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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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Hagedorn J, Rao K, Belt M, Policeni B. Quantifying Interruptions for On-Call Radiology Residents, and Resident Perception of Reading Room Coordinators. J Am Coll Radiol 2024:S1546-1440(24)00192-3. [PMID: 38369047 DOI: 10.1016/j.jacr.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/12/2024] [Accepted: 02/03/2024] [Indexed: 02/20/2024]
Affiliation(s)
- Joshua Hagedorn
- Department of Radiology, University of Iowa, Iowa City, Iowa; Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Karan Rao
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | - Monica Belt
- Department of Radiology, 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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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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Service evaluation of radiographer-led vetting and protocoling of Computed Tomography (CT) scan requests in a Singapore public healthcare institution. Radiography (Lond) 2023; 29:139-144. [PMID: 36370639 DOI: 10.1016/j.radi.2022.10.011] [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: 07/13/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION A service improvement project involving the vetting and protocoling of Computed Tomography (CT) scan requests by qualified CT radiographers was initiated in 2018. AIM This study provides a comprehensive evaluation of how a radiographer-led initiative aims to ensure that the CT scan requests received by the Radiology department are clinically appropriate, which in turn will reduce interruptions to the interpretation and reporting of imaging examinations by radiologists, who might otherwise be required to attend to clinically inappropriate and wrongly protocolled CT scan requests. METHOD Outpatient CT scan requests received from July to October 2021 were vetted and protocolled by a qualified CT-trained radiographer for parameters which included the appropriateness of the clinical indication, adequacy of patient preparation for the scan, as well as the suitability of the requested examination protocol pertaining to the need for contrast media, multiple contrast-enhanced imaging phases, and the appropriateness of the scan range. RESULTS Poor patient preparation and insufficient or inaccurate clinical indications were the most common findings during the vetting process (71%). Out of the 64 CT scan requests with protocol errors, 77% were attributed to contrast media type errors. The odds of incorrect CT scan requests increased with the requesting clinician's rank, while there was no such significant correlation with the clinical specialty of the requesting clinician or the CT scan type. CONCLUSION The meticulous vetting of imaging requests helps to ensure that limited imaging hardware resources are allocated to more clinically appropriate cases, correct protocols are applied to requested imaging scans, and that patients undergoing imaging are adequately prepared, thereby enhancing overall patient care. IMPLICATIONS FOR PRACTICE Vetting of imaging requests by radiographers, who are capable to make appropriate clinical decisions related to their enhanced level of practice ensures patient safety and optimisation of Radiology resources.
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Virarkar M, Coleman JA, Siddiqui ZA, Leal VB, McClinton AE, Steele JR, Yang W, Bhosale PR, Klekers AR. Engaging nurse practitioners and physician assistants to improve patient care and drive productivity in a radiology consult practice at a comprehensive cancer center. J Am Assoc Nurse Pract 2022; 34:941-947. [PMID: 35796110 DOI: 10.1097/jxx.0000000000000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The demand for health care in the United States is increasing because of an aging population and an increase in the number of individuals insured. This has led to requests to revamp the primary care infrastructure fundamentally. LOCAL PROBLEM The optimal use of nurse practitioners (NPs) and physician assistants (PAs) is still a subject of debate, but recently, it was reported that for many medical conditions, NP and PA-managed care outcomes are consistent with physician-managed care outcomes. METHODS Radiologists' productivity was measured according to relative value units (RVUs)/shift and professional billing changes. Patient care metrics measured were prescribed protocol to patient appointment lead time and number of same-day prescribed imaging protocol changes. INTERVENTIONS The focus was on radiologists' productivity and patient care for three months before and three months after integrating NP and PA into our abdominal radiology consult service. RESULTS We observed significant increases in the mean RVUs/shift (15.2 ± 0.9 vs. 6.2 ± 1.8; p = .02), studies read per shift (10.1 ± 0.5 vs. 4.4 ± 1.5; p = .003), revenue per shift hour ($756.20 ± 55.40 vs. $335.40 ± 32.60; p = .007), and protocol prescription to patient appointment lead time (39.3 ± 6.7 days vs. 16.3 ± 2.9 days; p = .005) and saw significant decreases in the mean prescribed CT (19.3 ± 0.6 vs. 3.3 ± 0.6; p = .001) and MRI (11.7 ± 0.6 vs. 8.30 ± 0.12; p = .011) same day protocol changes in NP and PA integrated workflow. CONCLUSIONS These findings suggest that NP and PA can be effectively integrated into the abdominal radiology consult service, increasing radiologists' productivity and enhancing clinical care.
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Affiliation(s)
- Mayur Virarkar
- Division of Abdominal and General Body Imaging, University of Florida College of Medicine, Jacksonville, Florida
| | - Joseph A Coleman
- College of Natural Sciences, Biology Major, University of Houston, Houston, Texas
| | - Zeeshan A Siddiqui
- Department of Ambulatory Operation & Access, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Viola B Leal
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Angel E McClinton
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joseph R Steele
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wei Yang
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Priya R Bhosale
- Department of Abdominal Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Albert R Klekers
- Department of Abdominal Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Virarkar M, Coleman JA, Siddiqui ZA, Leal VB, McClinton AE, Steele JR, Yang W, Bhosale P, Klekers AR. PAs and NPs improve patient care and productivity in a radiology consult practice. JAAPA 2022; 35:46-51. [PMID: 35762956 DOI: 10.1097/01.jaa.0000832596.64788.f1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effects on efficiency and patient care of the addition of physician assistants (PAs) and NPs to the abdominal radiology consult service. METHODS We obtained radiologist productivity and patient care metrics for 3 months before and 3 months after the integration of PAs and NPs into our consult service. RESULTS Integrating PAs and NPs into the workflow led to a significant increase in mean RVUs/shift (15.2 ± 0.9 versus 6.2 ± 1.8; P = .02), number of studies read per shift (10.1 ± 0.5 versus 4.4 ± 1.5; P = .003), revenue per shift hour ($756.20 ± $55.40 versus $335.40 ± $132.60; P = .007), protocol prescription to patient appointment lead time (39.3 ± 6.7 versus 16.3 ± 2.9 days; P = .005), and significant decreases in mean CT (19.3% ± 0.6 versus 3.3% ± 0.6; P = .001) and MRI (11.7% ± 0.6 versus 8.3% ± 0.12; P = .011) same-day protocol changes as patient appointments. CONCLUSIONS PAs and NPs can be effectively integrated into abdominal radiology consult service, increasing the productivity of radiologists, and enhancing clinical care.
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Affiliation(s)
- Mayur Virarkar
- Mayur Virarkar is an assistant professor in the Division of Abdominal and General Body Imaging at the University of Florida College of Medicine in Jacksonville, Fla. Joseph A. Coleman is a student at the University of Houston in Houston, Tex. At the University of Texas' MD Anderson Cancer Center in Houston, Zeeshan A. Siddiqui is a project director in the Department of Ambulatory Operation and Access, Viola B. Leal is a program manager, Angel E. McClinton practices in surgical oncology, Joseph R. Steele is an interventional radiologist, Wei Yang is a professor and chair of the Department of Diagnostic Radiology, Priya Bhosale is a professor in the departments of diagnostic radiology and abdominal imaging, and Albert R. Klekers is an assistant professor in the Department of Abdominal Radiology. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Weir BS, Vordtriede C, Lee JE, Metter EJ, Talbot LA. An Interdisciplinary Dashboard to Streamline Medication Processing at Patient Discharge: A Quality Improvement Initiative. Mil Med 2021; 188:usab526. [PMID: 34950952 DOI: 10.1093/milmed/usab526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/01/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The purpose of this quality improvement project was to develop and evaluate the use of an electronic medication request dashboard to reduce the amount of time required for medication processing and decrease time lost to workflow interruptions during patient discharge. Delayed discharges are associated with increased health care costs and adverse patient outcomes. Processing of medication requests at discharge contributes to these delays and to workflow interruptions for nursing and pharmacy staff at the project site. Electronic dashboards have been successfully implemented in multiple medical settings to streamline patient processing and enhance communication. MATERIALS AND METHODS The Human Protections Office at Carl R. Darnall Army Medical Center (Fort Hood, TX) reviewed and approved the project with a non-human research determination. A multi-disciplinary workgroup with representatives from nursing, pharmacy, and health information technology (HIT) was formed to develop the dashboard. Based on a logic flow diagram of the desired communication, HIT created a medication request form and status dashboard using SharePoint and Nintex workflows. The dashboard was implemented for a 30-day pilot on a 25-bed medical/surgical nursing unit. The time required for medication processing, the time from discharge order to patient exit, the number of phone calls between nursing and pharmacy, and the usability of the medication request process were measured before and after implementation. The results were analyzed with descriptive statistics and evaluated for statistical significance with a P value ≤.05. RESULTS With implementation of the dashboard, the average medication processing time decreased from 125 minutes to 48 minutes (P < .0001), and the average patient discharge time decreased from 137 minutes to 117 minutes (P = .002). The usability score of the medication request process increased from 40 to 87 for nursing (P < .0001) and from 62 to 85 for pharmacy (P = .003). The total number of voice calls between nursing and pharmacy decreased from 1,115 to 434, while the total time on voice calls decreased from 33 hours and 50 minutes to 13 hours and 19 minutes (P < .0001). CONCLUSIONS The electronic dashboard is an effective method to enhance interdisciplinary communication during patient discharge and significantly reduces medication processing times. However, despite the medication processing time decreasing by over an hour, the discharge time only decreased by 20 minutes. Additional investigation is needed to evaluate other contributors to delayed discharge. A key limitation of this study was the convenience sampling used over a 30-day pilot on a single unit. The process has since been adopted by the entire hospital, and additional analysis could better reveal the impact to the organization. This communication system shows high usability and reduces phone call interruptions for both nursing and pharmacy staff. Additionally, this technology could easily be applied to other communication pathways or request processes across military medicine.
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Affiliation(s)
- Brett S Weir
- Nursing Operations, Pharmacy Department, Carl R. Darnall Army Medical Center, Fort Hood, TX 76544, USA
| | - Caitrin Vordtriede
- Nursing Operations, Pharmacy Department, Carl R. Darnall Army Medical Center, Fort Hood, TX 76544, USA
| | | | - E Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Laura A Talbot
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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Watura C, Kendall C, Sookur P. Direct Access and Skill Mix Can Reduce Telephone Interruptions and Imaging Wait Times: Improving Radiology Service Effectiveness, Safety and Sustainability. Curr Probl Diagn Radiol 2021; 51:6-11. [PMID: 34284928 DOI: 10.1067/j.cpradiol.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/23/2021] [Accepted: 06/11/2021] [Indexed: 11/22/2022]
Abstract
Unnecessary telephone calls to reporting radiologists impede organizations' workflow and may be associated with a higher chance of errors in reports. We conducted a prospective study in two cycles, which identified vetting plain CT heads as the most common reason for these calls and vetting CT urinary tracts (KUB) was also frequent. Clear vetting and protocolling guidelines exist for both of these scans, which do not routinely require discussion with a radiologist. Therefore, our approach was to create new flow diagrams to allow radiographers to directly accept routine requests for plain CT head and CT KUB scans in- and out-of-hours. After this intervention, incoming calls to radiology for vetting CT heads decreased by 30% and for vetting CT KUBs by 100%. The average wait time between CT head request and scan completion was reduced by 40%. The number of CT head and CT KUB scans performed remained stable. In future, maximizing the benefit of direct access in-patient imaging pathways will rely on effective and sustained communication of the protocols to the junior clinical staff rotating through the organization, as they were responsible for requesting the vast majority of tests.
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Affiliation(s)
- Christopher Watura
- Chelsea and Westminster Hospital NHS Foundation Trust, Imaging Department, Chelsea and Westminster Hospital, Chelsea, London.
| | - Charlotte Kendall
- Chelsea and Westminster Hospital NHS Foundation Trust, Imaging Department, Chelsea and Westminster Hospital, Chelsea, London
| | - Paul Sookur
- Chelsea and Westminster Hospital NHS Foundation Trust, Imaging Department, Chelsea and Westminster Hospital, Chelsea, London
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Yacoub JH, Swanson CE, Jay AK, Cooper C, Spies J, Krishnan P. The Radiology Virtual Reading Room: During and Beyond the COVID-19 Pandemic. J Digit Imaging 2021; 34:308-319. [PMID: 33620622 PMCID: PMC7901504 DOI: 10.1007/s10278-021-00427-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic has disrupted the radiology reading room with a potentially lasting impact. This disruption could introduce the risk of obviating the need for the reading room, which would be detrimental to many of the roles of radiology that occur in and around the reading room. This disruption could also create the opportunity for accelerated evolution of the reading room to meet the strategic needs of radiology and health care through thoughtful re-design of the virtual reading room. In this article, we overview the impact of the COVID-19 pandemic on radiology in our institution and across the country, specifically on the dynamics of the radiology reading room. We introduce the concept of the virtual reading room, which is a redesigned alternative to the physical reading room that can serve the diverse needs of radiology and healthcare during and beyond the pandemic.
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Affiliation(s)
- Joseph H Yacoub
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA.
| | - Carl E Swanson
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - Ann K Jay
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - Cirrelda Cooper
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - James Spies
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - Pranay Krishnan
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
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Jalal S, Parker W, Ferguson D, Nicolaou S. Exploring the Role of Artificial Intelligence in an Emergency and Trauma Radiology Department. Can Assoc Radiol J 2020; 72:167-174. [DOI: 10.1177/0846537120918338] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Emergency and trauma radiologists, emergency department’s physicians and nurses, researchers, departmental leaders, and health policymakers have attempted to discover efficient approaches to enhance the provision of quality patient care. There are increasing expectations for radiology practices to deliver a dedicated emergency radiology service providing 24/7/365 on-site attending radiologist coverage. Emergency radiologists (ERs) are pressed to meet the demand of increased imaging volume, provide accurate reports, maintain a lower proportion of discrepancy rate, and with a rapid report turnaround time of finalized reports. Thus, rendering the radiologists overburdened. The demand for an increased efficiency in providing quality care to acute patients has led to the emergence of artificial intelligence (AI) in the field. AI can be used to assist emergency and trauma radiologists deal with the ever-increasing imaging volume and workload, as AI methods have typically demonstrated a variety of applications in medical image analysis and interpretation, albeit most programs are in a training or validation phase. This article aims to offer an evidence-based discourse about the evolving role of artificial intelligence in assisting the imaging pathway in an emergency and trauma radiology department. We hope to generate a multidisciplinary discourse that addresses the technical processes, the challenges in the labour-intensive process of training, validation and testing of an algorithm, the need for emphasis on ethics, and how an emergency radiologist’s role is pivotal in the execution of AI-guided systems within the context of an emergency and trauma radiology department. This exploratory narrative serves the present-day health leadership’s information needs by proposing an AI supported and radiologist centered framework depicting the work flow within a department. It is suspected that the use of such a framework, if efficacious, could provide considerable benefits for patient safety and quality of care provided. Additionally, alleviating radiologist burnout and decreasing healthcare costs over time.
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Affiliation(s)
- Sabeena Jalal
- Department of Trauma and Emergency Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- McGill University, Montreal, Quebec, Canada
| | - William Parker
- Department of Trauma and Emergency Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Duncan Ferguson
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Savvas Nicolaou
- Department of Trauma and Emergency Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
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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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Watura C, R Desai S. Radiology report alerts - are emailed ‘Fail-Safe’ alerts acknowledged and acted upon? Int J Med Inform 2020; 133:104028. [DOI: 10.1016/j.ijmedinf.2019.104028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 10/15/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
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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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