Roper St. Francis gains advantages from CR/DR

Managing CR and DR implementations is a carefully orchestrated effort at Roper St. Francis Healthcare in Charleston, SC. Our healthcare system includes two hospitals in Charleston (Bon Secours St. Francis and Roper Hospital) that represent almost 600 beds, a day hospital, a hospital soon to begin construction in Mt. Pleasant, and eight outpatient facilities with imaging services in the midcoastal area of the state.

Implementing digital image capture began in 2003 as part of a system-wide PACS implementation. The first modalitiesto be integrated wereCT, M­RI, and ultrasound. During the installation of PACS, Roper St. Francis simultaneously upgraded to DICOM-enabled modalities and determined what technologies would be used for diagnostic radiology. Mammography and diagnostic radiography were the last to be integrated to PACS. Diagnostic radiography represented 50% to 55% of our total imaging volume of 230,000 studies performed in 2006.

Achieving optimal cost and time efficiencies within a health system employing an all-digital imaging environment requires the appropriate blending of CR and DR systems. CR can be 60% less costly than DR, depending on the models and features selected for both platforms. In a study conducted jointly by Roper St. Francis and Carestream Health (formerly Kodak, makers of the CR and DR systems we discuss) at our location, image capture with CR was about 25% faster than film from a postexposure to image display or film production standpoint, while DR was shown to be an average of 71% faster than analog film display in a wide range of diagnostic studies.

As we evaluated these technologies, we developed a plan to install DR systems in the hospitals' general radiology and emergency departments and employ CR systems for outpatient imaging centers and hospital-based portable exams.

Study volume is one of the primary factors in our decision to use DR, but in the case of our emergency rooms, the need for immediate image review was the driving concern. We installed a DR system at St. Francis Hospital two years ago and a dual-detector DR system recently at Roper Hospital. Not only are images available within seconds, they can be viewed by ER physicians and radiologists simultaneously.

Increased patient throughput and staff productivity was the motivation for installing two DR systems in each hospital's radiology department. Installing the second DR unit allowed our staff to handle peak volumes that occur throughout the day, primarily due to unscheduled outpatients who are referred from medical offices on a walk-in basis. Facilities like ours may perform a high percentage of studies during a concentrated period during the workday, so we need to base our equipment decisions on providing the capacity required to handle those hourly volumes. The second DR system allows us to do that.

We also maintain multicassette units in our main hospital radiology departments to process portable exams and to provide additional patient imaging capacity, with single-cassette systems in the operating rooms and ICUs.

All of the outpatient locations except one now have digital imaging for general radiography. These locations represent varied clinical environments, including medical office buildings, urgent care facilities, and outpatient imaging centers. Each site has a single-cassette CR system with the exception of our larger day hospital campus that includes a surgical center, emergency room, and medical office building. This location requires a multicassette CR reader with better throughput for higher patient volumes.

As a multifacility healthcare system, we need to be able to allocate staff and equipment in response to changing needs. We have selected the same supplier for both CR and DR, in part because a shared user interface for all models of CR and DR platforms enhances staff productivity and allows technologists to move easily between different platforms and different technologies. Since our technologists periodically work in various areas of the hospital and at different locations within our system, equipment standardization is a vital element in maintaining productivity and reducing the need for additional training and staff.

Implementing CR and DR technologies has led to a dramatic improvement in patient wait times, report turnaround for referring physicians, staff productivity, and employee satisfaction scores.

Mr. Ricciardone is director of imaging services at Roper St. Francis Healthcare, and Ms. Ward is director of imaging services at Bon Secours St. Francis Hospital, both in Charleston, SC.