When Schuylkill Health in Pottsville, Pennsylvania, started evaluating PACS to replace an existing system, a radiology information system (RIS) was not on the shopping list. The radiology department that served two hospitals and two specialty imaging centers used a hospital information system that had provided basic RIS functionality.
Once the PACS replacement evaluation team learned how versatile RIS could be, they began to reconsider. The functionality of a critical-and-urgent-results module offered with a Synapse RIS from FUJIFILM Medical Systems U.S.A., Inc., Stamford, Conn. was a compelling factor that convinced the radiology department and hospital administrators to allocate the funds to purchase an integrated Synapse RIS/PACS. With the launch of the new system in August 2013, visible improvements in workflow and efficiency in the radiology department have had a ripple effect that has spread throughout the hospital, positively impacting patients and caregivers.
Schuylkill Health serves the population of Schuylkill County located in Northeastern Pennsylvania. Its two hospital campuses total 305 beds and several freestanding clinics provide auxiliary services. Four full-time and two part-time radiologists interpret the 125,000 imaging exams performed annually, augmented by the services of an interventional radiologist and specialty after-hours teleradiology.
“The radiology department was making do with what it had, but our hospital administrators knew that major improvements were needed to guarantee critical and urgent results reporting,” says Luke Rissinger, BS, RT®(MR)(CT), CIIP, PACS administrator, Schuylkill Medical Center–East Norwegian Street. “The process was manual, inefficient, and labor-intensive, and not at all foolproof. We always were worried about accidentally overlooking something and having a patient who needed immediate care fall through the cracks. The critical/urgent results reporting and escalation management module in the Synapse RIS has changed this situation dramatically. It’s like night and day.”
Prior critical-results workflow
In the pre-RIS era, a radiologist would document whatever action he/she took to notify an ordering physician/physician’s assistant/nurse practitioner as part of the radiology report and in a “notes” field in the PACS. This would include the date and time of a requisite telephone call and a summary of the conversation if one took place. Other details included the time a faxed report was sent or a voicemail or answering service message was sent, as well as the need (if applicable) to call again.
However, the only way to track an “open” critical or urgent results notification alert was by manually recording the name of the patient. And although radiology department staff were diligent about adding notes to the patient’s records in PACS after the results had been reported to the ordering physician or the staff covering for him, there was no way to automatically check that this had been done except by opening up the patient’s file using a manual list and double-checking. This was done as part of the department’s protocol, but it was laborious and time consuming.
Today, when a radiologist needs to notify medical staff about critical or urgent results, he or she still picks up the telephone. That is the protocol. But thanks to a streamlined workflow utilizing the Powerjacket of the Synapse PACS, the radiologist is enabled to more efficiently document the process, with every activity made time stamped. If the results are successfully conveyed, a response is noted and the feedback loop is closed.
If it is not, the patient’s file enters one of two “uncompleted” worklists, one for critical results, which must be communicated to an ordering physician or colleague covering him or another for urgent results. A member of the supervisory staff in the department takes responsibility at that point. Hospital policy requires that critical results—such as a cerebral hemorrhage/hematoma, pneumothorax, acute appendicitis, pulmonary embolism, ruptured aneurysm—must be directly conveyed by the radiologist to the patient’s caregiver within 60 minutes. Urgent results, which include such conditions as pneumonia, an abscess, fractures, cholecystitis or congestive heart failure, need to be communicated within eight hours, but can be conveyed to the caregiver by a radiology staff member and
Cynthia Keen is a contributing writer for Radinformatics