Policy minimizes reading room interruptions, protocol-related patient delays

Updating protocol and contrast media policies can lead to less interruptions in radiology reading rooms, according to a study published in the Journal of the American College of Radiology.

Elizabeth M. Hecht, MD, and colleagues noticed that radiologists regularly received a lot of phone calls from technologists and nursing staff members while working inside the reading room. Technologists called regarding protocols, and nurses called for contrast media.

The authors acknowledged that prescribing protocols and ordering contrast media are both important parts of a radiologist’s job, but the parade of phone calls was leading to interruptions for patients, technologists, nurses, and radiologists alike.

“For patients, wait times were potentially prolonged because orders were not in place in advance of patients’ arrival to the department,” the authors wrote. “For technologists and nurses, the time spent trying to contact physicians negatively affected throughput and could potentially lead to errors due to interruptions in their workflow. For radiologists, interruptions in the reading room lead to prolonged turnaround times, foreshortened consultations with referring clinicians and readout sessions with trainees and potential errors in image interpretation or reports.”

The authors attempted to fix this situation by making two changes at the institutions where they practice, Columbia University Medical Center and New York-Presbyterian Hospital, both in New York, N.Y. First, they updated contrast media policies to comply with current ACR guidelines and established an algorithm that informed nurses and technologists if they needed to consult with a radiologist.

Second, a brand new policy was put together that permitted the use of standardized order sets for technologists to refer to when ordering a procedure. In addition, a similar policy was created to standardize contrast order sets for CT and MRI scans. Putting these standards in place improved the workflow, but still made it possible for an alternative path to be taken if needed.

“The effort was not intended to limit radiologists in terms of choice of contrast media or dose, as individual patients and clinical situations may require alternative contrast media and doses,” the authors wrote. “The policy allowed radiologists or radiologists in training to substitute any standard contrast order with a US Food and Drug Administration–approved contrast agent on the hospital formulary as long as a signed order accompanied that deviation from the standardized protocol.”

Radiologists, technologists and nurses all underwent training before these new policies were fully implemented. And radiologist for each division would take turns being the “point person” for protocols and be responsible for assigning protocols for cases up to a week in advance. This person would also address additional questions related to protocol or contrast media, so that even last-minute questions would go to this one designated person.

Radiologists were surveyed before these new policies went into effect, three months after implementation and six months implementation. After six months, the results showed:

·         Radiologists who said they received 6-10 phone calls per day to the reading room for contrast orders and protocols dropped 36%.

·         Radiologists who said they received 3-5 in-person visits per day to the reading room for contrast orders and protocols dropped 78%.

Although not an intended goal of the project, the number of radiologists who spent at least 21 minutes in consultation with referrers regarding image interpretation and results dropped 29%.

Technologists and nurses were also surveyed about their experiences. After six months, the results showed:

·         Technologists and nurses who said they could not find a radiologist 3-5 times per day when assistance was needed with contrast orders and protocols dropped 17%.

·         Technologists and nurses who said they spent more than 21 minutes per day trying to contact a physicians for contrast orders and protocols dropped 15%.

Overall, 71% of radiologists and 38% of technologists and nurses said they noticed a definite improvement six months after implementation. These results show that the updated and new policies did lead to fewer interruptions, the authors wrote, but there is still room to research even better ways to improve the situation.

The authors noted that “better integration of the electronic medical record and decision-making support software would likely improve workflow,” and that adding a “reading room assistant” is another way interruptions could be cut down even further.