Emergency department (ED) radiologists are crediting speech recognition technology with a dramatic reduction in report turnaround times at a level I trauma center. Final reports for "routine" procedures are being generated in an hour or less, compared to 3.6 days before implementation of a multiphase process improvement project.
The achievement is reported in the November 2008 issue of Emergency Radiology (Vol. 15:6, pp. 405-412), which documents the outcomes of the 40-month project at Baystate Medical Center. Located in Springfield, MA, the 641-bed academic medical center affiliated with Tufts University School of Medicine serves as the regional referral hospital for major trauma in western and central Massachusetts.
More than 110,000 patients are admitted annually to Baystate's 60-bed emergency department. During the project, approximately 70,000, or 28%, of the 250,000 diagnostic imaging exams performed at the hospital were ordered for these patients, the study authors reported.
The project sought to measure and analyze the needs of the emergency department and the resources of the radiology department by both department staff and hospital administrators. Changes would be implemented in achievable, incremental steps. The simple measurement of emergency radiology service performance drove steps to make continuous improvements, the group wrote.
The first phase of the project took place from April 2002 through November 2004. A mini-PACS networked a dedicated ED computed radiography (CR) system and the CT modalities.
CR exams were read by a staff radiologist and CT exams were read by a CT specialist, who conveyed findings verbally or by handwritten "wet reads" to the emergency physicians. Reports prepared by the hospital transcription system from digital dictation were electronically sent to the RIS/PACS for review and electronic sign-off by the interpreting radiologists. The report would be electronically available in the RIS and a paper copy placed in the patient's file because the RIS was not yet interfaced to the hospital information system.
In addition to slow turnaround times averaging more than 72 hours for final reports, the researchers identified two serious communications roadblocks. If interpretation of a procedure required comparison with prior studies, and significant findings were subsequently identified, there was no process for documenting if the new findings were reported to the emergency department. And while the PACS allowed both the emergency physicians and radiologists to enter electronic notes and interpretations for each other's review, the emergency physicians seldom entered comments. Finally, there was no way for the radiologists to verify if the emergency physicians were reading their electronic interpretations.
Major changes were made between December 2004 and November 2006, the second phase of the project. The RIS and HIS were interfaced, providing immediate electronic access of both preliminary and final reports to the emergency physicians and other hospital staff. An ED-dedicated radiology reading room was created with onsite staffing from 7:30 a.m. to 4:30 p.m. daily, and speech recognition (PowerScribe version 4.6 SP2, Nuance Communications, Burlington, MA) was implemented.
All radiologists and residents were expected to proof, edit, and sign their dictated reports immediately. Residents' reports would be marked as "preliminary," but all reports were transferred to the HIS as soon as they were completed. A special worklist for exams that required comparison with prior ones before a final report could be generated was monitored by clerical staff, and it was a priority for them to rapidly retrieve the hard-copy films for the interpreting radiologist.
Report turnaround time dropped from 86.4 hours on average to 2.3 hours. Twenty percent of the reports were delivered in less than one hour, and 37% were delivered between one and two hours. Previously, final reports had never been delivered in less than two hours, the group noted.
Lead author Dr. Robert DeFlorio, a radiology resident at Baystate during the project, noted that while radiology workflow changes may have contributed to this improvement, the use of speech recognition and protocols established for immediate radiologist review were responsible for the dramatic change.
In February 2006, onsite coverage was extended until 8 p.m. An on-call staff radiologist would read all CR and urgent ED exams, as well as nonurgent unread exams, during these hours. With the extended coverage, average report turnaround time dropped to 1.7 hours during the month of February, and the percentage of reports signed in less than one hour increased to 49%.
A second staff radiologist was assigned to provide coverage from 5 p.m. to 8 p.m. starting in July 2006. For the month of July, the average report turnaround time dropped to 57 minutes or less, and the percentage of signed reports increased to 65%. Only 8% of all reports for emergency physicians took more than two hours to deliver.
In an interview with AuntMinnie.com, radiology department manager Peter Vassallo said that the department is maintaining its target goal of providing reports in less than an hour for the majority of ED-ordered exams. Critical exam results always exceed the target goal. Reports are printed on paper and taken directly to the ordering physician, the protocol the emergency department prefers in lieu of telephone notification.
Reports of "specialized" procedures ordered for ED-admitted patients take longer to generate. When they are included in the total turnaround time, the average is less than three hours. This reflects an improvement over comparable statistics in July 2006, Vassallo said, and is attributed in great part to the fact that all of the radiologists use speech recognition and do their own self-editing.
"The process improvement program of the emergency and radiology departments is an ongoing one," Vassallo stated. "It didn't end in July 2006. We now provide 16-hour daily coverage for ED reading. Several months ago, a radiologist specializing in emergency imaging joined the department. It's possible that with this addition to our team, our turnaround reporting will improve even more."
By Cynthia Keen
AuntMinnie.com staff writer
November 19, 2008
Related Reading
Speech recognition shrinks report turnaround time, May 29, 2008
Voice recognition key to fast report turnaround, April 24, 2008
Speech recognition cuts report turnaround times, May 4, 2007
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