Prioritizing Radiology Work Flow

Three years ago, the radiology department at the University of Arkansas for Medical Sciences was performing and reading 6,500 PET/CT cases, a number that was rising. But that high volume meant staff was losing hours a day answering phone calls from referring clinicians looking for study interpretations. Patients returned for their follow-up clinical appointment, and 20 percent of the time, their PET/CT interpretations weren’t ready.

“We couldn’t stay caught up,” said James McDonald, vice chair of the department of radiology and director of the division of nuclear medicine.

By last year, only 5 percent of PET/CT interpretations weren’t at the referring clinic in time for the patient visit (one case a day), and the radiology department stress level decreased. What changed? A new work list prioritization system.

Work list software can help radiology groups schedule and delegate readings to the best suited radiologist. One company, Medicalis, for example, allows the institution to define different types of studies with different turnaround times, incorporating load balancing and time due, said Teri Yates, founder and principal consultant of Accountable Radiology Advisors in Ohio who has done some work with Medicalis. The software assigns the case to the right subspecialist or fellowship-trained radiologist if needed, to make sure it’s read on time. These work list software systems integrate with PACS.

At the University of Arkansas for Medical Sciences, their current Epic electronic medical record system and Sectra PACS are widely adopted, but McDonald could not sort the work lists by when the patient would return to the clinic. He said they’re designed to show you what’s on the work list, assuming you’ll read the whole list through. To coordinate the reading and return time, he had to look at Epic to see when a patient was scheduled for a radiology study, then go to PACS to see if it was complete. This was the only way he could find to prioritize a large work list, where many of the studies were done on nights and weekends, to make sure studies were interpreted by the time needed.

McDonald started searching for a commercial system to prioritize reading based on the time the patient would return to the clinic and couldn’t find one to fit the department needs.  

After he spent several months looking for a suitable commercial solution, one of his colleagues suggested using the Microsoft SharePoint enterprise software. The hospital already had it, so there was no cost, and it’s HIPAA compliant, he said.

They created a spreadsheet with the patient name, record number, referring physician, clinical appointment time, study completion time, reading radiologist’s name, radiopharmaceutical injection site, modality and blood sugar level. The data is input manually, mostly by clerical staff when the patient is scheduled. The radiologist inputs his or her name when reading it. While the steps are minimal, “people have to enter as you go along. It’s not that much trouble if you take the time to train people,” McDonald said. The IT department created the worksheet in about eight hours, he added, and then the radiology staff and referring clinic staff needed training on how to use it.

What’s made the program so helpful for McDonald’s department is that they can search for blank or nonblank entries in a particular column. When MacDonald sits down to read in the morning, he customizes a search to find the patient with the next doctor’s appointment whose study needs reading. For less urgent reads, they enter a time to ensure that it’s read by a specified time (24 hours for inpatients, no more than three working days for others).

While the system is handy for work list prioritizing, McDonald found it had other uses too, and published the results in the Journal of Nuclear Medicine Technology in December, 2013. It’s been helpful because the patient’s status through the PET/CT imaging process is documented, and this built up trust with referring clinics, who can view a “read only” version of the document.

“If it’s 10 a.m. and a patient is seeing the doctor at 1 p.m., and the nurse doesn’t see the PET report, they can flip to SharePoint,” he said. The program has decreased the number of phone calls coming in from clinics, and “referring clinic staff has increased confidence that we’ll get them what they need, in the time they need it.”

The new software tool has also saved them at least a 0.5 FTE of clerical staff, because they don’t need someone looking for paperwork, answering phones and finding doctors to read something last minute. It’s easier for the radiologist to sit and work, and McDonald estimated that the SharePoint software saved the department a 0.5 FTE radiologist as well, plus enhancing their productivity.

“The tool” he said, “enables us all to participate in the process of trying to get the patient taken care of.”