Environment aims to enrichinterdepartmental teamwork

December 1, 2008

Enhancing collaboration with referring physicians is the focus of a major renovation currently under way at the University of Virginia Health System's radiology department.

Enhancing collaboration with referring physicians is the focus of a major renovation currently under way at the University of Virginia Health System's radiology department.

As the trend toward PACS and digital radiology has moved forward, many radiologists have become concerned that face-toface interactions with clinicians have declined. Dr. Alan H. Matsumoto, interim chair for the department, said the problem needed a fresh approach.

"With the successful dissemination of our PACS throughout the Health System, access to clinical information has increased dramatically, enhancing clinical productivity," Matsumoto said. "However, the resultant impact has been a decline in multispecialty clinical interaction around the patient."

During the planning process, Dr. Michael D. Dake, former department chair, saw an opportunity to rethink facility planning with an eye to the future digital imaging environment by creating a setting that encourages clinical productivity, enhances clinical collaboration and patient care, and ultimately improves radiologists' job satisfaction.

As part of the first phase of the project, the vacated film file space was built as a prototypical reading area to test more ergonomic workstations and ways of enhancing collaboration with referring physicians.

MASTER PLAN

Perkins Eastman, a major healthcare facility planning and design firm, was retained by the university to develop a master plan, then carry out a program of phased renovations that could be undertaken without interrupting ongoing operations and patient care. The goals of the renovation project included:

• Improve patient circulation and way-finding;
• Rethink patient holding and recovery for greater efficiency and privacy;
• Improve the "front door" to make it more attractive as well as more functional;
• Implement new technology such as an Advanced Image Visualization Lab and provide for expansion of imaging;
• Rethink reading areas for improved work spaces and enhanced consultation;
• Provide an updated and consolidated educational support area; and
• Provide more efficient and flexible work areas for clinical staff.

The master plan outlined a series of phases designed to enable stepby- step renovation without major operational disruption

Planners noted that reading digital images required less centralized access to files but needed a more private and efficient work space where there would be fewer interruptions. The striking reading room design by Perkins Eastman consists of a flexible environment that uses controlled lighting and sound-absorbing materials to dramatic effect. Several types of openoffice workstations as well as a private work environment are being evaluated by radiology staff. Each work area features easily adjustable multiscreen flat-panel PACS displays, multiple CPUs, adjustableheight work surfaces, wire management, and sound-absorbing panels between stations.

The work room has a dark, neutral gray interior with sound-absorbing ceiling panels suspended above workstations, music and white noise systems for speech privacy, textured sound-absorbing walls, and variable lighting. Five independently controlled audio systems are installed throughout the reading room. Each system is from a different manufacturer and consists of an internal or external amplifier and a loudspeaker featuring sound-focusing technology.

Additionally, sound masking has also been installed throughout the reading room. Loudspeakers are placed in a grid-like pattern above the suspended ceiling. Small zones and fine-tuned volume and frequency controls enable the sound to be customized for each space, increasing its effectiveness and occupant comfort.

Akilah Hugine, a graduate student in the systems and information engi neering department at UVA, is conducting a formal evaluation of this reading room environment to assess whether these new components facilitate better workflow, encourage referring clinician collaboration, and enhance radiologist satisfaction. The results of this evaluation will help determine which elements are most successful as we transition these ideas to a larger space in a future phase of the renovation.

ROUNDING ROOM

The rounding room, or image interpretation theatre, is a unique and visually dramatic element, as is the round translucent wall that encircles it. A concierge sits at the entrance to the theatre and the reading room to handle requests for consults, thereby minimizing disruption to radiologists during peak reading periods.

The theatre is furnished with comfortable swivel chairs, variable lighting, and advanced audiovisual systems. The private and intimate setting offers the capability to display a variety of digital images, depending on the topic, in a flexible and collaborative environment.

The theatre's video wall is composed of six 50-inch Barco OV-515 DLP cubes for a total screen space of 10 x 5 feet. In a single-screen configuration, we are able to utilize a touchscreen interface, which provides the physicians a new level of interactivity with patient studies, as all PACS functions are available to the user through that interface.

Each cube can be split into separate video sources, facilitating a wide variety of configurations. The physicians are able to review PACS, patient data from the electronic medical record, PowerPoint slides, DVDs, and a live case feed simultaneously, providing the working group with unparalleled insight into patient care.