When this process was simplified, the entire department benefited

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 - Improved Quality Get Better

Making significant workflow changes at large academic medical centers can be quite difficult, but a team of researchers at the Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee, were able to do just that. Lead author Richard G. Abramson, MD, and colleagues shared their success in the Journal of the American College of Radiology, providing an in-depth look at what they changed and the impact it had on the entire radiology department.

At VUMC’s department of radiology, the authors explained, 1 to 2 percent of the 600,000 procedures performed each year are done entirely for research purposes, and it had created some potential issues for the entire department.

“Because most research imaging is embedded within the routine clinical workflow, steps must be taken to ensure protocol and billing compliance (that is, research subjects must be scanned according to trial-specific imaging guidelines, which often differ from standard-of-care clinical protocols, and research procedures must be appropriately billed to either a research grant or to a patient’s medical insurance, depending on the study),” wrote Abramson et. al. “The stakes for protocol and billing compliance are high: Protocol deviations may diminish the usefulness of acquired research data and could prompt sponsors to close their studies, while billing compliance violations could lead to civil and even criminal penalties for the institution.”

These issues had long been contained via trial-specific radiology research study orders (RRSOs), which contained key information about how to acquire and bill the examinations. However, the workflow surrounding RRSOs was complex and those involved were not happy. So Abramson’s team worked to improve RRSO workflow process, hopefully fixing it one and for all.

Creating change

The first step was to establish a committee responsible for simplifying the RRSO workflow from the ground up. “The committee included the radiology modality technologists responsible for research, their managers, and representatives from the compliance office, billing office, and radiology finance, scheduling, and registration,” the authors wrote. “A radiology physician-scientist faculty member was recruited to serve as the committee chair. Over time, the committee grew to include representatives from the VUMC research oversight and IT offices.”

The committee worked to fully understand the current workflow, mapped it out in great detail and developed a list of its issues. This helped them determine root causes for the department’s compliance errors—scans being ordered too early and errors in how the RRSOs were filled out, for example—and began deploying solutions to prevent those issues from happening again.

An online collaborative platform was implemented that allowed users to track the RRSO process from beginning to end, a detailed user’s manual was created, and the entire workflow was simplified. One of the key elements of simplifying the workflow, the authors noted, was shifting leadership responsibilities to a specific technologist.

“Under the new core system, a dedicated radiology modality technologist now oversees the entire workflow process, is the centralized point of contact for researchers and workflow participants, and coordinates all interactions between stakeholders,” the authors wrote. “The technologist-administrator has protected time to engage in core duties, and the radiology department receives compensation for this dedicated effort by charging an administrative fee back to individual research grants.”

The benefits of a simplified workflow

Abramson and colleagues reported that their updates were a huge success for VUMC’s department of radiology. Six months after implementation, RRSOs had been created for 135 clinical trials. The average turnaround time for creating the RRSOs improved dramatically, going from 3-6 months to 2-3 weeks. In addition, stakeholders reported increased satisfaction, as measured by a seven-point Likert-like scale. Before implementation of the team’s changes, satisfaction ranged from 2.83 to 3.92; after implementation, it jumped to a range of 5.12-6.31.

Administrators will also be pleased to know the updated workflow resulted in cost savings for the department. “By charging research studies for administrative work that was previously provided free of charge, the radiology department now saves an estimated $82,200 per year in formerly uncompensated technologist effort,” the authors wrote.