Community hospitals have a unique set of needs when it comes to imaging. Though they also once faced a corresponding set of challenges, advances in telecommunications have, to some degree, leveled the playing field, enabling them to provide radiology services on par with those of their larger peers. ImagingBiz.com spoke with David Harrison, RT, MBA, imaging services manager at Wooster Community Hospital (WCH) in Ohio, about what community hospitals want from their radiologists.
ImagingBiz.com: As imaging services manager at WCH, which aspect of your radiology provider’s service is most important to you?
Harrison: It’s very difficult to pin that down; there are multiple facets to be concerned about—we want rapid report-turnaround time, but as a community hospital, we need to be able to provide on-site service for our patients. We need a radiologist on-site who can do fluoroscopy, and in our community, we also want to provide interventional procedures.
If I have great report-turnaround times, that’s good, but if I still need to send patients away for procedures we can’t provide, the community loses out on a complete radiology service department; if I can do interventional procedures here, but my turnaround times are two weeks, that won’t work, either. We need to balance on-site services with interventional capabilities and report-turnaround time to provide our patients with the complete package.
ImagingBiz.com: How are you tracking report-turnaround times, and what are your expectations?
Harrison: We have it broken down into several classifications. We like to have routine studies turned around in 24 hours, and with our current group, the average turnaround time is around seven hours.
We have another classification, known as expedited: Those would be the inpatients who are stable, but we prefer a short length of stay, so we would rather not wait 24 hours for the results. Generally, the expedited cases are back within four to six hours.
The big one is, of course, the stat-case category, because stat exams are the catch-all: everything from the emergency department to potentially serious issues spotted by a referring physician in the office. We want those turned around as quickly as possible. At WCH, our fourth-quarter 2010 numbers showed 86% back within 30 minutes, with an average of 22 minutes for all cases, once they were received by the radiology group.
The last classification is hyperacute, and that could be any life-threatening situation. Those are required back in less than 30 minutes, and we’re hitting that mark.
ImagingBiz.com: How do you approach critical findings?
Harrison: I got lucky on this one, because we’re working with Radisphere (Beachwood, Ohio), and their system for handling critical results is great. If there is a critical finding determined by the radiologist, he or she (or his or her designee) will make contact with the referring physician, and will relay the finding.
What’s exceptionally nice about the way this is handled, for us, is that if you look at WCH final reports, there’s documentation that the critical-finding results were relayed to the right person, at the right time. To me, that’s huge, because it makes the tracking required by the Joint Commission much easier.
ImagingBiz.com: What kind of peer-review process do you have?
Harrison: We have a couple of things in place. With our general radiologists, about 2.5% of cases are pulled and evaluated in a peer-review process. A second radiologist overreads the study; if he or she concurs with the finding, the review is complete, but if there’s a disagreement, a second radiologist is involved. If Radisphere finds a perceived error, it will review the case and make sure to achieve consensus among the individuals on its quality-assurance (QA) committee before talking to the radiologist. It provides checks and balances.
The other option I like is that if I get a call from a referring physician questioning the results of a study, I can submit that case for QA review, and the study goes for double-blind overreading. I get documentation back that says the case was reviewed and shares the outcome, and if an addendum is required, the referring physician is contacted. I also receive a quarterly report on the radiologists who read for me, showing the cases reviewed and the percentage of errors (classified according to the acuteness level of the patient’s condition).
ImagingBiz.com: Is there a way to quantify radiology’s