With the exception of new facilities, a phased approach is often viewed as the most prudent way to proceed on the path to filmless radiology. But a rapid conversion to large-scale PACS can also work, according to the experience of Elmhurst Hospital Center in Elmhurst, NY.
In an article in the June issue of the Journal of Digital Imaging, Elmhurst representatives reported their experience with a 60-day conversion to filmless operation. Elmhurst Hospital Center is a 543-bed municipal teaching hospital owned by the New York City Health and Hospitals Corporation. The center's radiology department performed approximately 116,000 procedures in 1999 (Journal of Digital Imaging, June 2001, Vol 14:2: pp 62-71).
Elmhurst decided to implement PACS as a means to solve its problem of lost films and slow reporting. The facility's emergency department initiated 45% of all requests for radiology procedures, and films often moved with patients before radiologists could report them. And other films were taken away by residents and faculty before they were read and reported, the researchers said. As a result, 25% of all examinations were never reported formally.
As films were retrieved by file clerks, the delays led to slow reporting turnaround times. In 1996, 97% of all of Elmhurst's procedures took 12 or more hours to report.
Some administrative changes -- such as locating a radiologist near the emergency department and CT areas, as well as eliminating the batching of films -- helped, as did the implementation of a speech recognition system. But the gains (33.8% of reports reported and approved within 24 hours) still were not acceptable, the researchers said. In addition, the hospital believed the lost-film problem necessitated a PACS network, with an expedient implementation timeline.
"A comprehensive digital solution was needed to solve the lost-film problem," the researchers wrote. "Phased implementation of a PACS would not have brought the results we required to achieve the projected return on investment."
After months of planning and the enthusiastic support of Elmhurst's executive director and hospital staff, Elmhurst began implementing an Impax PACS network (Agfa, Ridgefield Park, NJ), which included 13 diagnostic workstations with 2K monitors. The emergency department, surgical intensive care unit (SICU), and respiratory intensive care units (RICU) each received a high-resolution, single-monitor diagnostic workstation, while the neonatal intensive care unit (NICU) received a clinical review workstation with dual 1K monitors. Web-based access is provided using existing PCs to the remainder of the hospital.
The system included online redundant array of inexpensive disks (RAID) storage capacity to hold the equivalent of 40 days of examinations, while images are archived on two 500-platter magneto optical disk (MOD) jukeboxes. Elmhurst also employs a backup digital linear tape (DLT) archive off-site for disaster-recovery purposes. Agfa's RIS Broker connects the hospital's RIS (Per Se Technologies) and its speech recognition system (Talk Technology, Bensalem, PA)
Elmhurst launched the PACS network on November 15, 1999, with soft-copy interpretation beginning in most areas. By January 1, 2000, printing of all film (except for mammography) was discontinued. The researchers reported quantifiable advances in lost films and reporting.
"Implementation of a hospital-wide PACS has achieved an improvement in radiology services that were unachievable by other means," the authors wrote. "With the aid of a PACS, Elmhurst Hospital Center gained complete control of a runaway film problem, reducing lost films to 0.01% and unreported films to less than 1% in a matter of 5 months."
By Erik L. Ridley
AuntMinnie.com staff writer
July 9, 2001
Related Reading
Proper training can reduce errors in PACS implementation, July 4, 2001
PACS/RIS integration saves time and money, June 1, 2001
PACS quality control ensures that exams get read, May 30, 2001
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