Interruptions in medical imaging: Delays can take up as much time as core radiology work
A study conducted by researchers at Nationwide Children's Hospital quantified the significant impact of interruptions on radiologists efficiency and patient care in their pediatric radiology department.
The group observed thirteen board-certified pediatric radiologists at Nationwide Children’s for a total of 61 hours. The results reveal that interruptions are common, affecting radiologist workflows and ultimately slowing patient care. The full study is published in Current Problems in Diagnostic Radiology. [1]
Interruptions in radiology and their impact on patient care
The study's authors grouped activities into three main categories: time spent interpreting studies, active interruptions initiated by the radiologist and passive interruptions initiated by external sources. Overall, radiologists spent 52% of their time interpreting studies, 29% involved in active interruptions and 18% of their time involved in passive interruptions.
These interruptions varied based on the type of reading room, with the highest frequency observed during mid-morning and mid-afternoon hours, correlating with increased hospital-wide consultations. In-person conversations or consults constituted about 50% of non-interpretive time, and 16% of this time involved phone calls, of which most were incoming.
“Ninety percent of interruptions lasted less than 3 minutes or less and 70% lasted 1 minute or less. Administrative work, including e-mail, comprised 13% of all non-interpretive time,” wrote lead author Summit H. Shah, MD, and colleagues. “In the main reading room, there was interpretation of 18 CTs, 1 MRI, 32 ultrasounds, and 415 radiographs. In the body reading room, there was interpretation of 11 CTs, 25 MRIs, and 16 radiographs. In the neuroradiology reading room, there was interpretation of 10 CTs, 29 MRIs, and 20 radiographs.”
In short, the study reveals that radiologists spent nearly as much time on interruptions as they did interpreting studies. These interruptions negatively impacted efficiency and report interpretation times. While the researchers acknowledge the importance of communication and consultation in radiology, it suggests that strategic interventions can balance these demands and enhance efficiency.
“Interruptions not only cost the radiologist whatever time it took to address the interruption, but also cost additional total time to finalize the report dictation,” the authors wrote. “Interruptions may increase duplication of work with search patterns that need to start again from the beginning.”
Developing solutions to mitigate radiologist interruptions
Recognizing the need to address the issue of interruptions, the institution utilized these findings as a basis for planning and implementing various interventions as part of a quality improvement initiative. These interventions included changes to the physical environment of reading rooms to create barriers, increased utilization of reading room assistants, the implementation of a new PACS system with a study list manager and intra-department communicator; the standardization of acquisition and reporting protocols; and optimization of trainee schedules to minimize interruptions during interpretative times.
While the researchers did not quantitatively assess the impact of these interventions due to resource constraints, they were anecdotally reported to have led to improvements in workflow and a reduction in interruptions.
“Our department has seen improvements with the interventions already implemented,” the authors wrote. “Future studies should examine the total cost of interruptions and cost-effectiveness of higher resource interventions.”
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