Automating Management of Critical Results

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When Jane Wheatley, CEO of Taylor Regional Hospital, Campbellsville, Kentucky, needed to make a decision regarding her facility’s handling of radiology services, she had two imperatives in mind: cost and quality. After the hospital’s radiology group disbanded in the early 2000s, the 90-bed acute care center contracted with an outside radiology group “under a financial arrangement that was not good for our hospital,” Wheatley says. “The quality was good, but the economics of it were not good at all.”
imageJane Wheatley, CEO
Around a year ago, Wheatley solved the issue by contracting with Franklin & Seidelmann Subspecialty Teleradiology, Beachwood, Ohio, for all radiology services. As a regional hub covering six counties, located 80 miles or so from the nearest large city (Louisville), Taylor Regional Hospital needed 24/7 coverage; Franklin & Seidelmann supplied one full-time radiologist who works on-site Monday through Friday, performs interventional procedures, and provides nighttime and weekend readings remotely. “For hospitals like ours that are more remote, it’s just a wonderful thing to be able to have radiology services 24/7,” Wheatley says. “Now, we have specialists in place, and we can go to them when we need them.” One piece of the puzzle was still missing, however. As a rural acute care facility, Taylor Regional Hospital has a general surgeon on call 24/7, but up until five months ago, when a patient’s diagnosis required advanced imaging after hours, the patient could be sent to a nearby urban area (Louisville, Lexington, or Bowling Green). “In the past, a lot of reports were done by voice clips, so if that wasn’t clear enough, it could create problems,” Wheatley says. “Then, a lot of times, the reports weren’t transcribed until later, so there was a day or two of delay in getting the final report.” Slashing Turnaround Times It’s only been five months since Taylor Regional Hospital implemented Franklin & Seidelmann’s critical-result–management solution into its workflow, but turnaround times have already been slashed from one to two days to a matter of minutes. “We actually have a couple of different levels set up now,” Wheatley says. “We have hyperacute, which means a life-or-death situation, and there we have a 15-minute target turnaround. Then we have stat, which means a 30-minute turnaround.” The management solution is part of Franklin & Seidelmann’s proprietary, Web-based radiology workflow system, and it ensures the automation of critical-results notification. The entire process is fully documented, Wheatley notes, “and we can transcribe and document that conversation on our side as well.” The auditable trail of data helps Taylor Regional Hospital be better prepared for Joint Commission inspections, she adds, and the entire solution is provided free. Before contracting with Franklin & Seidelmann, Taylor Regional Hospital was dividing its radiology services between the outside group, which covered daytime, and a night-coverage teleradiology provider. This led to some confusion regarding the handling of critical results. “It would be a combination of the on-site physician or the teleradiologist calling,” she says. “You catch it, you make this call, and you make that call.” Wheatley explains that now, the report is not only sent to the ordering physician within the new, abbreviated timeframe; Franklin & Seidelmann also makes a phone call to confirm that the results have been received. “There’s somebody available 24/7 to call our physicians, and if it’s after hours, the call goes to a general surgeon or to the emergency department,” she says. “There wasn’t a system in place before to make sure everything was handled appropriately and in a timely manner. It was more informal. Now, we’re hitting the 30-minute mark on stat results around 75% of the time, and we’re at 98% for 60 minutes.” Fringe Benefits The new critical-results–management system gives Taylor Regional Hospital’s physicians the opportunity to discuss findings with Franklin & Seidelmann’s subspecialty radiologists—an enhancement that Wheatley says improves patient care. “Even on the findings that aren’t critical, our physicians have the opportunity to go over results with the radiologist,” she says, “but it’s especially useful with critical findings. They like having the opportunity to discuss the films.” Taylor Regional Hospital’s facility includes a five–year-old cancer center visited weekly by a mobile PET/CT unit. “It’s been very good for the cancer center from a diagnostic perspective,” Wheatley says. “It’s able to do the scans it needs and treat the patient without having to send him or her elsewhere.” Because more patients can be kept on-site with the rapid turnaround of critical radiology results, Wheatley also notes that Taylor Regional Hospital has benefited financially from the new system. “We continue to treat those patients here,” she says, “which we weren’t always able to do before. If it’s something the general surgeons needed critically and they couldn’t get the results, they used to transfer the patient. Now ,they’re able to operate on the patient here.” Of course, patients benefit as well; nowhere is this more evident than in Taylor Regional Hospital’s handling of potential stroke patients. “We do a lot of stroke triage,” Wheatley says. “We have a robot through the University of Louisville that gives us immediate access to its stroke team. In the past, we would have been transferring patients to Louisville if we couldn’t get an answer on their images soon enough. Now, we can get those results back and administer the medications here, and that means we can keep the patients here. They don’t want to be flown to Louisville if they can stay here. It’s been a win–win situation for our physicians and our patients.” Cat Vasko is editor of and associate editor of Radiology Business Journal.