As 2013 comes to a close, expert radiologists provided their input on how to improve performance in the coming year.
1- Only use final reads: Radiology groups using nighttime coverage services or depending on the emergency physician to perform preliminary reads may be causing themselves extra work.
“Lots of radiology groups use nighthawk type services to maintain control of night-time reads, having them do prelims. And they come in and do final reads in morning. That’s not a very efficient workflow,” said founder and principal consultant of Accountable Radiology Advisors in Ohio, Teri Yates.
“Radiology groups fear that allowing the nighttime service to do final reads weakens their position and puts contracts at risk, which is a legitimate concern. But using preliminary reads from others increases communication problems if discrepancies are found by the radiologist providing the final read. In emergent cases, the patient may already have been treated and sent home. Sometimes that discrepancy doesn’t get effectively communicated, to the patient,” Yates added.
2- Employ voice recognition with self-editing: Voice recognition software enables a radiologist to get their thoughts down quickly. However, they also shouldn’t wait around for someone else to edit their work.
“By self-editing it on the spot, you get the report out right away. When a group converts to voice recognition and 100 percent self-editing, turnaround time becomes very fast,” said Yates. With this method, radiologists can complete a read and report within 30 minutes, which means that the ordering physician, like an emergency physician, doesn’t feel the need to do a preliminary read.
3- Go for structured reporting: Automation and technology can enhance efficiency with structured reporting, and there’s less dictation required. Additionally, those who utilize it make fewer errors.
“Think of it as a diagnostic check list. If reading a chest CT scan looking for a pulmonary embolus, you’re obligated to look at everything in the chest, not just for the embolus. With structured reporting, a template or checklist guides you through the reporting and dictation process. Templates can populate predetermined phrases and the structure makes sure the radiologist comments on each area, hopefully with consistent language. This is helpful to the referring physicians, because they’ll see the same system order every time,” said Yates.
4- Depend on automated communication of vital discoveries: “Following up with referring physicians about critical findings is a very time consuming process for radiologists. It can disrupt the reading workflow, and if the referring physician isn’t available, there needs to be a tracking system so it doesn’t get lost,” notes Yates.
Multiple software solutions incorporate with dictation systems, or are individual systems. Paper logs used by some radiology practices are not proficient. Using software, a radiologist can launch the tool when needed to enter the finding on a work list, and this object must to be checked off before it’s removed from the electronic list. Some systems populate the referring physician’s contact information or tell the administrative aide to reach the doctor by phone. Some systems allow information to go by text or smartphone application.
Once communication is made, the software system can put a statement on the radiology report, noting the time that results were communicated.
5- Implement rule-based scheduling: Radiology offices usually have various rules when scheduling an imaging exam. Examples might be that the office can’t do a diagnostic mammogram on a specific day because there’s no radiologist available to read it, or the imaging machine is reserved for research, so it’s unavailable at that time for a patient exam.
“One of the biggest failures I see is when people make those rules and they’re not built into their scheduling system, and it’s dependent on someone remembering it. We push to make sure the system they use to schedule is as closely reflective of the rules of their department. This way there’s less error, and the patients are properly scheduled.” said Philadelphia healthcare consultant specializing in call center technology, Irene Vergules.
“It can be as simple as making sure schedules are constantly maintained in the computer system. If you can’t do a contrast study in the evening, don’t let the system offer those time slots,” she said.
6- Utilize scheduling software to the fullest extent: Most offices don’t utilize scheduling system software to its full capabilities.
“Push your system to the limits and figure out what else the system can do for you,” Vergules states.
“That might be using modifiers to determine if a study should be longer or shorter. Learn what the system can do by contacting user groups or asking other organizations about their use of the same software. Ask those challenging questions,” she said.
7- Team up: Even if the organization is tiny, radiologists can share best practices, quality initiatives, and even gain financially by teaming up with like-minded groups. An example, Yates notes, is Strategic Radiology, a conglomerate of 17 large radiology practices that merged together partly for economic advantages as a group purchasing organization.
“They said they can be more efficient and effective if they work together. The practices are independent, but share data, which helps them lower practice costs by seeing how similar organizations are run. Most radiology groups in county have 10 persons or less. An eight-person group has the same basic needs as a 100-person group. Due to small scale, individual practices may not be able to afford some of the resources of larger organizations, but by banding together they work together to meet some of those needs,” she said.
8- Make things easier for the patients: Especially when growing a practice, radiologists should ensure their hours of operation aren’t restrictive, so that patients can reach scheduling staff or get appointments at times convienient for them.
“Some places close for lunch or open only 8 to 4. It’s hard for some people to call during those hours,” said Vergules.
This involves knowing your community and your location limitations.
“Depending on where you live, some people wouldn’t go there at night or on weekends,” she said, due to safety issues. For other facilities, nights and weekends are an effectiveuse of imaging time.
When scheduling a study, be sure to make it as simple as possible for the scheduler and the patient by asking only the right screening questions.