Take 3RADS and call me in the morning

Relief is just a click away for on-call radiologists at Johns Hopkins University School of Medicine, where researchers have devised an Internet-based application that serves as an order-entry, reporting, and workflow manager during off-hours.

One factor that makes on-call radiology difficult is lack of personnel. It is a challenge for a single radiologist to coordinate the imaging needs of an entire hospital overnight.

The solution provides an organized environment to obtain radiology consultations, according to Dr. Krishna Juluru, a radiologist at Johns Hopkins Hospital. It's called 3RADS for the Hopkins radiology on-call pager number.

"It empowers a single radiologist to coordinate and organize what can be a chaotic work environment," he said.

Advantages of the system, implemented in 2003, include custom tailoring of workflow, ease of development and support, low cost, and hospital-wide availability, Juluru said. 3RAD is documented in the current issue of the American Journal of Roentgenology (2005;184(3):1017-1020).

3RAD was initially used for overnight radiology workflow management, but widespread availability and ease-of-access made it so popular among radiologists and clinicians that the developers recently expanded the system.

What started out as a FileMaker database running on a Pentium-based 90-MHz processor with 32 MB of RAM has been upgraded to a more robust ColdFusion platform with an Access database.

"3RAD now takes orders for many radiology modalities 24 hours a day," Juluru said.

The system is effective in obtaining more thorough patient histories from referring physicians, documenting communication between radiologists and clinical services, and reducing the number of phone calls, according to Juluru. He estimates that 3RAD saves night call radiologists one to two hours per shift.

Before it was implemented, for instance, on-call radiologists often complained of having to review the same case with multiple clinicians at different times. In January 2004, after the system went live, radiologists were receiving an average of 35 study requests per night shift, and clinicians were viewing preliminary reports an average of 63 times per day.

Juluru estimates if only half of the viewed preliminary reports averted a telephone call in that month, the night radiologist had 66 fewer pages to answer to discuss findings. This estimate does not include saved calls to technologists.

"If the time spent in returning a page and discussing a case averaged between one to two minutes, the overall time saving was one to two hours per day," he said.