PACS can lead to significant and sustained improvements in reporting times and productivity, according to a five-year study published in Clinical Radiology.
"When PACS is coupled with a change in departmental workflow, there can be a substantial and sustained improvement in reporting times and productivity: 27-36% and 18%, respectively; with no deterioration in the unreported film rate," wrote a research team from St. George's Hospital NHS Trust in London.
To evaluate the impact of PACS on these metrics in a 1,055-bed teaching hospital, the researchers examined mean radiologist reporting time and productivity for a single quarter (February 1 through April 30) over two years before PACS (2002, 2003) and three years after adoption (2004 through 2006).
The institution had installed an Easy Access Enterprise PACS network, Release 10.1 (Philips Healthcare, Andover, MA), in June 2003, while digital dictation was added a year later.
Reporting time was defined as the time from performing the image exam to availability of the report, while productivity was measured by the number of reports per whole time equivalent (WTE) radiologist per month. Mean reporting times were calculated for plain radiography, CT, MRI, ultrasound, and nuclear medicine studies. The researchers also tracked total department workload and unreported film rates.
Between 2002 and 2006, the number of radiological episodes increased from 11,531 per month to 15,057, an increase of 30%. Meanwhile, the number of WTE radiologists increased only 15% from 32 to 37.
"However, as the reporting times and unreported film rates show, the disproportionate rise in department activity was accommodated by the efficiencies introduced by PACS," according to the authors.
The number of radiographers was reduced during the study period from 74.5 to 71.9 WTE, while the number of clerical staff was also cut from 35 to 27.1 WTE.
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In other findings, productivity grew from 336.6 films reported per radiologist pre-PACS to 406.9 films per month after PACS, an 18% improvement.
The researchers also found a decrease in the number of unreported plain radiographs, dropping from 5% pre-PACS to 4% post-PACS. For the other imaging studies, the number of unreported films declined from 1.11% pre-PACS to 0.97% post-PACS.
"Sustained improvements are felt to reflect the efficiencies and cultural change that accompanied the introduction of PACS and digital dictation," the authors wrote.
Two areas failed to achieve gains from PACS, however. Reporting times increased slightly for general practitioner (GP)-requested plain radiographs, despite a stable number of requested studies. The researchers cited a delay in the scanning of the request form as a cause for the increase.
"Although the change is numerically small, it is an example of how PACS may sometimes reduce the performance of an otherwise efficient service," the authors wrote. "Currently, the GP reporting service is being reviewed, and by prioritizing the scanning of these request forms, the deterioration may be rectified."
In addition, MRI reporting times were also up post-PACS, a development possibly due to the highly specialized nature of these studies.
"Encouragingly, a recent reaudit showed that MRI reporting times were at about a similar level to 2002 (mean reporting time 5.4 days on spot monthly audit in January 2007)," the researchers wrote.
The group is planning a new study this year to examine the impact of speech recognition technology.
By Erik L. Ridley
AuntMinnie.com staff writer
April 24, 2008
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