Automated examination notification of Emergency Department images in a picture archiving and communication system

Abstract

This study compares the timeliness of radiology interpretation of Emergency Department (ED) imaging examinations in a picture archiving and communication system (PACS) before and after implementation of an automated paging system for notification of image availability. An alphanumeric pager for each radiology subspecialty (chest, pediatrics, bone, neuroradiology, and body) was used to alert the responsible radiologist that an ED imaging examination is available to be viewed on the PACS. The paging system was programmed to trigger off of the PACS database when an image is received on the appropriate radiology display station. The pager message includes the radiology accession number and examination description (such as chest, two-view, or c-spine, etc). The PACS paging tool performance was assessed by calculating the time elapsed, for each ED imaging examination, from the Time Imaged to the Time of Interpretation, where the Time Imaged is the actual image completion time measured at the imaging modality, and the Time Interpreted is the time a radiology interpretation is rendered to the ED, and is measured from the Radiology-to-ED fax time stamp. These measures were analyzed pre- and post-paging system implementation to determine any impact of the automated notification tool on radiology service turnaround time. Results show an improved radiology response time from image completion to interpretation rendered to ED clinicians, down from hour(s) to minutes, with the automated paging examination notification system. Examinations are read by the appropriate radiology specialty section in a more timely fashion, and fewer cases go unread by radiology.

Impact of Pager Notification on Report Verification Times

“…Our results are in agreement with those of a study in which implementation in an emergency department of a similar automated paging system for notification of image availability provided more timely reporting and less lost cases without a report (8).…”

“…In addition to improving communication between physicians by producing an official report more rapidly, a reduction in turnaround times can also produce increased revenue because of the fewer days during which charges are in accounts receivable (1)(2)(3)(4)(5)(6)(7)(8). Report turnaround times are also one of the standards regulated by the American College of Radiology (Standard for Communication-Diagnostic Radiology), accreditation organizations, utilization review panels, and some managed care organizations.…”

The Effectiveness of Service Delivery Initiatives at Improving Patients’ Waiting Times in Clinical Radiology Departments: A Systematic Review

“…These technologies included pager-notification systems [135][136][137], digital imaging [138], computer coded reporting [139], workflow management system [140]. Two studies used the controlled postintervention design [138,139] while the remaining studies used the uncontrolled pre-and post-intervention designs [135][136][137]140].…”

“…All five studies measured the RTAT with different timelines and included different patient population as well. Most of the studies reported positive findings [135-137, 139, 140], however one study noted that the gains were not sustained beyond 1 week post implementation of a pager-notification system [136,137]. Mixed results were reported on a digital radiography system [138].…”

“…We illustrate the inconsistent definition of the RTAT outcome measures: the time interval between the examination and the finalised report. This was measured by different studies to start from the: time a patient arrived the X-ray reception desk [138], start of examination [122,154], completion of image acquisition [135][136][137], completion of the examination on the RIS [126,127] and time the image became available on the PACS [140] to the time of final radiology report. Many studies failed to define the timelines used in computing RTAT [92,94,97,105,115,116,120].…”