Emergency department (ED) physicians use PACS technology to view imaging studies concurrently or even before radiologists, potentially resulting in discrepancies and miscommunication, according to a study presented at the recent 2006 RSNA meeting in Chicago.
"Quality service in an emergency setting may require multiple systems; we can take a look at policies that we can implement, timely reporting, discrepancy handling, and look to find ways to capture emergency physician (findings) related to imaging," said Christopher Toland, who is from the University of Maryland Medical Center (UMMC) in Baltimore, and presented the group's research.
The study aimed to determine how fast is fast enough to have the report alongside the images for effective medical management in the ED, Toland said.
"We want the reports there when the ED physician looks at the images," he said.
In an ideal workflow setting, radiologists would read the studies following image acquisition, then send the results to the ED physician. At UMMC, residents may read the study, the attending radiologist will either agree or disagree with the findings, and get the results to the ED physician, Toland said.
"What we noticed was that emergency physicians are viewing them before the images or studies get to the radiology domain," he said. "The problem is, there are opportunities for discrepancy and miscommunication at each step."
The researchers mined PACS audit logs between January 1, 2006, and April 5, 2006, noting when studies were accessed, when preliminary reports were offered, when reports were dictated, and the patient care roles of those accessing studies. They then determined who was the first to view the imaging study and in what percentage of cases radiology interpretations were available at the time of initial ED physician review.
Of the initial dataset, 8,385 met the criteria of a patient location correlating to the ED and a preliminary or final report available within one hour to the PACS.
Of the cases, 64% were first reviewed by a radiologist and 32.9% were first reviewed by the ED physician. Only 51% of the cases had interpretations available at the time of ED physician review of the studies, Toland said.
In addition, 66.7% of the cases were not reviewed by the ED physicians after last changes such as markups or annotations. ED physicians never reviewed 29% of the completed imaging studies.
The mean time from study arrival until the initial radiologist review was 21.83 minutes, while the mean time from study arrival until initial ED physician review was 21.7 minutes.
ED physicians viewed computed radiography (CR) exams first before a radiologist in 39.1% of the cases, compared with 27.7% for CT and 11.5% of MRI.
"If we want to hit the majority of cases, one example is that we could try to improve rapid reporting for just CR," he said. "If we want to take a look at studies that we've noted that ED physicians are outside of their comfort zone such as CT, we could focus on those as well. If we're unable to improve either one of these, that makes discrepancy handling even more important."
Some technology that can help improve radiology reporting turnaround times include speech recognition software, automated postprocessing for 3D tasks, and advanced notification systems for passing along significant findings, Toland said.
By Erik L. Ridley
AuntMinnie.com staff writer
December 11, 2006
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