methods To meet the needs for improve communication, it was determined that an online, internet-based communication system would likely be more valuable than a telephonybased system. All departmental imaging equipment is either networked or is closely linked
G.R. Aben et al. / International Congress Series 1268 (2004) 357–360
359
to the department Radiology Information System (RIS). In addition to RIS proximity to the technologists at all work locations, the RIS is deployed throughout the department, including stations at all radiologist reading areas and office locations. The requirements of the proposed system included an instant messaging system similar to MSN MessengerR so that ‘‘instant messages’’ could be communicated, Voice over IP (VOIP) in order to facilitate voice communication, web camera capability, and applicationsharing in order to allow the radiologist to review real-time examinations being performed by the technologist. It was felt that a system that could be hosted within the institution would be optimal to ensure rapid and secure communication. An integrated communication system that included all of the required features was desired. The AtinavR, ave CommR Integrated Communication System was identified as a suitable system and was installed in the digital mammography setting. The time required for completion of diagnostic digital mammograms, both without and with the communication system, was evaluated utilizing the built in features of the department RIS. Stopwatch evaluation of the travel time between the digital mammography suite and the mammography reading area was also performed. The average time required to complete diagnostic examinations in the department was determined both without and with the communication system. The average daily number of diagnostic exams performed in the digital setting was determined as well as the annual number of diagnostic digital examinations. 3. Results The average time for diagnostic exams prior to the introduction of the communication system was 21.9 min (N = 72, standard deviation 8.5). The average time after the communication system was introduced was 19.8 min (N = 41, standard deviation 8.9). There was a reduction in the average time per case (2.1 min), which was not statistically significant (q = 0.22). The travel time obtained by observation of the technologists indicated that at a minimum, 1.16 min would be consumed for each case as a result of the time required to travel from the mammography suite to the reading room. Our facility currently schedules 24 diagnostic examinations each week. The savings of 1.16 min per examination results in a reduction of technologist time each week of 28 min. This is an annual saving of 24.25 h or the equivalent of three working days. If a reduction of 2.1 min as suggested in our sample was achieved, the weekly savings would be 50.4 min with an annual savings in technologist time of 43.7 h or the equivalent of more than a full work week. The savings in technologist time that was noted in our observations would increase as the volume of diagnostic examinations in the department increased or as the utilization of the digital mammography equipment increased for diagnostic mammography. 4. Discussion The impact of the integrated communication system was immediately noted by the technologists. The technologist did not have to leave the patients unattended while consulting with the supervising radiologist, and that helped reduce patient anxiety during the process. The impact of performing diagnostic mammograms, utilizing the digital
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G.R. Aben et al. / International Congress Series 1268 (2004) 357–360
mammography system in reduced time, potentially allows for an adjustment in the mammography schedule thereby increasing the available imaging slots. Communication in the radiology department is not a process that is given regular or focused attention. This lack of focused attention to our communication needs led to a substantial cost in wasted human capital prompting us to upgrade our communication system. The introduction of an integrated communication system into a portion of our practice has led to improvements in efficiency and productivity. These efficiency gains have translated into better patient care. Patients spend less time in the department waiting for release by the supervising radiologist. It is hoped that by providing an easy means of communication, fewer return visits will be necessary as the result of incomplete examinations. The anticipated addition of more robust integration of this or similar products into the image acquisition devices will offer significant improvement in the ability to communicate between the radiologist and the technologist. The availability of voiceover IP and web camera ability provides an especially powerful tool, providing both technologist supervision and support with more real time interaction with the radiologist. In conclusion, the rapid advances in internet-based technologies including instant messenger, VOIP, webcam technology, and application sharing provide new tools that invite a reevaluation of current workflow scenarios. Our experiences support the value of an integrated communication system that results in improved radiology department productivity, as well as improved patient satisfaction that derives from a more rapid passage through the imaging system. Acknowledgements We thank AtinavR for providing ave Comm software. References [1] B.S. Reiner, Eliot, Carrino, Workflow optimization: current trends and future directions, Journal of Digital Imaging 15 (3) (2002) 141 – 152. [2] B.S. Reiner, et al., SCAR radiologic technologist survey: analysis of technologist workforce and staffing, Journal of Digital Imaging 15 (3) (2002) 121 – 131. [3] D.D. Saketkhoo, et al., Findings in 2002 from a help wanted index of job advertisements: is the job-market shortage of diagnostic radiologists easing? American Journal of Roentgenology 181 (2003) 351 – 357.
www.ics-elsevier.com
Integrated communication: workflow enhancement in the digital diagnostic radiology department G.R. Aben a,*, M. Morita b, S. Fors b, M. Switzer a a
Department of Radiology, Switzer Michigan State University, 185 Radiology Building, East Lansing, MI 48823-1303, USA b Fors GE Medical, USA
Abstract. Numerous factors have an impact on the workflow efficiency in a typical Diagnostic Radiology Department. Enhancing workflow efficiency is especially critical given the current staffing levels of radiologists and radiology technical personnel. Our observation is that one factor that plays an increasingly important role in the adverse effect on technologist productivity is the availability of the supervising radiologist for consultation. Communication patterns were evaluated in our department. Based on our observation, it was determined that a more efficient mechanism of communication was necessary in order to reduce radiologists and technologists time commitments. It was determined that an online, internet-based communication system would be more valuable than a telephony-based system. An integrated communication system was identified and installed in the digital mammography setting. The time required for completion of diagnostic digital mammograms both without and with the communication system was evaluated. Technologist travel time was also evaluated. The impact of the integrated communication system was immediately noted by the technologists. A time saving of between 1.2 and 2.1 min was noted. An annual saving in technologist time of between 3 and 5 days could be realized. An improvement in patient care was noted. D 2004 CARS and Elsevier B.V. All rights reserved. Keywords: Communication; Mammography; Efficiency
1. Introduction Numerous factors have an impact on the workflow efficiency in a typical diagnostic radiology department. Enhancing workflow efficiency is especially critical given the current lean staffing levels of radiologists and radiology technical personnel. Saketkhoo et al. [3] comment that the continued shortage of radiologists can compromise patient care. A recent article by Reiner et al. [2], pertaining to the evaluation of 112 facilities, noted that, on average, the facilities were short two FTEs in general radiology technical positions. They also note that the introduction of digital modalities have done little to reduce that
* Corresponding author. Tel.: +1-517-355-0120x265; fax: +1-517-432-2849. E-mail address: [email protected] (G.R. Aben). 0531-5131/ D 2004 CARS and Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2004.03.099
358
G.R. Aben et al. / International Congress Series 1268 (2004) 357–360
shortage. Reiner et al. [1], in 2002, also evaluated technologist workflow and identified multiple factors that impact that work flow. Their observations indicated that transition to filmless operations enhanced workflow. They as well suggested the need to evaluate other variables that might lead to workflow gains. Our observation is that one factor that plays an increasingly important role in the adverse effect on technologist productivity is the availability of the supervising radiologist for consultation. This is especially noted in three distinct areas: (1) patients are delayed while waiting for radiologist review of examinations prior to patient release, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasound (US), and Digital Mammography (DM); (2) the productivity of technologists is reduced when they are required to travel from the imaging area to the radiologist reading area to consult with the radiologist (DM and US); and (3) time is consumed during radiologist feedback to technologist on technical issues using current communication modes (all areas). The cumulative impact of these inefficiencies on the day-to-day management of a radiology department can be substantial. Communication patterns between radiologists and technologists were evaluated in our department. It was determined that significant roadblocks existed in the communication between the radiologist and the technologist when diagnostic imaging modalities required physician ‘‘sign off’’ prior to patient discharge from the unit. This was especially significant in MRI, CT and US. It was also noted that the digital mammography technologist, who was performing diagnostic mammography, spent considerable time traveling between the digital mammography suite and the digital mammography reading areas to consult with the radiologist regarding the need for additional views or maneuvers. On many occasions, several trips between the areas became necessary before the case could be resolved. To some extent, a similar problem was noted in the ultrasound suite. On many occasions, it was observed that the radiologist would direct the technologist to return to the US suite for additional imaging prior to the radiologist actually proceeding to the suite to observe/perform real-time evaluation. In our facility, general radiology reading is centralized. During the course of our evaluation, we noted that the reading radiologist(s) would spend considerable time on the telephone searching for various technologists to discuss quality control issues or to request patient-specific information. Each call would necessitate the involvement of a departmental clerk who would consequently become unavailable for patient calls while locating the technologist for the calling radiologists. In addition, the technologist was frequently interrupted during an ongoing procedure leading to additional delays to the patient and referring physician. Based on our observation, it was determined that a more efficient mechanism of communication was necessary in order to reduce this time commitment, representing a human capital loss, in part caused by the existing communication systems. 2. Methods To meet the needs for improve communication, it was determined that an online, internet-based communication system would likely be more valuable than a telephonybased system. All departmental imaging equipment is either networked or is closely linked
G.R. Aben et al. / International Congress Series 1268 (2004) 357–360
359
to the department Radiology Information System (RIS). In addition to RIS proximity to the technologists at all work locations, the RIS is deployed throughout the department, including stations at all radiologist reading areas and office locations. The requirements of the proposed system included an instant messaging system similar to MSN MessengerR so that ‘‘instant messages’’ could be communicated, Voice over IP (VOIP) in order to facilitate voice communication, web camera capability, and applicationsharing in order to allow the radiologist to review real-time examinations being performed by the technologist. It was felt that a system that could be hosted within the institution would be optimal to ensure rapid and secure communication. An integrated communication system that included all of the required features was desired. The AtinavR, ave CommR Integrated Communication System was identified as a suitable system and was installed in the digital mammography setting. The time required for completion of diagnostic digital mammograms, both without and with the communication system, was evaluated utilizing the built in features of the department RIS. Stopwatch evaluation of the travel time between the digital mammography suite and the mammography reading area was also performed. The average time required to complete diagnostic examinations in the department was determined both without and with the communication system. The average daily number of diagnostic exams performed in the digital setting was determined as well as the annual number of diagnostic digital examinations. 3. Results The average time for diagnostic exams prior to the introduction of the communication system was 21.9 min (N = 72, standard deviation 8.5). The average time after the communication system was introduced was 19.8 min (N = 41, standard deviation 8.9). There was a reduction in the average time per case (2.1 min), which was not statistically significant (q = 0.22). The travel time obtained by observation of the technologists indicated that at a minimum, 1.16 min would be consumed for each case as a result of the time required to travel from the mammography suite to the reading room. Our facility currently schedules 24 diagnostic examinations each week. The savings of 1.16 min per examination results in a reduction of technologist time each week of 28 min. This is an annual saving of 24.25 h or the equivalent of three working days. If a reduction of 2.1 min as suggested in our sample was achieved, the weekly savings would be 50.4 min with an annual savings in technologist time of 43.7 h or the equivalent of more than a full work week. The savings in technologist time that was noted in our observations would increase as the volume of diagnostic examinations in the department increased or as the utilization of the digital mammography equipment increased for diagnostic mammography. 4. Discussion The impact of the integrated communication system was immediately noted by the technologists. The technologist did not have to leave the patients unattended while consulting with the supervising radiologist, and that helped reduce patient anxiety during the process. The impact of performing diagnostic mammograms, utilizing the digital
360
G.R. Aben et al. / International Congress Series 1268 (2004) 357–360
mammography system in reduced time, potentially allows for an adjustment in the mammography schedule thereby increasing the available imaging slots. Communication in the radiology department is not a process that is given regular or focused attention. This lack of focused attention to our communication needs led to a substantial cost in wasted human capital prompting us to upgrade our communication system. The introduction of an integrated communication system into a portion of our practice has led to improvements in efficiency and productivity. These efficiency gains have translated into better patient care. Patients spend less time in the department waiting for release by the supervising radiologist. It is hoped that by providing an easy means of communication, fewer return visits will be necessary as the result of incomplete examinations. The anticipated addition of more robust integration of this or similar products into the image acquisition devices will offer significant improvement in the ability to communicate between the radiologist and the technologist. The availability of voiceover IP and web camera ability provides an especially powerful tool, providing both technologist supervision and support with more real time interaction with the radiologist. In conclusion, the rapid advances in internet-based technologies including instant messenger, VOIP, webcam technology, and application sharing provide new tools that invite a reevaluation of current workflow scenarios. Our experiences support the value of an integrated communication system that results in improved radiology department productivity, as well as improved patient satisfaction that derives from a more rapid passage through the imaging system. Acknowledgements We thank AtinavR for providing ave Comm software. References [1] B.S. Reiner, Eliot, Carrino, Workflow optimization: current trends and future directions, Journal of Digital Imaging 15 (3) (2002) 141 – 152. [2] B.S. Reiner, et al., SCAR radiologic technologist survey: analysis of technologist workforce and staffing, Journal of Digital Imaging 15 (3) (2002) 121 – 131. [3] D.D. Saketkhoo, et al., Findings in 2002 from a help wanted index of job advertisements: is the job-market shortage of diagnostic radiologists easing? American Journal of Roentgenology 181 (2003) 351 – 357.