Radiology has never been busier-and it's only going to get worse. Here are real-world tips from departments on how you can more done in the same amount of time.
Over the past decade, radiology’s technologies and modalities have advanced to improve your ability to quickly and accurately render diagnoses for your patients, making your to-do list longer. The faster you work, the more patients you see-the more images you have to read.
In 10 years, it’s possible you’ve seen your individual caseload climb from approximately 30 studies daily to nearly 100, according to industry estimates. Keeping up while avoiding backlogs and burnout means you need efficient systems to set you up for success.
“As radiologists we’re seeing anywhere from 50 to 100 to 200 patients daily, depending upon the practice. That’s a huge number of patients,” says Alexander Towbin, MD, chair of radiology informatics and associate chief of clinical operations and informatics at Cincinnati Children’s Hospital. “And, to do so safely and be an effective radiologist, you must have efficient systems.”
Not only do efficient systems keep your practice or department running smoothly, he says, but they also keep costs down by limiting the personnel you hire to accommodate your needs.
Because your report is your final product, streamlining your workload is paramount, but maximizing your overall efficiency is equally important.
Creating an efficient radiology value stream
Radiology’s value stream-the production line culminating with a specific good-ends with the radiology report. And, Towbin says, you can take several steps to improve your process. The following changes helped Cincinnati Children’s reduce the number of clicks needed to read 10 studies from approximately 100 to 15:
Standardize ordering: Create an order-naming protocol, including modality, body part, any special instructions, and side of the body for ordering providers, radiologists, and technologists to use.
Re-name confusing orders: Examine your frequently mis-ordered studies and switch them to more accurate names. Consider building alternate names, such as sonography or US for ultrasound, into the electronic medical record so ordering providers can easily find and correct tests. Additionally, create combination orders for tests typically performed together, such as CT of the chest, abdomen, and pelvis.
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These order changes, Towbin says, reduce incorrectly placed orders and phone calls to correct them.
Data entry: Simplify filling in orders. For example, default priority status based on location, such as always assigning “ASAP” priority to emergency department orders. This makes it easier for you and your technologists to triage orders. Additionally, require clinical history and exam reason. Not only does it inform your diagnosis, but it also ensures you answer the clinician’s question, eliminating a possible follow-up call.
Structured reports: Having structured reports leads to both upstream and downstream efficiency, Towbin says. Because reports have standardized language and information, clinicians for all Cincinnati’s departments have used the findings to guide treatment. Additionally, structured reports make it easier fulfill any payer requests.
Results delivery: Create a system that allows for the most flexibility in delivering results, he says. A system that lets radiologists and clinicians determine whether they want to communicate via telephone is preferable because it could expedite care for critically ill patients.
For less acute cases, consider hiring reading room assistants to deliver results and build rapport with ordering physicians. Those relationships eliminate unnecessary communications in the future.
“These representatives have a better knowledge of each ordering provider’s preferred method of communication, and, if needed, alternate modes of communication,” Towbin says.
Although you can buy workflow engines or add-ons to improve your efficiency, Towbin recommends working with vendors to integrate them into your existing systems.
“We encouraged our vendor friends to implement tools in the systems we already had,” he says. “We pushed them to work with our RIS, PACS, and dictation systems to limit the number of individual systems we had to log into.”
Consequently, with a single click, Cincinnati’s radiologists can send critical results notifications to a reading room assistant who contacts the clinician. They’ve also employed a tracking system that facilitates identifying specific studies if clinicians or specialists visit the reading room with questions.
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The next technological step, Towbin says, will be personalized workstation log-in profiles. This tool would allow individual radiologists to sign into the RIS, PACS, and dictation systems simultaneously, but it could also immediately launch preferred music streaming services, favorite educational websites, and teaching resources.
“It would be nice to have that sort of automated log-in, but so far, we haven’t seen an application like that,” he adds.
Creating a detailed system can help your practice process studies more quickly, but there are also individual steps to minimize the time you spend not focused on your task-at-hand.
In a recent study published in Current Problems in Diagnostic Radiology, Creighton Lewis, MD, a radiology resident in the University of Colorado School of Medicine, and his colleagues outline tactics for ignoring the side trails of daily life in favor of cranking through your caseload.
Consider these tips:
Minimize your internet-based distraction: Set your smartphone to “to-not-disturb,” leave it face down on the desk, or put it in your pocket. Designate a few minutes between cases to address text messages, social media notifications, personal phone calls, or emails. And, handle your email expeditiously, because stuffed inboxes can create low-level stress. Instead, follow the 5Ds, he says. Depending upon the email: delete it, do it, delegate it, deposit it, or defer it.
Take short breaks: Work rest time into your reading schedule. Lewis suggested the Pomodoro Technique-set a timer for 25 minutes of work, then break for 5 minutes. After two hours, take a longer 15-to-30 minute break. Use this down time to deal with the aforementioned Internet distractions.
Organized ergonomics: Everything you use and see should be within minimal distance while you work. Keep the distance your eyes and mouse cursor must move while you’re dictating a study as limited as possible. Be sure your dictation software, as well as your PACS palette, is located near displayed images.
According to Jay Patti, MD, chief radiology informatics officer with Mecklenburg Radiology Associates in Charlotte, North Carolina, tips like these not only increase your efficiency, but they also boost care quality because your eyes stray from patient studies less.
As with all major radiology changes, Towbin says, the most significant obstacle is ensuring you have the right radiologist at the table for decision-making. When maximizing efficiency is the goal, he recommended a radiologist familiar with informatics lead the charge.
“Having a radiologist who understand the workflow throughout the practice or department and has the power to make decisions is helpful,” he says. “He or she can act as the eyes and ears of a department to identify inefficiencies by talking with colleagues and listening to their suggestions and complaints.”
Overall, in the hectic pace of today’s healthcare environment, doing everything you can to keep your practice or department as efficient as possible will help not only with your productivity but with your job satisfaction, Towbin says.
“If practices or departments don’t work on and address efficiency, there’s going to be more and more provider burnout. Parties will feel overworked and understaffed,” he says. “It will take a lot more time to read the same number of studies. You’ll need more people to stay in the office longer, and they’ll be sweeping through and could get sloppy in their work. It could become a cost liability and decrease patient care.”