A Radiology Dashboard as a Tool to Improve the Turnaround ... · A Radiology Dashboard as a Tool to...
Transcript of A Radiology Dashboard as a Tool to Improve the Turnaround ... · A Radiology Dashboard as a Tool to...
A Radiology Dashboard as a Tool to Improve the Turnaround Time of Dictated ReportsAlexander J. Towbin MD, Seth Hall, Jay Moskovitz MS, Laurie Perry RN, Neil Johnson MD, Lane F. Donnelly MD
Introduction to the Problem:
Materials and Methods:
lOneofthehopesofdigitalimagingwasthattheproblemofstudiesbeinglostandsubsequentlynotdictatedwoulddisappear
lWhilethenumberofundictatedstudieshasdecreased,theproblemstillexiststCauseoftheproblemhaschangedn Film-basedera:undictatedstudiesinthepossessionoftheorderingclinicianorlostinthefileroomn Digitalera:technologisterrorandradiologisterror
lTechnologisterrortDifferentateachhospitalanddependentontheinformationsystemsandfail-safemethodsemployedtopreventerrors
tTypesoftechnologisterroratourinstitutionn Studynotcompletedintheradiologyinformationsystem(RIS)n Studynotenteredintodepartmentalworkflowmanagementsystem,RadStream
lRadiologisterrortFailureofaradiologisttodictateastudyontheirindividualworklistn Potentialtocausedelayindiagnosisn Studydoesnotappearonotherradiologists’worklistsn Unlessanotherradiologistisnotified,thestudyremainsunread
tFailuretolinkastudyn Doesnotaffectpatientcarebutdoesaffectbillingn Dictatedreportisavailabletocliniciansbutisnotassociatedwithallindividualcomponentsof
thestudy
lHypothesistAdashboardwilldecreasetheturnaroundtimeforradiologyreports
lAradiologydashboardwascreatedtDashboardobtainsdatafromRISandRadStreamtProvidesagraphicalrepresentationforeachmodality(Fig.1)n Numberofstat-casestobereadn Numberofnon-statcasestobereadn Numberofcaseswherethetimesinceend-examis>24hours
tHighlightsstudiescompletedinRISbutthathavenotbeenenteredintoRadStreamformorethan30minutes(Fig.2)
lRetrospectivestudytEvaluatetheutilityofthedashboardindecreasingtheaveragetimebetweentheend-examstepandstudycompletion(dictatedandsignedbythestaffradiologist)
lAllstudiesevaluatedandreportedusingthesameinformationsystemstRIS(GECentricityRISv1.0;GE,Milwaukee,WI)tPACS(GECentricityv2.1;GE,Milwaukee,WI)tSpeechrecognitionsoftware(PowerScribeSDKembeddedforGECentricity;Nuance,Boston,MA)
lOutcomesevaluatedtTotalnumberofstudiesdictatedtAveragetimefromendexamtothefinalizedstatustAveragenumberofstudiespermonthwithaturnaroundtime>24hours
lThreeseparatestudyperiodstBetweenJanuary1,2006,andDecember31,2006,beforethedashboardwasimplementedtBetweenSeptember1,2007,andAugust31,2008,immediatelyafterthedashboardwasimplementedtBetweenSeptember1,2008,andJune1,2009,afterapolicywasimplementedwheretechnologistmanagersactivelymonitoredthedashboardforproblemcasesn Problemcasedefinitionn Studynotbeendictatedfor>24hoursn StudycompletedinRISbutnotenteredintoRadStream
lBetweenJanuary1,2006,andDecember31,2006tBeforethedashboardwasimplementedn 204,022studiesreadn 32radiologistsn 523minutes(8.7hours)betweenendexamandafinalizedreportn 696studiespermonthwithturnaroundtime>24hours
lBetweenSeptember1,2007,andAugust31,2008tImmediatelyafterthedashboardwasimplementedn 217,965studiesreadn 34radiologistsn 426minutes(7.1hours)betweenendexamandafinalizedreportn 527studiespermonthwithturnaroundtime>24hours
lBetweenSeptember1,2008,andJune1,2009tAftertheimplementationofthepolicyfortechnologistmanagerstocheckthedashboardactivelyforproblemcasesn 159,652casesreadn 35radiologistsn 237minutes(3.9hours)betweenendexamandafinalizedreportn 467studiespermonthwithturnaroundtime>24hours
lThenumberofstudiesreadpermonthperradiologistcomparedtotheaverageturnaroundtimeisshowninFigure3
lAveragenumberofstudiesreadpermonthcomparedtotheaveragenumberofstudiespermonthwithaturnaroundtime>24hoursisshowninFigure4
lTurnaroundtimeforreportsdecreasednearly55%overthestudyperiod.tNootherimprovementsonworkflowefficiencywereimplemented
lImprovementcanbeattributedtothreemajorfactorstIncreasedawarenessofadelayedturnaroundtimetDecreaseinthenumberofoutstandingproblemcasestIncreasedfocusofdepartmentalleadershiptoimprovetheturnaroundtime
lMethodsbywhichthedashboardimproveddepartmentalawarenesstContinuousdisplayinthemainreadingroominourdepartment(Fig.5).n Centrallocationn Visibletoeveryonepassingthroughthedepartmentn Providesup-to-the-minutesnapshotofoutstandingwork
tAccessiblethroughthehospitalintranettAllowsreadingroomassistantstogaugethestatusofthedepartmentn Ifaradiologistisbehindby>40studies,thereadingroomassistantpagesallradiologiststohelp
readstudies
lDecreaseinproblemcasessignificantlydecreasedturnaroundtimetLargestimprovementinturnaroundtimeoccurredafterthetechnologistmanagersbeganactivelymonitoringthedashboard
tDashboardwasdesignedtoidentifythemainsourcesofundictatedstudiesn Technologisterror(Fig.2)v CasesnotenteredintoRadStreamidentifiedbyalargerednumbernexttothemodalityv Technologistmanageridentifiestheoffendingstudybyclickingthenumberonthedashboardn Radiologisterror(Fig.6)v Studiesundictatedfor>24hoursv Investigatedbyclickingtheyellowbaronthedashboardv Technologistcontactsradiologisttoreaddelinquentstudy
lIncreasedattentionfromdepartmentalleaderstThedashboardhelpedtoidentifytheproblemandincreaseawarenessn Centrallocationofdashboardv Highlightedproblemofunreadstudiesv Madeproblemahighpriorityinthedepartmentn Continuedpolicychangesbasedonproblemsidentifiedbythedashboardv Institutedpolicyfortechnologistmanagerstocheckthedashboardactivelyforproblemcasesv Institutedpolicyforreadingroomassistantstopageallradiologistsifthenumberofunread
studieswas>40
lImprovementinturnaroundtimesrelatedtothedashboardrivalgainsseenwithimplementationofPACSandspeechrecognitionsystems[1–5]
lOneotherreportofimprovedturnaroundtimethroughimplementationofadashboard[6]tDashboarddifferedinseveralrespectsn Metricsmeasuredv Ourdashboardm Numberofunreadstudiesindifferentcategoriesm Numberofstudiesnotavailabletoreadm Patientswaitingfortheirimagingstudies
v Previouslyreporteddashboardm Individualnotificationsm Divisionalnotificationsm System-widenotifications
v Differencesattributedtosizeandneedsoftwodepartmentsv Foradashboardtobesuccessful,eachdepartmentmustdeterminethebottleneckstepsthat
slowturnaroundtimesn Causeofimprovedturnaroundtimev Ourdashboardm Identificationofproblemstudies
v Previouslyreporteddashboardm Notificationofnumberofreportsreadytobesigned
v Highlightsimportanceofeachindividualdepartmentidentifyingbottleneckstepsn Locationofdashboardv Ourdashboardm Internetbasedm Largemonitorinacentrallocation
v Previouslydescribeddashboardm IntegratedintoPACSm Visibletoeachradiologistwhileworking
v IntegrateddashboardisidealbutnotpossiblewithmostPACStCommonalitybetweenthetwodashboardsn Increasedawarenessofaproblemv Providesasnapshotofthesystemandidentifiesbottlenecksn Increasedawarenessofmonitoringbydepartmentalleadership
lLimitationsofourstudytRetrospectivenaturen Hardtoensurethatallgainsweretrulyaresultofthedashboardv Possiblethatotherpolicychangesaffectedturnaroundtimev Noothersystemsinstalledtoimproveworkflowefficiency
tDoesnottakeintoaccountthechangeinstaffingoverthestudyperiodn Possiblechangeinreadingratesofdifferentradiologistsn Overallincreaseinradiologistsoverstudyperiodn Notthoughttobemainsourceofimprovedturnaroundtimev Increasednumberofradiologistswasusedtofreeradiologistsformoreresearchtimev Day-to-dayschedulewasnotsignificantlyaffectedv Averagenumberofstudiesreadperradiologistpermonthdidnotchangesignificantly(Fig.3)v Duringthetimewhenthelargestgainswerenotedonlyoneadditionalstaffmemberwasadded
lLargestgainswereattributedtopolicyrequiringtechnologistmanagerstoactivelymonitorthedashboardforproblemcasestCombinationoftechnologyandhumaninterventionisoftenneededtoworkinconcerttoaffectthelargestchange
lDashboardwassuccessfulindecreasingtheturnaroundtimeforradiologyreports
lCausesofimprovementsinturnaroundtImplementationofdashboardtImplementationofapolicywheretechnologistmanagersactivelyidentifyproblemcasesonthedashboard
tIncreasedawarenessofaproblem
1. HaytDB,AlexanderS.TheprosandconsofimplementingPACSandspeechrecognitionsystems.JDigitImaging.2001;14:149-157.
2. MatternCW,KingBFJr,HangiandreouNJ,etal.Electronicimagingimpactonimageandreportturnaroundtimes.JDigitImaging.1999;12(Suppl1):155-159.
3. BolandGW,GuimaraesAS,MuellerPR.Radiologyreportturnaround:expectationsandsolutions.EurRadiol.2008;18:1326-1328.Epub2008Mar8.
4. NitrosiA,BorasiG,NicoliF,etal.Afilmlessradiologydepartmentinafulldigitalregionalhospital:quantitativeevaluationoftheincreasedqualityandefficiency.JDigitImaging.2007;20:140-148.Epub2007Feb23.
5. LepantoL,ParéG,AubryD,etal.ImpactofPACSondictationturnaroundtimeandproductivity.JDigitImaging.2006;19:92-97.
6. MorganMB,BranstetterBF4th,LionettiDM,etal.Theradiologydigitaldashboard:effectsonreportturnaroundtime.JDigitImaging.2008;21:50-58.Epub2007Mar3.
© 2009 Cincinnati Children’s Hospital Medical Center, Radiology Department, Digital Imaging Lab, Glenn Miñano
Results:
Discussion:
Conclusion:
References
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Figure 1. Screen capture of the dashboard used in our department. The dashboard displays three key pieces of information. The largest and most visible information is the graph at the top of the image. This graph gives a snapshot of the outstanding work within the department. The outstanding studies are first separated by modality (CT, interventional, MRI, orthopedics clinic, radiography, ultrasound, and teleradiology). Within each modality, the number of outstanding studies is further broken down into stat cases (red), cases outstanding for over 24 hours (yellow), and non-stat cases (blue). On the bottom right side of the dashboard, the number of studies completed in the radiology information system but not entered on the radiologist’s worklist is highlighted, again broken down by modality. Finally, on the bottom left side of the dashboard is an area for technologists to identify the patients who are currently checked in and waiting for their study to be performed. There is a drop-down field for each modality to identify individual patients. This last portion of the dashboard was not assessed in this study.
Figure 2. In the bottom right corner of the dashboard, the number of studies completed in the radiology information system but not entered into the radiologist’s worklist are highlighted. If the user clicks on the red number, he or she is able to see the accession number of the offending study. This allows the technologist to correctly enter the study onto the worklist.
Figure 3. Graph showing the average number of studies read per radiologist per month over the study period (purple bars) compared to the average number of minutes between the end-exam step and a finalized report (blue line). While the average number of studies read per month per radiologist stayed relatively stable, the turnaround time dropped by more than 50%.
Figure 3. Graph showing the average number of studies per month over the study period (purple bars) compared to the average number of studies per month with a turnaround time greater than 24 hours (blue line). While the average number of studies read per month increased slightly the number of studies per month with a turnaround time over 24 hours decreased.
Figure 5. Photograph showing the central location of the main dashboard within the central reading room in the department. This central location allows radiologists, technologists, reading room assistants, and administrators to obtain an up-to-the-minute snapshot of activity in the department.
Figure 6. Studies that have not been dictated in over 24 hours (yellow bars on the dashboard) can be investigated as to the source of the delayed dictation. The technologist clicks on the yellow bar and the offending cases and their information are displayed (shown in the lower half of the figure).