Filmless in 60 Days: The Impact of Picture Archiving and Communications Systems Within a Large Urban Hospital

Abstract

Many large urban hospitals converting to filmless radiography use a phased approach for digital imaging implementation. In fact, this strategy often is recommended by picture archival communication systems (PACS) experts and vendors alike for large, busy hospitals installing PACS in existing physical facilities. The concern is that comprehensive conversion from film-based to digital imaging may be too overwhelming an adjustment in operations for a medical staff to effectively handle without serious disruption of workflow for patient treatment and care. Elmhurst Hospital Center is a 543-bed hospital located in the Borough of Queens in New York City. Owned by the New York City Health and Hospitals Corporation, this municipal teaching hospital provides services to a patient mix that is 38% indigent with no insurance, 50% covered by Medicaid or Medicare, and 12% affiliated with HMOs. Most inpatients are admitted through the emergency department. Forty-five percent of all radiology procedures conducted are for emergency patients. Historically, up to 25% of all diagnostic imaging examinations were never reported formally by radiologists. Report turnaround time for the remaining 75% was unacceptable, with only 3% of all imaging examinations reported within a 12-hour period in 1996. Both situations existed in great part because physicians and residents who felt they needed access to films simply took them. Many were never located or returned days after they were taken. In 1998, Elmhurst Hospital Center replaced its RIS and added voice recognition dictation capabilities in January 1999. A hospitalwide PACS was deployed 10 months later. With the exception of mammography, the hospital converted to filmless radiography within 60 days. The critical objectives to maintain control of films and radically improve the reporting process were achieved immediately. Over 99% of all examinations now are formally reviewed and reported. Only 7% of all reports take 1 or more days to generate. This report describes Elmhurst Hospital's efforts to make improvements in the delivery of radiology services and the reasons attributed to its rapid conversion to becoming a filmless (mammography excluded) medical center. The impact of the PACS on radiology department operations and service is discussed.

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

“…QMMs appear to have a huge potential to improve the global radiology workflow processes especially when combined with PETs [152][153][154]. Implementing PETs without QMMs is unlikely to yield the optimum results [112,145,152].…”

“…Most of the studies combined multiple PETs [141][142][143][144][145][146][147][148][149][150]. The remainder combined quality management methodologies (QMMs) with PETs [151][152][153][154]. The studies used varied research designs including the post-intervention only design [147,148] and the uncontrolled pre-and post-intervention design.…”

“…The studies used varied research designs including the post-intervention only design [147,148] and the uncontrolled pre-and post-intervention design. In terms of outcome measure, most of the studies reported RTAT [141,142,[146][147][148][151][152][153][154], two studies measured TRWT [143][144][145] and one study reported the PEWT [149].…”

“…Most of the studies reported positive findings [141,142,145,146,150,[152][153][154]. For example, the average RTATs were 115 and 23 h pre-and post-intervention, respectively [141,150].…”

“…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].…”