Study quantifies report turnaround and productivity improvements under PACS

A five-year hospital audit showed PACS use leads to sustained improvements in productivity and reporting times, according to a recent U.K. study.

In the three years following PACS installation in 2003, reporting times were found to have decreased by 25% and productivity improved by 18% at St. George's Hospital NHS Trust in London (Clin Radiol 2008;63(7):796-804).

"These improvements are felt to reflect the efficiencies and cultural change that accompanied PACS and digital dictation," said Dr. Andrew D. Mackinnon, a clinical research fellow at St. George's.

PACS circumvents many of the rate-limiting factors involved in the production of a radiology report, resulting in significantly improved turnaround and productivity, Mackinnon said.

The improvements were sustained over a three-year period, in spite of a 30% increase in patient episodes. The total number of plain and specialist film studies performed annually increased from 138,000 in 2002 to just over 180,000 in 2006. Expansion of radiology staff (32 to 37) during this period was modest.

"Prior to PACS, productivity was decreasing and reporting times were stable or increasing," Mackinnon said.

Both deteriorating trends were reversed after PACS installation, he said.

Reporting time was defined as the time taken from patient registration to report availability, and productivity was the number of reports issued per full-time radiologist per month. Both were studied for two years pre- and three years post-PACS. Mean reporting time was calculated for plain radiographs and for CT, MRI, ultrasound, and nuclear medicine.

Mean reporting times for plain radiographs improved under PACS by 26% (from 6.8 days to five days), and specialty modalities improved by 24% (4.1 days to 3.1 days), according to the study.

The present study is the largest of its kind, addressing global reporting performance over a five-year period, Mackinnon said. Contrast fluoroscopy and interventional studies were not included in the analysis, however.

"These are often performed by trainee radiologists or trained radiographers and then reported with a senior radiologist, so it was felt that reporting times on these should be addressed in a separate audit," he said.

Mackinnon plans next to re-audit the department following implementation of a voice recognition system.

"With the introduction of voice recognition, further reduction in the number of steps can be anticipated, although caution is needed here, as there are reports that voice recognition may reduce an individual radiologist's productivity," he said.