PACS productivity boost proves elusive for ED technologists

One pole holding up the PACS tent is the projected increase in technologist productivity.

A survey sponsored last year by the Society for Computer Applications in Radiology, for instance, showed that shifting to a filmless environment can produce clear gains in technologist productivity. Adding a PACS allowed institutions to boost productivity from 3572 exams per technologist FTE to 4098, an increase of 15%. Adding a RIS at the same time accounted for an additional 11% productivity increase.

These gains are not always evident, however, in an intense emergency department setting. When previous studies at the University of Pennsylvania Medical Center ED failed to show a significant increase in productivity after a switch to a filmless image management, a new evaluation was planned, this time controlling for exam difficulty and a variable workload.

"Our findings suggest that for plain-film radiography, in a volatile environment like the ED, improvements in technologist productivity after PACS implementation may be very small," said Regina O'Connell Redfern, R.T.(R), a tech at Penn. "Other factors such as patient volume, technologist experience, and the arrival of a trauma patient have a far greater effect."

More substantial time savings may be realized by automating the process of requesting imaging exams.

"In our study, emergency physicians faxed paper copies of a request form to radiology when they wanted radiographic exams," Redfern said.

Redfern measured a seven-minute time delay from the completion of a request until it was faxed to radiology, with 25% of the requests delayed more than 12 minutes.

"This initial delay is much greater than the two minutes of time savings gained by implementing PACS, so perhaps automating the requesting process would better serve productivity," she said.

The study, published online (J Digit Imaging, DOI: 10.1007/s10278-002-0024-5) is important because managers faced with making the decision whether to purchase PACS should know that productivity improvements for technologists are not guaranteed and therefore should not be heavily weighted.

"Managers should also note that productivity decreased during the initial implementation phase of PACS and that this phase may be lengthy, as was measured by several other studies," Redfern said.

Many other benefits to PACS, however, like improved report turnaround time, were not evaluated in this study.

"This is just one piece of the puzzle," she said.