Impact of electronic imaging on clinician behavior in the urgent care setting

Abstract

Although it is intuitively valuable that more expedient delivery of radiographic images and reports to clinicians would improve patient care, it is important to document these outcomes to validate further advances in these areas. We evaluated the care of 215 patients seen at a walk-in clinic to determine what benefit digital imaging is to the patient. Cohorts consisted of all patients for whom specified radiology examinations were ordered during a 7-day period. The first cohort was recruited when analog films were used. The second cohort received examinations performed with computed radiography (CR) acquisition and computer display, which had been in use for 2 years. Patients were categorized as to the type of study they received, as well as whether a staff radiologist was immediately available to read the study. Clinical behavior was characterized by outcome measures of time to final diagnosis, time to final treatment, and need for follow-up. Our analysis demonstrated a reduction in time to final diagnosis that was better appreciated during the times when a staff radiologist was not immediately available. It also suggested that greater time reductions were seen for patients who received extremity examinations than those who received chest, sinus, or rib fUms. These data suggest that digital imaging is a useful tool to improve clinical outcome of patients seen in the acute care setting. Copyright 9 1999 by W.B. Saunders CompanyI N THE CURRENT ERA of digital imaging, with the widespread use of computed radiography (CR) and picture archiving and communication systems (PACS), it is assumed that these advances have correlated to an improvement in the delivery of patient care. Many authors have examined this question focusing on time savings in regard to patient, film, and report flow times. ~-3 The results of these investigations have varied with the state of technology, the clinical setting, and the users' experience. Others have looked at the manner in which clinicians use a PACS. 4,s However, research focusing on the effects of digital technology on clinical behavior is limited. ~ We are currently at a point in time where the technology has been refined and well established in clinical practice, v-I~ As radiology departments around the country are replacing conventional film/screen radiography units with CR and PACS, little evidence exists that these investments truly benefit the patient. Our aim, then, was to answer that question.