Look out into your waiting room or the emergency department — what do you see? Chances are, those spaces are filled with an ever-growing line of patients waiting for a study that will reveal the cause or state of their ailments. And, it’s your job to get those results to them as soon as possible.
At least for the past decade, the length of report turnaround time (TAT) has been a hot topic in the field. Not only do patients and referring physicians want diagnostic information quickly, but working through imaging studies efficiently can also improve how your facility functions.
And, the emergency department (ED) is the prime location for attacking longer TATs, according to several imaging professionals. It’s the gateway to the hospital where patients receive either acute care before going home or are admitted for an inpatient stay. In most cases, the factors contributing to slower reads are similar with many institutions taking steps to streamline their efforts.
“We want to increase throughput in the emergency department and continue to provide better care,” said Eric England, MD, assistant professor of radiology at the University of Cincinnati Health. “A lot of that can be obtained by expediting TAT to generate reports.”
Overall, though, efforts to reduce TAT affect imaging studies collected in almost any location — the ED, as well as inpatient or outpatient settings.
The Biggest TAT Factor
The most significant factor inhibiting efficient TAT, said Peter Sachs, MD, a radiology professor at the University of Colorado Hospital (UCH), is poor study prioritization. Unless a radiologist knows how important a study is or the circumstances around a patient’s condition or care, he or she can’t produce a report in the most timely fashion. The fix: teaching referring physicians how to identify which studies are the most important.
In 2014, Sachs said, UCH, which partners with two private radiology practices, tackled this problem, revealing if physicians have proper guidance on how best to rank an ordered study, TAT times fall.
“We realized that we had exams that needed to be performed quickly, read quickly, or both,” he said. “We wanted to provide more guidance to the ordering provider to help radiologists figure out which scans really needed to be read first.”
To reach that goal, the department created five study priority levels, numbered 0-4, that both radiologists and technologists can see. Priority 0 is a disaster, 1 is ED, 2 is ICU, 3 is discharge-pending patients, and 4 is anyone else. Based on location, ED and ICU studies are automatically marked as such within the PACS. Referring doctors can also manually tag a study to give it higher priority, such as cases where patients traveling long distances are waiting for a diagnosis.
After implementing the initiative, Sachs said, TAT for highest priority studies dropped to 12 minutes-to-20 minutes and 88 minutes for lowest priority studies. The private practices associated with the department reported an even faster time for low-priority studies — 65 minutes.
Although many practices and departments have addressed the most commonly identified elements impacting radiology report TAT, other factors can still play a role.
Non-Interpretive Tasks: In some instances, activities that don’t impact the report directly can increase TAT. For example, phone calls or face-to-face reading room visits can slow down a radiologist, said McKinley Glover, MD, a neuroradiology fellow at Massachusetts General Hospital.
In a recent JACR study, he reported every minute devoted to a phone call adds 4.25 minutes to TAT. However, the result isn’t necessarily negative because communication between providers is imperative.
“In many ways, we found non-interpretive tasks added value even when they increased TAT,” he said. “Many are critical and eliminating them in favor of faster TAT could impact the quality of care.”
But he did recommend employing a radiology assistant to field phone calls coming into the reading room as a way to limit the number of distractions providers have during the day.
Clear Expectations: Be sure you have a clear idea of what’s important to each department you serve, said Alexander Towbin, MD, associate chief of clinical operations and informatics and radiology informatics chair for Cincinnati Children’s Hospital. Meeting those expectations can significantly streamline TAT.
“Your ER might want you to focus on X-rays because that’s what churns their department,” he said. “It helps them meet the goal of moving people through the department or admitting them quickly.”
Structured Reporting/Voice Recognition: Using these tools can shave off precious seconds with TAT, Towbin said. You save time with the automatically-completed portions of structured reporting templates, and voice recognition eliminates the need to type out your findings. If you self-edit, as well, instead of having a transcriptionist fix your mistakes, you reduce wait times.
In addition to academic environments, private practices and community hospitals are equally equipped to study their TAT times and make the changes needed for reductions.
Earlier this year, Greensboro Radiology — part of healthcare technology company Canopy Partners in North Carolina — designed an initiative to decrease TAT times. The efforts also improved their work list organization, the practice reported.
To control times, the practice assigned radiologists to read studies from either the ED or various sub-specialties, and studies were divided by priority level: ED/STAT, inpatient, and outpatient. The general and sub-specialty work lists were also integrated so providers no longer needed to switch between lists to find and read studies.
The work list also helped the practice avoid a backlog of studies by assigning target TATs to each study. As the target times approached, unread studies were automatically bumped to the top of the list regardless of whether they were a general or sub-specialty study.
As a result, practice leaders said, Greensboro Radiology reduced their overall TAT by 57%— a more than 4-minute drop.
Mary Washington Hospital, a 442-bed community facility in Fredericksburg, VA, had similar success.
By bringing together radiology, ED, information systems, and industrial engineering representatives, the hospital minimized TAT for CT scans with and without contrast.
Through a partnership with the ED, radiologists added a contrast refrigerator to the ED medication room. A PACS was placed in each CT scanner to prevent back-logs, and an ED phone line was dedicated to CT use. Additionally, CT assistants took over several duties, including obtaining lab values, completing medical histories, prepping rooms, and conducting patient positioning and transport.
Based on these efforts, according to an American Healthcare Radiology Administrators poster, the hospital lowered its ED room turnaround time from 15 minutes to 9 minutes, and report TATs for CTs with and without contrast fell by 16 minutes and 6 minutes, respectively.
The Residency Role
The overall goal, though, is to lower TAT well into the future. Perhaps the most influential way to do so, said University of Cincinnati Health’s England, is to better engage radiology residents. Although they aren’t responsible for final reads, their interpretations provide a solid foundation for attending radiologists who sign off on reports.
Radiology programs should incorporate instruction about the best ways to reduce TAT so residents enter the workforce already armed with the skills needed to create reports in the most efficient manner.
“We need to instruct the next generation of radiologists that are being trained in how to work within the reality of turnaround time,” he said. “We need to teach them the value and importance of turnaround time — they must be able to work around it for the best patient care purposes.”