These five challenges can cripple the productivity and effectiveness of a radiology department. Learn how to identify them and address them head on.
Having an efficient workflow is vital for any healthcare department. However, there are few areas where a broken workflow will impact the health system more than in radiology. An inefficient radiology workflow not only negatively effects the performance and productivity of radiology staff, it has a trickle-down effect that impacts other departments, onsite and referring clinicians, and ultimately the patients and their families. Ensuring radiology workflow is as streamlined as possible is crucial to the overall operation of the health system. Unfortunately, this is often easier said than done. Radiology is a complex environment with several points of potential workflow failure. Dr. James Rawson, Chair of Radiology at the Medical College of Georgia at Augusta University outlines the following five areas as common radiology workflow pitfalls. By identifying and addressing the challenges that are inherent to the specialty, you can measurably improve workflow and performance.
Radiology has multiple customers to serve.
Perhaps the biggest challenge to optimizing radiology workflow is the fact that the department has so many customers to serve. Radiology departments not only need to meet the needs of patients and referring physicians, they also need to satisfy the production and volume requirements of other hospital departments (such as the ER). Furthermore, they need to do all this within the tight budgetary constraints of the hospitals in which they are employed. Establishing workflows designed to keep all of these customers happy requires open lines of communication between the radiology department and each of these stakeholders as well as agreed upon performance metrics.
Radiology has two different workflows to optimize.
Another workflow challenge unique to the specialty is that radiology departments actually have two separate workflows that they need to optimize – the radiologists’ workflow and the workflow of nurses and/or technologists. The radiologists’ workflow consists of interpreting image scans using a worklist, PACS workstation or similar image reading tools. It also includes the workflow in rooms where the radiologists perform procedures such as angiographies and biopsies. The nurses’/technologists’ workflow, on the other hand, is all about getting patients scanned on imaging equipment (e.g. X-Ray, CT, MRI machines, etc.) in the most expedient manner possible.
“If you optimize workflow in one of these areas, but not the other, then you really haven’t optimized the workflow at all,” says Dr. Rawson. “For example, if you maximize the productivity and efficiency with which the radiologist can interpret scans, but haven’t changed the capacity of the health system to scan more patients, you may still have backlogs and patients waiting to be scanned. Conversely, if you optimize the throughput of the health system to scan patients, but don’t equip the radiologist to read these incoming scans any faster, then you’ll have clinicians and patients waiting for the results.”
The key is to balance workflow optimization in both of these areas. This again requires communication between the radiology department and hospital management and establishing some standardized reporting metrics for things like volume, throughput and capacity.
Radiology volume is variable and unpredictable.
Healthcare is extremely unpredictable. The volume of radiology procedures and their corresponding complexity vary from day to day and hour to hour. This variation makes balancing your capacity and your staffing-to-patient needs very difficult. Miscalculations in this area can impede workflow. There are several steps you can take to ensure you can adjust to volume variability. The first is to be flexible.
“For example, every Monday our radiology department at AU Medical Center reviews the outpatient appointment schedules for all imaging to be performed at the hospital,” says Dr. Rawson. “If we start to see an increased demand, we flex our staff to address those needs. Sometimes that means extending hours into the evening or on Saturday and Sunday.”
Another key to addressing volume variability is to get frontline staff involved in the workflow optimization process. Good ideas on maximizing scanner throughput usually won’t come from senior management. They will come from the nurses and technicians that work on these pieces of equipment every day.
Radiology images are often unconnected to other systems.
Historically, radiology images have been stored in proprietary PACS and largely disconnected from patient records in EHR systems. This lack of integration causes workflow problems not only for point-of-care clinicians, but radiology professionals as well. In an unconnected environment, point-of-care clinicians need to go outside their core EHR workflow to view the actual images that correspond to the radiology reports connected to the patient record. This is a time-consuming step that is often bypassed, resulting in potential negative outcomes for patients.
A lack of integration also creates more work for radiologists. For example, if a patient transfers from another hospital or patient images are acquired due to a merger, a limited amount of information about these patients will exist in the incumbent PACS. Gathering this information from other sources requires additional clicks, navigation and phone calls on the part of the radiology department. When images are already linked to corresponding patient records, it makes this process much more seamless. Making the technology investments necessary to link patient images to the EHR is a must that is underscored by Stage 2 Meaningful Use requirements.
Radiology departments are often spread out geographically.
Finally, many radiology departments are spread out over several locations within a hospital or health system. For example, a radiologist may work in one location to interpret studies, but then many need to walk down the hall or to another floor or building to perform a biopsy procedure. The same is true for nursing and technical staff. Depending on the modality, they may have to transport patients to several different (and often geographically dispersed) locations. The time it takes to move from one location to another impacts workflow. Optimizing this location-based workflow requires a very conscious exercise focused on reducing steps and centralizing radiology operations as much as possible.