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Sevenster M, Hergaarden KFM, Hertgers O, Kruithof NHM, Roelofs JJH, Foster-Dingley JC, Romeijn SR, Nguyen DD, Vosbergen S, Lamb HJ. A Novel Radiology Communication Tool to Reduce Workflow Interruptions: Clinical Evaluation of RadConnect. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01157-z. [PMID: 38955962 DOI: 10.1007/s10278-024-01157-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 07/04/2024]
Abstract
Despite the importance of communication, radiology departments often depend on communication tools that were not created for the unique needs of imaging workflows, leading to frequent radiologist interruptions. The objective of this study was test the hypothesis that a novel asynchronous communication tool for the imaging workflow (RadConnect) reduces the daily average number of synchronous (in-person, telephone) communication requests for radiologists. We conducted a before-after study. Before adoption of RadConnect, technologists used three conventional communication methods to consult radiologists (in-person, telephone, general-purpose enterprise chat (GPEC)). After adoption, participants used RadConnect as a fourth method. Technologists manually recorded every radiologist consult request related to neuro and thorax CT scans in the 40 days before and 40 days after RadConnect adoption. Telephone traffic volume to section beepers was obtained from the hospital telephone system for the same period. The value and usability experiences were collected through an electronic survey and structured interviews. RadConnect adoption resulted in 53% reduction of synchronous (in-person, telephone) consult requests: from 6.1 ± 4.2 per day to 2.9 ± 2.9 (P < 0.001). There was 77% decrease (P < 0.001) in telephone volume to the neuro and thorax beepers, while no significant volume change was noted to the abdomen beeper (control group). Survey responses (46% response rate) and interviews confirmed the positive impact of RadConnect on interruptions. RadConnect significantly reduced radiologists' telephone interruptions. Study participants valued the role-based interaction and prioritized worklist overview in the survey and interviews. Findings from this study will contribute to a more focused work environment.
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Affiliation(s)
- Merlijn Sevenster
- Royal Philips Electronics, High Tech Campus 34, 5656AE, Eindhoven, The Netherlands.
- Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands.
| | | | - Omar Hertgers
- Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Natalie H M Kruithof
- Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Joost J H Roelofs
- Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | | | - Stephan R Romeijn
- Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Duy Duc Nguyen
- Royal Philips Electronics, High Tech Campus 34, 5656AE, Eindhoven, The Netherlands
| | - Sandra Vosbergen
- Royal Philips Electronics, High Tech Campus 34, 5656AE, Eindhoven, The Netherlands
| | - Hildo J Lamb
- Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
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Rao K, Perry S, Hagedorn J, Carter K, Balkenende B, Policeni B. Impact of a Reading Room Coordinator on Efficiency of On-Call Radiology Residents. J Am Coll Radiol 2024; 21:642-650. [PMID: 37777077 DOI: 10.1016/j.jacr.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES Few level I trauma, tertiary care, academic centers have a paid, permanent reading room coordinator (RRC) to facilitate image management services during off-hour calls, to minimize interruptions to reading workflow. The purpose of this study is to investigate the effect of an RRC on the efficiency of radiology residents signing preliminary reports for emergency department (ED) and inpatient studies. METHODS A pre- and postintervention retrospective review was performed, using carestream PACS to retrieve imaging studies read on call during two time periods-July 1 to December 1, 2019 (pre-RRC), and July 1 to December 1, 2021 (post-RRC). Efficiency of residents signing preliminary reports was measured by turnaround time (TAT), defined as the time from when a study was marked complete by a technologist to when a preliminary report was signed by a resident, in PACS. RESULTS In the above time periods, residents interpreted a total of 64,406 studies on call. For ED studies, the mean TAT was 7.0 min shorter post-RRC, compared with pre-RRC (95% confidence interval [CI]: -7.8 to -6.1, (t = 15.50, degrees of freedom (df) = 31,866, P < .0001). The percentage of ED studies signed within 30 min increased from 57.7% to 65.8%, an increase of 8.1% (95% CI: 7.0% to 9.1%) after employing an RRC (χ2 = 228.11, df = 1, P < .0001). For inpatient studies, the mean TAT was 10.2 min shorter post-RRC (95% CI: -12.3 to -8.0, t = 9.22, df = 25,193, P < .0001). CONCLUSIONS An RRC increased radiology resident on-call workflow efficiency, facilitating care for patients in both the ED and inpatient setting.
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Affiliation(s)
- Karan Rao
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | - Sarah Perry
- Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | - Joshua Hagedorn
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Knute Carter
- Clinical Associate Professor, Department of Biostatistics; Deputy Director, Center for Public Health Statistics, College of Public Health, University of Iowa, Iowa City, Iowa
| | | | - Bruno Policeni
- Clinical Professor, Director of Neuroradiology Fellowship; Vice-Chair for Operations and Education, Department of Radiology, University of Iowa, Iowa City, Iowa.
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Yacoub JH, Weitz DA, Stirrat TP, Fong A, Ratwani RM. Reading Room Interruptions are Less Disruptive When Using Asynchronous Communication Methods. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01073-2. [PMID: 38504083 DOI: 10.1007/s10278-024-01073-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/06/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
Radiologist interruptions, though often necessary, can be disruptive. Prior literature has shown interruptions to be frequent, occurring during cases, and predominantly through synchronous communication methods such as phone or in person causing significant disengagement from the study being read. Asynchronous communication methods are now more widely available in hospital systems such as ours. Considering the increasing use of asynchronous communication methods, we conducted an observational study to understand the evolving nature of radiology interruptions. We hypothesize that compared to interruptions occurring through synchronous methods, interruptions via asynchronous methods reduce the disruptive nature of interruptions by occurring between cases, being shorter, and less severe. During standard weekday hours, 30 radiologists (14 attendings, 12 residents, and 4 fellows) were directly observed for approximately 90-min sessions across three different reading rooms (body, neuroradiology, general). The frequency of interruptions was documented including characteristics such as timing, severity, method, and length. Two hundred twenty-five interruptions (43 Teams, 47 phone, 89 in-person, 46 other) occurred, averaging 2 min and 5 s with 5.2 interruptions per hour. Microsoft Teams interruptions averaged 1 min 12 s with only 60.5% during cases. In-person interruptions averaged 2 min 12 s with 82% during cases. Phone interruptions averaged 2 min and 48 s with 97.9% during cases. A substantial portion of reading room interruptions occur via predominantly asynchronous communication tools, a new development compared to prior literature. Interruptions via predominantly asynchronous communications tools are shorter and less likely to occur during cases. In our practice, we are developing tools and mechanisms to promote asynchronous communication to harness these benefits.
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Affiliation(s)
- Joseph H Yacoub
- Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC, USA.
| | - Daniel A Weitz
- School of Medicine, Georgetown University, Washington, DC, USA
| | | | - Allan Fong
- MedStar National Center for Human Factors Engineering in Healthcare, MedStar Health Research Institute, Washington, DC, USA
| | - Raj M Ratwani
- MedStar National Center for Human Factors Engineering in Healthcare, MedStar Health Research Institute, Washington, DC, USA
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Law W, Terzic A, Chaim J, Erinjeri JP, Hricak H, Vargas HA, Becker AS. Integrated Automatic Examination Assignment Reduces Radiologist Interruptions: A 2-Year Cohort Study of 232,022 Examinations. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:25-30. [PMID: 38343207 PMCID: PMC10976913 DOI: 10.1007/s10278-023-00917-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 03/02/2024]
Abstract
Radiology departments face challenges in delivering timely and accurate imaging reports, especially in high-volume, subspecialized settings. In this retrospective cohort study at a tertiary cancer center, we assessed the efficacy of an Automatic Assignment System (AAS) in improving radiology workflow efficiency by analyzing 232,022 CT examinations over a 12-month period post-implementation and compared it to a historical control period. The AAS was integrated with the hospital-wide scheduling system and set up to automatically prioritize and distribute unreported CT examinations to available radiologists based on upcoming patient appointments, coupled with an email notification system. Following this AAS implementation, despite a 9% rise in CT volume, coupled with a concurrent 8% increase in the number of available radiologists, the mean daily urgent radiology report requests (URR) significantly decreased by 60% (25 ± 12 to 10 ± 5, t = -17.6, p < 0.001), and URR during peak days (95th quantile) was reduced by 52.2% from 46 to 22 requests. Additionally, the mean turnaround time (TAT) for reporting was significantly reduced by 440 min for patients without immediate appointments and by 86 min for those with same-day appointments. Lastly, patient waiting time sampled in one of the outpatient clinics was not negatively affected. These results demonstrate that AAS can substantially decrease workflow interruptions and improve reporting efficiency.
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Affiliation(s)
- Wyanne Law
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Admir Terzic
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joshua Chaim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph P Erinjeri
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Oncologic Imaging Division, NYU Langone, New York, NY, USA
| | - Anton S Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Radiology, Oncologic Imaging Division, NYU Langone, New York, NY, USA.
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Sevenster M, Hergaarden K, Hertgers O, Nguyen D, Wijn V, Vlachomitrou AS, Vosbergen S, Lamb HJ. Design and Perceived Value of a Novel Solution for Asynchronous Communication in Radiology. Curr Probl Diagn Radiol 2024; 53:96-101. [PMID: 37914652 DOI: 10.1067/j.cpradiol.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
RATIONALE AND OBJECTIVES Communication with and within the Radiology Department is typically initiated over phone, face-to-face or general-purpose chat, causing frequent interruptions, additional mental workload, workflow inefficiencies and diagnostic errors. We developed and evaluated a new communication solution that aims to reduce avoidable interruptions caused by technologist-radiologist communication. MATERIALS AND METHODS Following an iterative design process with future end users, a scalable web-based software solution, RadConnect, was developed enabling a chat-based communication workflow between a technologist and a radiologist. As a first experimental implementation, technologists can send categorized tickets to a radiology section account. Radiologists receive the tickets in a worklist that is prioritized by urgency. Consented radiologists and technologists performed scripted tasks in 2 hr sessions and completed a structured questionnaire on perceived value and comparison to standard communication modes. RESULTS Of 17 participants from three academic European institutes, 65% (11/17) believed they would use RadConnect frequently; 53% (9/17) believed that it reduces phone calls >80%; and 88% (15/17) believed it adds value compared to general-purpose enterprise chat applications. DISCUSSION Participants recognized the value of RadConnect especially its categorized tickets, prioritized worklist and role-based interaction model. Inter-institute differences in perceived value of RadConnect may have been caused by technologist-radiologist proximity and communication alternatives in the institutions. CONCLUSION Chat-based role-based communication might be a viable mode of communication between technologists and radiologists to reduce avoidable interruptions. Tailoring the chat solution to the needs of and tightly integrated with the radiology workflow is valued by future end users after exposure to the tool in a simulated environment.
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Affiliation(s)
- Merlijn Sevenster
- Royal Philips Electronics, High Tech Campus 34, 5656AA Eindhoven, the Netherlands; Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands.
| | - Kenneth Hergaarden
- Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Omar Hertgers
- Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Duc Nguyen
- Royal Philips Electronics, High Tech Campus 34, 5656AA Eindhoven, the Netherlands
| | - Victor Wijn
- Royal Philips Electronics, High Tech Campus 34, 5656AA Eindhoven, the Netherlands
| | - Anna S Vlachomitrou
- Royal Philips Electronics, High Tech Campus 34, 5656AA Eindhoven, the Netherlands
| | - Sandra Vosbergen
- Royal Philips Electronics, High Tech Campus 34, 5656AA Eindhoven, the Netherlands
| | - Hildo J Lamb
- Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
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MacBeth R, Ravi S, Abuhamdeh I, Avery R, Wien M, Faraji N. Decreasing Workflow and Educational Interruptions in the Reading Room: Working Smarter, Not Harder. Curr Probl Diagn Radiol 2023; 52:511-514. [PMID: 37460359 DOI: 10.1067/j.cpradiol.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/26/2023] [Accepted: 06/28/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE Disruptions in image interpretation lead to interrupted education and inefficiency, and ultimately delay patient care. In the academic reading room, time can often be spent rerouting phone calls. The objective of this study was to evaluate resident perception of current workflow, decrease interruptions, and improve patient care and resident education by implementing a cost-effective automated centralized phone tree. MATERIALS AND METHODS Phone call records were obtained between January 25 and February 23, 2021 and May 3 and June 30, 2021 prior to implementation of an automated centralized phone tree within the Emergency Radiology reading room. Calls during weekday business hours were evaluated. Postimplementation phone records were obtained over 4 weeks (August 20-September 16, 2021). Residents on rotation were surveyed prior to and after phone tree implementation regarding the qualitative impact. RESULTS The total number of phone calls decreased after phone tree implementation to 8 calls over a 19-day period from 100-200 phone calls over a 20-22 day period. There is a statistically significant difference (p-value < 0.017) in the median number of phone calls postimplementation for all compared preimplementation time points. Resident surveys also demonstrate a statistically significant improvement (p-value < 0.05) in the evaluated metrics. CONCLUSIONS Data demonstrate a quantitative decrease in the number of calls arriving at the Emergency Radiology reading room as well as qualitative improvements in resident workplace satisfaction, feelings of burnout, and burden of interruptions. These data suggest that a self-directed triage system (eg, phone tree) could provide a cost-effective and simple means of decreasing interruptions.
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Affiliation(s)
- RaeLynne MacBeth
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH.
| | - Shweta Ravi
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Imran Abuhamdeh
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Ross Avery
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Michael Wien
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Navid Faraji
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
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7
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Subhas N, Johnson S, Caruso C, Kollai E, Obuchowski NA, Mody R, Parker HJ, Borkowski GP. Imaging Service Navigators: An Approach Toward More Efficient and Effective Communications. J Am Coll Radiol 2023; 20:79-86. [PMID: 36494062 DOI: 10.1016/j.jacr.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Many practices have implemented support services to assist radiologists with noninterpretive tasks; however, little research has been performed to assess the overall effect of these services. The purpose of this study was to evaluate the effect of a team of imaging service navigators (ISNs) incorporated into a practice on (1) number of communications, (2) time saved by radiologists, and (3) radiologist satisfaction with the service. METHODS The numbers and types of reports dictated by radiologists were captured for 6-month periods before and after ISN implementation. Communication rates before and after implementation were then calculated. The amount of perceived time savings using the ISN team and satisfaction with the service were assessed through pre- and postimplementation surveys of participating radiologists. Mean and median time savings and satisfaction rates were calculated. RESULTS The overall communication rate increased from 2.196% before ISNs to 3.278% after ISNs (49% increase; 95% confidence interval, 47%-52%). Communication rates increased among all communication subtypes (critical, urgent, routine, and actionable), with the highest increases in urgent (94%) and actionable (75%) findings. Before implementation, radiologists reported spending 39 min on average per day on communications tasks, with only 33% of radiologists indicating that the communication process was efficient. After implementation, radiologists reported mean time savings of 28 min (95% confidence interval, 19.9-35.1), and 82% of radiologists indicated a positive or highly positive view of the ISN service. CONCLUSIONS After ISN implementation, communication rates increased and radiologists reported spending less time performing communications. Most radiologists were satisfied with the service.
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Affiliation(s)
- Naveen Subhas
- Institute Vice Chair, Imaging Institute, Cleveland Clinic, Cleveland, Ohio.
| | | | | | | | - Nancy A Obuchowski
- Department Vice Chair, Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Rekha Mody
- Institute Quality Officer, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - H Joseph Parker
- Institute Administrator, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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Wang Z, Manassi M, Ren Z, Ghirardo C, Canas-Bajo T, Murai Y, Zhou M, Whitney D. Idiosyncratic biases in the perception of medical images. Front Psychol 2022; 13:1049831. [PMID: 36600706 PMCID: PMC9806180 DOI: 10.3389/fpsyg.2022.1049831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Radiologists routinely make life-altering decisions. Optimizing these decisions has been an important goal for many years and has prompted a great deal of research on the basic perceptual mechanisms that underlie radiologists' decisions. Previous studies have found that there are substantial individual differences in radiologists' diagnostic performance (e.g., sensitivity) due to experience, training, or search strategies. In addition to variations in sensitivity, however, another possibility is that radiologists might have perceptual biases-systematic misperceptions of visual stimuli. Although a great deal of research has investigated radiologist sensitivity, very little has explored the presence of perceptual biases or the individual differences in these. Methods Here, we test whether radiologists' have perceptual biases using controlled artificial and Generative Adversarial Networks-generated realistic medical images. In Experiment 1, observers adjusted the appearance of simulated tumors to match the previously shown targets. In Experiment 2, observers were shown with a mix of real and GAN-generated CT lesion images and they rated the realness of each image. Results We show that every tested individual radiologist was characterized by unique and systematic perceptual biases; these perceptual biases cannot be simply explained by attentional differences, and they can be observed in different imaging modalities and task settings, suggesting that idiosyncratic biases in medical image perception may widely exist. Discussion Characterizing and understanding these biases could be important for many practical settings such as training, pairing readers, and career selection for radiologists. These results may have consequential implications for many other fields as well, where individual observers are the linchpins for life-altering perceptual decisions.
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Affiliation(s)
- Zixuan Wang
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States,*Correspondence: Zixuan Wang,
| | - Mauro Manassi
- School of Psychology, University of Aberdeen, King’s College, Aberdeen, United Kingdom
| | - Zhihang Ren
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States,Vision Science Group, University of California, Berkeley, Berkeley, CA, United States
| | - Cristina Ghirardo
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Teresa Canas-Bajo
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States,Vision Science Group, University of California, Berkeley, Berkeley, CA, United States
| | - Yuki Murai
- Center for Information and Neural Networks, National Institute of Information and Communications Technology, Koganei, Japan
| | - Min Zhou
- Department of Pediatrics, The First People's Hospital of Shuangliu District, Chengdu, Sichuan, China
| | - David Whitney
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States,Vision Science Group, University of California, Berkeley, Berkeley, CA, United States,Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
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Jeong WK, Choi BI. [Burnout among Radiologists in Korea: Prevalence, Risk Factors, and Remedies]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:776-782. [PMID: 36238907 PMCID: PMC9514575 DOI: 10.3348/jksr.2022.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/15/2022]
Abstract
Burnout among radiologists has recently emerged as an issue that poses a threat to patient safety. Burnout adversely effects the quality of patient care and may lead to health problems in physicians. Approximately 84% of board-certified radiologists working in large hospitals in Korea responded that they had experienced burnout at least once. To overcome this, the standardization of physicians' workloads, as well as improvements in the professional workflow are necessary to ensure a healthy lifestyle balance.
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Shah SH, Atweh LA, Thompson CA, Carzoo S, Krishnamurthy R, Zumberge NA. Workflow Interruptions and Effect on Study Interpretation Efficiency. Curr Probl Diagn Radiol 2022; 51:848-851. [PMID: 35870962 DOI: 10.1067/j.cpradiol.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/09/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Interruptions have been shown to adversely impact efficiency, accuracy, and patient safety. OBJECTIVE To analyze the frequency and types of interruptions and effect on report interpretation efficiency. MATERIALS AND METHODS A business process improvement team was consulted to make detailed recordings of the activities of the radiologists. Activities were categorized as interpreting studies, active interruptions initiated by the radiologist, and passive interruptions initiated by an external source. RESULTS Thirteen board-certified, pediatric radiologists were observed for 61 hours. Radiologists spent 52% of their time interpreting studies, 29% on active interruptions, and 18% on passive interruptions. Approximately 50% of non-interpretive time involved in-person conversations or consults and 16% involved phone calls of which 67% were incoming. The longest time period without an interruption was 20 minutes. 85% of the time, an interruption came within 3 minutes of beginning an interpretation and lasted 1 minute or less 70% of the time. Interruptions increased the time a radiologist needed to read a study by 1 minute for radiographs, 2 minutes for ultrasounds, 6 minutes for CTs, and 10 minutes for magnetic resonance imaging. CONCLUSION Total interruption time nearly equaled the total time interpreting studies for radiologists, and interruptions decreased efficiency and increased report interpretation times for all modalities studied. This study highlights the type and extent of interruptions in radiology and examines the effect on report interpretation times. With the frequency of interruptions and impact on efficiency, there is a need to dedicate resources to manage the radiologist workflow. Strategic interventions may ultimately improve outcomes, efficiency, and the overall work environment.
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Xavier BA, Chen PH. Natural Language Processing for Imaging Protocol Assignment: Machine Learning for Multiclass Classification of Abdominal CT Protocols Using Indication Text Data. J Digit Imaging 2022; 35:1120-1130. [PMID: 35654878 PMCID: PMC9582109 DOI: 10.1007/s10278-022-00633-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 03/09/2022] [Accepted: 04/05/2022] [Indexed: 11/25/2022] Open
Abstract
A correct protocol assignment is critical to high-quality imaging examinations, and its automation can be amenable to natural language processing (NLP). Assigning protocols for abdominal imaging CT scans is particularly challenging given the multiple organ specific indications and parameters. We compared conventional machine learning, deep learning, and automated machine learning builder workflows for this multiclass text classification task. A total of 94,501 CT studies performed over 4 years and their assigned protocols were obtained. Text data associated with each study including the ordering provider generated free text study indication and ICD codes were used for NLP analysis and protocol class prediction. The data was classified into one of 11 abdominal CT protocol classes before and after augmentations used to account for imbalances in the class sample sizes. Four machine learning (ML) algorithms, one deep learning algorithm, and an automated machine learning (AutoML) builder were used for the multilabel classification task: Random Forest (RF), Tree Ensemble (TE), Gradient Boosted Tree (GBT), multi-layer perceptron (MLP), Universal Language Model Fine-tuning (ULMFiT), and Google’s AutoML builder (Alphabet, Inc., Mountain View, CA), respectively. On the unbalanced dataset, the manually coded algorithms all performed similarly with F1 scores of 0.811 for RF, 0.813 for TE, 0.813 for GBT, 0.828 for MLP, and 0.847 for ULMFiT. The AutoML builder performed better with a F1 score of 0.854. On the balanced dataset, the tree ensemble machine learning algorithm performed the best with an F1 score of 0.803 and a Cohen’s kappa of 0.612. AutoML methods took a longer time for completion of NLP model training and evaluation, 4 h and 45 min compared to an average of 51 min for manual methods. Machine learning and natural language processing can be used for the complex multiclass classification task of abdominal imaging CT scan protocol assignment.
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Affiliation(s)
- Brian Arun Xavier
- Imaging Institute, Cleveland Clinic Foundation, 9500 Euclid Ave., P34, Cleveland, OH, 44195, USA.
| | - Po-Hao Chen
- Imaging Institute, Cleveland Clinic Foundation, 9500 Euclid Ave., P34, Cleveland, OH, 44195, USA
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12
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Montazeri M, Khajouei R. Determining the Effect of the Picture Archiving and Communication System (PACS) on Different Dimensions of Users' Work. Radiol Res Pract 2022; 2022:4306714. [PMID: 35265375 PMCID: PMC8901356 DOI: 10.1155/2022/4306714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/22/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
The impact of the picture archiving and communication system (PACS) on healthcare costs, information access, image quality, and user workflow has been well studied. However, there is insufficient evidence on the effect of this system on different dimensions of the users' work. The objective of this study was to evaluate the impact of the PACS on different dimensions of users' work (external communication, service quality, user intention to use the PACS, daily routine, and complaints on users) and to compare the opinions of different groups of users about the PACS. This study was performed on the PACS users (n = 72) at Kerman University of Medical Sciences, including radiologists, radiology staff, ward heads, and physicians. Data were collected using a questionnaire consisting of two parts: demographic information of the participants and 5-point Likert scale questions concerning the five dimensions of users' work. Data were analyzed using descriptive statistics, ANOVA, and Pearson's correlation coefficient statistical tests. The mean of scores given by the PACS users was 4.31 ± 0.86 for external communication, 4.18 ± 0.96 for user intention to use the PACS, 3.91 ± 0.7 for service quality, 3.16 ± 0.56 for daily routine, and 3.08 ± 1.05 for complaints on users. Radiologists and radiology staff had a more positive opinion about the PACS than other clinicians such as physicians (P < 0.01, CI = 95%). Factors such as user age (P < 0.01, CI = 95%), job (P < 0.001, CI = 95%), work experience (P < 0.001, CI = 95%), and PACS training method (P=0.037, CI = 95%) were related to the impact of the PACS on different dimensions of users' work. This study showed that the PACS has a positive effect on different dimensions of users' work, especially on external communication, user intention to use the system, and service quality. It is recommended to implement PACSs in medical centers to support users' work and to maintain and strengthen the capabilities and functions of radiology departments.
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Affiliation(s)
- Mahdieh Montazeri
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Spieler B, Baum N. Burnout: A Mindful Framework for the Radiologist. Curr Probl Diagn Radiol 2021; 51:155-161. [PMID: 34876307 DOI: 10.1067/j.cpradiol.2021.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/11/2021] [Accepted: 08/25/2021] [Indexed: 12/11/2022]
Abstract
Burnout, the outcome of prolonged stress or frustration, manifests as both mental and physical fatigue affecting over half of healthcare workers. This article will discuss the etiologies, problems, and potential solutions to burnout related issues that are impacting radiologists. Factors placing radiologists at risk for burnout as well the impact of burnout upon the radiologist, the department, staff, and patients they serve will also be discussed. An emphasis will also be placed upon recognition, solutions, and a collective response to burnout. Readers should be able to perform a self-assessment of their own risk for burnout and understand what can be done to dissolve and prevent burnout amongst their colleagues. In doing so, our hope is that radiologists will develop greater insight, awareness, and ultimately empathy for the unique challenges that others in the radiology community may face.
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Affiliation(s)
- Bradley Spieler
- Department of Diagnostic Radiology, Louisiana State University Health Sciences Center, New Orleans, LA.
| | - Neil Baum
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
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Streit U, Uhlig J, Lotz J, Panahi B, Seif Amir Hosseini A. Qualitative and Quantitative Workplace Analysis of Staff Requirement in an Academic Radiology Department. ROFO-FORTSCHR RONTG 2021; 193:1277-1284. [PMID: 34044451 DOI: 10.1055/a-1472-6530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The role of today's hospital-based radiologists goes far beyond interpretation-related tasks. This observational study defines these types of activities and quantifies the type of value-adding interactions radiologists experience on a daily basis with referring departments and other health personnel. The purpose of this study is to evaluate the quality and quantity of these value-adding non-image interpretation tasks in the daily routine of hospital-based residents and attending radiologists. METHODS A prospective, observational study was performed in the radiology department of a German university hospital. Two experienced radiologists performed a 30-day observation of the entire medical staff. The observers followed the subject radiologists throughout the workday, recording activities using a time and motion methodology. An evaluation matrix was developed to characterize and quantify image interpretation tasks (IITs), non-image interpretation tasks (NITs), and contingency allowance (CA) for residents and attending radiologists. Here, the example of the MRI unit is used. RESULTS Four main categories of responsibilities for NITs were identified including teaching and education, clinical decision support, management and organization, and patient care. The quantitative analysis for residents showed: IITs 15 h/d (53 %), NITs 9.8 h/d (34 %), CA 2.2 h/d (13 %). For attendings the analysis revealed: IITs 6.7 h/d (40 %), NITs 7.8 h/d (47 %), and CA 1.7 h/d (13 %). This resulted in staff requirements of 2 attendings and 3.4 residents for the MRI unit. On average, 6 TSEs/h occurred in the case of residents and 13 TSEs/h in the case of attendings. CONCLUSION NITs consumed a significant portion of a radiologist's workday. Therefore, the number of examinations performed is not a reliable surrogate for the daily workload of hospital-based radiologists especially in cross-sectional imaging units. Though time-consuming, these non-interpretive tasks are greatly contributing to the fact that modern radiology is assuming a central position in patient management, fulfilling a critical role that surpasses image interpretation-related tasks to include a more integrative and consultative role. These findings will help to further define the changing role of radiologists with respect to other physicians, non-medical personnel, hospital administrators, as well as policy makers. KEY POINTS · Staff requirements are a significant factor in department strategy.. · Targeted analysis can deliver valuable information about workload per activity and the required staff.. · The number of examinations performed is not a reliable surrogate for the daily workload of hospital-based radiologists.. · NITs comprise a significant portion of a radiologist's workday.. · Though time-consuming, non-interpretive tasks contribute to the fact that modern radiology is assuming a central role in patient management.. CITATION FORMAT · Streit U, Uhlig J, Lotz J et al. Qualitative and Quantitative Workplace Analysis of Staff Requirement in an Academic Radiology Department. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1472-6530.
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Affiliation(s)
- Ulrike Streit
- Radiology, University Medical Center Göttingen Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - Johannes Uhlig
- Radiology, University Medical Center Göttingen Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - Joachim Lotz
- Radiology, University Medical Center Göttingen Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - Babak Panahi
- Radiology, University Medical Center Göttingen Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - Ali Seif Amir Hosseini
- Radiology, University Medical Center Göttingen Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
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Smith EA, Schapiro AH, Smith R, O'Brien SE, Smith SN, Eckerle AL, Towbin AJ. Increasing Median Time between Interruptions in a Busy Reading Room. Radiographics 2021; 41:E47-E56. [PMID: 33646899 DOI: 10.1148/rg.2021200094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ethan A Smith
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (E.A.S., A.H.S., R.S., S.E.O., S.N.S., A.L.E., A.J.T.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (E.A.S., A.H.S., A.J.T.)
| | - Andrew H Schapiro
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (E.A.S., A.H.S., R.S., S.E.O., S.N.S., A.L.E., A.J.T.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (E.A.S., A.H.S., A.J.T.)
| | - Rachel Smith
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (E.A.S., A.H.S., R.S., S.E.O., S.N.S., A.L.E., A.J.T.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (E.A.S., A.H.S., A.J.T.)
| | - Sarah E O'Brien
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (E.A.S., A.H.S., R.S., S.E.O., S.N.S., A.L.E., A.J.T.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (E.A.S., A.H.S., A.J.T.)
| | - Sara N Smith
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (E.A.S., A.H.S., R.S., S.E.O., S.N.S., A.L.E., A.J.T.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (E.A.S., A.H.S., A.J.T.)
| | - Amy L Eckerle
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (E.A.S., A.H.S., R.S., S.E.O., S.N.S., A.L.E., A.J.T.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (E.A.S., A.H.S., A.J.T.)
| | - Alexander J Towbin
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (E.A.S., A.H.S., R.S., S.E.O., S.N.S., A.L.E., A.J.T.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (E.A.S., A.H.S., A.J.T.)
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Sheth S, Mudge B, Fishman EK. The pre-CT checklist: A simple tool to improve workflow and patient safety in an outpatient CT setting. Clin Imaging 2020; 66:101-105. [DOI: 10.1016/j.clinimag.2020.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022]
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Maurer MH, Brönnimann M, Schroeder C, Ghadamgahi E, Streitparth F, Heverhagen JT, Leichtle A, de Bucourt M, Meyl TP. Time Requirement and Feasibility of a Systematic Quality Peer Review of Reporting in Radiology. ROFO-FORTSCHR RONTG 2020; 193:160-167. [PMID: 32698235 DOI: 10.1055/a-1178-1113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To estimate the human resources required for a retrospective quality review of different percentages of all routine diagnostic procedures in the Department of Radiology at Bern University Hospital, Switzerland. MATERIALS AND METHODS Three board-certified radiologists retrospectively evaluated the quality of the radiological reports of a total of 150 examinations (5 different examination types: abdominal CT, chest CT, mammography, conventional X-ray images and abdominal MRI). Each report was assigned a RADPEER score of 1 to 3 (score 1: concur with previous interpretation; score 2: discrepancy in interpretation/not ordinarily expected to be made; score 3: discrepancy in interpretation/should be made most of the time). The time (in seconds, s) required for each review was documented and compared. A sensitivity analysis was conducted to calculate the total workload for reviewing different percentages of the total annual reporting volume of the clinic. RESULTS Among the total of 450 reviews analyzed, 91.1 % (410/450) were assigned a score of 1 and 8.9 % (40/450) were assigned scores of 2 or 3. The average time (in seconds) required for a peer review was 60.4 s (min. 5 s, max. 245 s). The reviewer with the greatest clinical experience needed significantly less time for reviewing the reports than the two reviewers with less clinical expertise (p < 0.05). Average review times were longer for discrepant ratings with a score of 2 or 3 (p < 0.05). The total time requirement calculated for reviewing all 5 types of examination for one year would be more than 1200 working hours. CONCLUSION A retrospective peer review of reports of radiological examinations using the RADPEER system requires considerable human resources. However, to improve quality, it seems feasible to peer review at least a portion of the total yearly reporting volume. KEY POINTS · A systematic retrospective assessment of the content of radiological reports using the RADPEER system involves high personnel costs.. · The retrospective assessment of all reports of a clinic or practice seems unrealistic due to the lack of highly specialized personnel.. · At least part of all reports should be reviewed with the aim of improving the quality of reports.. CITATION FORMAT · Maurer MH, Brönnimann M, Schroeder C et al. Time Requirement and Feasibility of a Systematic Quality Peer Review of Reporting in Radiology. Fortschr Röntgenstr 2021; 193: 160 - 167.
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Affiliation(s)
- Martin H Maurer
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern Universtity Hospital, University of Bern, Switzerland
| | - Michael Brönnimann
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern Universtity Hospital, University of Bern, Switzerland
| | - Christophe Schroeder
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern Universtity Hospital, University of Bern, Switzerland
| | | | | | - Johannes T Heverhagen
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern Universtity Hospital, University of Bern, Switzerland
| | - Alexander Leichtle
- Institute of Clinical Chemistry, Inselspital, Bern Universtiy Hospital, University of Bern, Switzerland
| | - Maximilian de Bucourt
- Institute for Diagnostic and Interventional Radiology, Charité University Medicine Berlin, Germany
| | - Tobias Philipp Meyl
- Medical Department, Medical Strategy, Inselspital, Bern University Hospital, University of Bern, Switzerland
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O' Neill SB, Vijayasarathi A, Nicolaou S, Walstra F, Salamon N, Munk PL, Khosa F. Evaluating Radiology Result Communication in the Emergency Department. Can Assoc Radiol J 2020; 72:846-853. [PMID: 32063052 DOI: 10.1177/0846537119899268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess the pattern of result communication that occurs between radiologists and referring physicians in the emergency department setting. METHODS An institutional review board-approved prospective study was performed at a large academic medical center with 24/7 emergency radiology cover. Emergency radiologists logged information regarding all result-reporting communication events that occurred over a 168-hour period. RESULTS A total of 286 independent result communication events occurred during the study period, the vast majority of which occurred via telephone (232/286). Emergency radiologists spent 10% of their working time communicating results. Similar amounts of time were spent discussing negative and positive cross-sectional imaging examinations. In a small minority of communication events, additional information was gathered through communication that resulted in a change of interpretation from a normal to an abnormal study. CONCLUSIONS Effective and efficient result communication is critical to care delivery in the emergency department setting. Discussion regarding abnormal cases, both in person and over the phone, is encouraged. However, in the emergency setting, time spent on routine direct communication of negative examination results in advance of the final report may lead to increased disruptions, longer turnaround times, and negatively impact patient care. In very few instances, does the additional information gained from the communication event result in a change of interpretation?
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Affiliation(s)
- Siobhan B O' Neill
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arvind Vijayasarathi
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Savvas Nicolaou
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frances Walstra
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Noriko Salamon
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Peter L Munk
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Faisal Khosa
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Moore W, Doshi A, Gyftopoulos S, Bhattacharji P, Rosenkrantz AB, Kang SK, Recht M. Enhancing communication in radiology using a hybrid computer-human based system. Clin Imaging 2020; 61:95-98. [PMID: 32004954 DOI: 10.1016/j.clinimag.2019.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Communication and physician burn out are major issues within Radiology. This study is designed to determine the utilization and cost benefit of a hybrid computer/human communication tool to aid in relay of clinically important imaging findings. MATERIAL AND METHODS Analysis of the total number of tickets, (requests for assistance) placed, the type of ticket and the turn-around time was performed. Cost analysis of a hybrid computer/human communication tool over a one-year period was based on human costs as a multiple of the time to close the ticket. Additionally, we surveyed a cohort of radiologists to determine their use of and satisfaction with this system. RESULTS 14,911 tickets were placed in the 6-month period, of which 11,401 (76.4%) were requests to "Get the Referring clinician on the phone." The mean time to resolution (TTR) of these tickets was 35.3 (±17.4) minutes. Ninety percent (72/80) of radiologists reported being able to interpret a new imaging study instead of waiting to communicate results for the earlier study, compared to 50% previously. 87.5% of radiologists reported being able to read more cases after this system was introduced. The cost analysis showed a cost savings of up to $101.12 per ticket based on the length of time that the ticket took to close and the total number of placed tickets. CONCLUSIONS A computer/human communication tool can be translated to significant time savings and potentially increasing productivity of radiologists. Additionally, the system may have a cost savings by freeing the radiologist from tracking down referring clinicians prior to communicating findings.
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Affiliation(s)
- William Moore
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America.
| | - Ankur Doshi
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| | - Soterios Gyftopoulos
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| | - Priya Bhattacharji
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| | - Andrew B Rosenkrantz
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| | - Stella K Kang
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| | - Michael Recht
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
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Simon AF, Holmes JH, Schwartz ES. Decreasing radiologist burnout through informatics-based solutions. Clin Imaging 2019; 59:167-171. [PMID: 31821974 DOI: 10.1016/j.clinimag.2019.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/21/2019] [Accepted: 10/28/2019] [Indexed: 01/06/2023]
Abstract
Increased performance demands have interacted with suboptimal use of technology and contributed to burnout among radiologists. Although the problem of radiologist burnout has been well documented, there is a gap in the literature in terms of how technology can be better utilized to lessen the problem. Informatics-based modifications to existing technology hold the potential to reduce the amount of time radiologists spend on noninterpretive tasks, decrease interruptions, facilitate connections with colleagues, and improve patient care. Examples of successful modifications to technology are presented and discussed in relation to how they contribute to improving workplace engagement among radiologists.
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Affiliation(s)
- Andrew F Simon
- Department of Psychology, Seton Hall University, South Orange, NJ, United States of America
| | - John H Holmes
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Erin Simon Schwartz
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America.
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Sabat S, Kalapos P, Slonimsky E. Quantifying disruption of workflow by phone calls to the neuroradiology reading room. BMJ Open Qual 2019; 8:e000442. [PMID: 31637315 PMCID: PMC6768390 DOI: 10.1136/bmjoq-2018-000442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/12/2019] [Accepted: 08/18/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction The purpose of this study was to understand the source and the reason for the phone calls to our neuroradiology suit and to quantify the size of the problem in terms of duration of individual and aggregated calls. Materials and methods Observation of the neuroradiology reading room for the entire duration of the working hours over three non-consecutive days was performed, and included telephone calls start time, end time and calls duration for incoming telephone calls. After each phone call the recipients were queried on the details of the phone call; the origin of the call, the reason for the call and the response. Results The average total number of minutes (min) spent on the phone each day was 64 min per working day with a total of 39 phone calls per day and 4.4 per hour on average. The trainees answered 71% of the phone calls with additional intervention by attending in 13% of phone calls. The most common source of phone calls was from either the MRI/CT technicians (48%), followed by providers (20%) and returning pages (18%). Conclusion Cumulative time spent on the phone by neuroradiologists in the reading room ended up in more than an hour per working day, while trainees were taking the majority of phone calls. Most phone calls originated from technicians, hence, requiring specific solutions to mitigate this kind of interruption.
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Affiliation(s)
- Shyam Sabat
- Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Paul Kalapos
- Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Einat Slonimsky
- Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
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Large-Scale Assessment of Scan-Time Variability and Multiple-Procedure Efficiency for Cross-Sectional Neuroradiological Exams in Clinical Practice. J Digit Imaging 2019; 33:143-150. [PMID: 31292770 DOI: 10.1007/s10278-019-00252-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Scheduling of CT and MR exams requires reasonable estimates for expected scan duration. However, scan-time variability and efficiency gains from combining multiple exams are not quantitatively well characterized. In this work, we developed an informatics approach to quantify typical duration, duration variability, and multiple-procedure efficiency on a large scale, and used the approach to analyze 48,766 CT- and MR-based neuroradiological exams performed over one year. We found MR exam durations demonstrated higher absolute variability, but lower relative variability and lower multiple-procedure efficiency, compared to CT exams (p < 0.001). Our approach enables quantification of real-world operational performance and variability to inform optimal patient scheduling, efficient resource utilization, and sustainable service planning.
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Watura C, Blunt D, Amiras D. Ring Ring Ring! Characterising Telephone Interruptions During Radiology Reporting and How to Reduce These. Curr Probl Diagn Radiol 2019; 48:207-209. [DOI: 10.1067/j.cpradiol.2018.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/08/2018] [Indexed: 11/22/2022]
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Wynn RM, Howe JL, Kelahan LC, Fong A, Filice RW, Ratwani RM. The Impact of Interruptions on Chest Radiograph Interpretation: Effects on Reading Time and Accuracy. Acad Radiol 2018; 25:1515-1520. [PMID: 29605562 DOI: 10.1016/j.acra.2018.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/02/2018] [Accepted: 03/12/2018] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES The objective of this study was to experimentally test the effect of interruptions on image interpretation by comparing reading time and response accuracy of interrupted case reads to uninterrupted case reads in resident and attending radiologists. MATERIALS AND METHODS Institutional review board approval was obtained before participant recruitment from an urban academic health-care system during January 2016-March 2016. Eleven resident and 12 attending radiologists examined 30 chest radiographs, rating their confidence regarding the presence or the absence of a pneumothorax. Ten cases were normal (ie, no pneumothorax present), 10 cases had an unsubtle pneumothorax (ie, readily perceivable by a nonexpert), and 10 cases had a subtle pneumothorax. During three reads of each case type, the participants were interrupted with 30 seconds of a secondary task. The total reading time and the accuracy of interrupted and uninterrupted cases were compared. A mixed-factors analysis of variance was run on reading time and accuracy with experience (resident vs attending) as a between-subjects factor and case type (normal, unsubtle, or subtle) and interruption (interruption vs no interruption) as within-subjects factors. RESULTS Interrupted tasks had significantly longer reading times than uninterrupted cases (P = .032). During subtle cases, interruptions reduced accuracy (P = .034), but during normal cases, interruptions increased accuracy (P = .038). CONCLUSIONS Interruptions increased reading times and increased the tendency for a radiologist to conclude that a case is normal for both resident and attending radiologists, demonstrating that interruptions reduce efficiency and introduce patient safety concerns during reads of abnormal cases.
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Affiliation(s)
- Rachel M Wynn
- MedStar Health, National Center for Human Factors in Healthcare, 3007 Tilden Street, NW, Suite 7L, Washington, DC.
| | - Jessica L Howe
- MedStar Health, National Center for Human Factors in Healthcare, 3007 Tilden Street, NW, Suite 7L, Washington, DC
| | - Linda C Kelahan
- Department of Radiology, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Allan Fong
- MedStar Health, National Center for Human Factors in Healthcare, 3007 Tilden Street, NW, Suite 7L, Washington, DC
| | - Ross W Filice
- MedStar Health, National Center for Human Factors in Healthcare, 3007 Tilden Street, NW, Suite 7L, Washington, DC; Department of Radiology, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Raj M Ratwani
- MedStar Health, National Center for Human Factors in Healthcare, 3007 Tilden Street, NW, Suite 7L, Washington, DC; Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia
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Bell L, James R, Rosa J, Pollentine A, Pettet G, McCoubrie P. Reducing interruptions during duty radiology shifts, assessment of its benefits and review of factors affecting the radiology working environment. Clin Radiol 2018; 73:759.e19-759.e25. [DOI: 10.1016/j.crad.2018.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/11/2018] [Indexed: 11/28/2022]
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Lee MH, Schemmel AJ, Pooler BD, Hanley T, Kennedy T, Field A, Wiegmann D, Yu JPJ. Radiology Workflow Dynamics: How Workflow Patterns Impact Radiologist Perceptions of Workplace Satisfaction. Acad Radiol 2017; 24:483-487. [PMID: 27769823 DOI: 10.1016/j.acra.2016.08.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES The study aimed to assess perceptions of reading room workflow and the impact separating image-interpretive and nonimage-interpretive task workflows can have on radiologist perceptions of workplace disruptions, workload, and overall satisfaction. MATERIALS AND METHODS A 14-question survey instrument was developed to measure radiologist perceptions of workplace interruptions, satisfaction, and workload prior to and following implementation of separate image-interpretive and nonimage-interpretive reading room workflows. The results were collected over 2 weeks preceding the intervention and 2 weeks following the end of the intervention. The results were anonymized and analyzed using univariate analysis. RESULTS A total of 18 people responded to the preintervention survey: 6 neuroradiology fellows and 12 attending neuroradiologists. Fifteen people who were then present for the 1-month intervention period responded to the postintervention survey. Perceptions of workplace disruptions, image interpretation, quality of trainee education, ability to perform nonimage-interpretive tasks, and quality of consultations (P < 0.0001) all improved following the intervention. Mental effort and workload also improved across all assessment domains, as did satisfaction with quality of image interpretation and consultative work. CONCLUSION Implementation of parallel dedicated image-interpretive and nonimage-interpretive workflows may improve markers of radiologist perceptions of workplace satisfaction.
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Affiliation(s)
- Matthew H Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, M/C 3252, Madison, WI 53792-3252
| | - Andrew J Schemmel
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, M/C 3252, Madison, WI 53792-3252
| | - B Dustin Pooler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, M/C 3252, Madison, WI 53792-3252
| | - Taylor Hanley
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin, Madison, Wisconsin
| | - Tabassum Kennedy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, M/C 3252, Madison, WI 53792-3252
| | - Aaron Field
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, M/C 3252, Madison, WI 53792-3252; Department of Biomedical Engineering, College of Engineering, University of Wisconsin, Madison, Wisconsin
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, Madison, Wisconsin
| | - John-Paul J Yu
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, M/C 3252, Madison, WI 53792-3252; Department of Biomedical Engineering, College of Engineering, University of Wisconsin, Madison, Wisconsin; Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Wisconsin Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin.
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Lee MH, Schemmel AJ, Pooler BD, Hanley T, Kennedy TA, Field AS, Wiegmann D, Yu JPJ. Workflow Dynamics and the Imaging Value Chain: Quantifying the Effect of Designating a Nonimage-Interpretive Task Workflow. Curr Probl Diagn Radiol 2016; 46:275-281. [PMID: 28049559 DOI: 10.1067/j.cpradiol.2016.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/10/2016] [Accepted: 11/13/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE To assess the impact of separate non-image interpretive task and image-interpretive task workflows in an academic neuroradiology practice. MATERIALS AND METHODS A prospective, randomized, observational investigation of a centralized academic neuroradiology reading room was performed. The primary reading room fellow was observed over a one-month period using a time-and-motion methodology, recording frequency and duration of tasks performed. Tasks were categorized into separate image interpretive and non-image interpretive workflows. Post-intervention observation of the primary fellow was repeated following the implementation of a consult assistant responsible for non-image interpretive tasks. Pre- and post-intervention data were compared. RESULTS Following separation of image-interpretive and non-image interpretive workflows, time spent on image-interpretive tasks by the primary fellow increased from 53.8% to 73.2% while non-image interpretive tasks decreased from 20.4% to 4.4%. Mean time duration of image interpretation nearly doubled, from 05:44 to 11:01 (p = 0.002). Decreases in specific non-image interpretive tasks, including phone calls/paging (2.86/hr versus 0.80/hr), in-room consultations (1.36/hr versus 0.80/hr), and protocoling (0.99/hr versus 0.10/hr), were observed. The consult assistant experienced 29.4 task switching events per hour. Rates of specific non-image interpretive tasks for the CA were 6.41/hr for phone calls/paging, 3.60/hr for in-room consultations, and 3.83/hr for protocoling. CONCLUSION Separating responsibilities into NIT and IIT workflows substantially increased image interpretation time and decreased TSEs for the primary fellow. Consolidation of NITs into a separate workflow may allow for more efficient task completion.
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Affiliation(s)
- Matthew H Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Andrew J Schemmel
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - B Dustin Pooler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Taylor Hanley
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin, Madison, WI
| | - Tabassum A Kennedy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Aaron S Field
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Biomedical Engineering, College of Engineering, University of Wisconsin, Madison, WI
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin, Madison, WI
| | - John-Paul J Yu
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Biomedical Engineering, College of Engineering, University of Wisconsin, Madison, WI; Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI.
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Snaith B, Milner R, Harris M. Beyond image interpretation: Capturing the impact of radiographer advanced practice through activity diaries. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2016.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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A Human Factors Approach to Understanding the Types and Sources of Interruptions in Radiology Reading Rooms. J Am Coll Radiol 2016; 13:1102-5. [DOI: 10.1016/j.jacr.2016.02.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 02/14/2016] [Accepted: 02/19/2016] [Indexed: 11/23/2022]
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