Closed loop imaging project slashes CT tech time 65%
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Even academic medical centers like the University of Chicago are not immune to the effects of reimbursement cuts and bundling discounts that have shuttered scores of imaging centers, Chang said in an interview.
Chang and colleagues devised a CQI to examine bottlenecks and inefficiencies in the CT scanning process. “We found that we are pretty efficient in the reading room, but incredibly inefficient in the scanning area. It makes no difference [to patients and referring physicians] if I’m efficient in the reading room and we are inefficient in the scanning area.”
So Chang and club threw out the conventional definition of turn-around time as they set out to identify the low-hanging fruit and streamline the process.
The new turn-around clock begins when a referring physician decides an imaging study may be contributory to the patient’s diagnosis and ends when the physician receives a report from the radiologist, explained Chang. The goal, he said, is improved information throughput—not just faster patient throughput or expedited report turnaround.
Armed with that definition, Chang and a group of residents combed through the department to detect inefficiencies. They honed in on paper. “When you see a piece of paper, that’s a clue that you have a problem,” offered Chang. That’s because paper indicates that a human is being used as an integrating agent, or to facilitate workflow in some way.
The team found the reading room fairly devoid of paper. But the scanning suite represented a different story. It was littered with paper, and consequently, riddled with inefficiency.
Techs’ work included a lot of busy work—such as calling transport, completing studies in the RIS and reconstructing datasets. “This is a problem,” stated Chang.
To apply the tried and true methods of electronic workflow orchestration, the team had to treat the modality and the injector as IT devices. At that point, they could develop software to offload, integrate and automate the busy work.
Before and after
The revamped protocol process illustrates the power of closed loop imaging.
In the conventional department, the tech has to set up the scanner before the patient can be scanned, which means manually entering data from the RIS into the scanner. However, Chang pointed out, “If you protocol the case correctly, there is only one right way to set up the scanner.”
The researchers automated the protocol process, so that radiologists can automatically protocol the scan via a web client and map the protocol to the scanner via DICOM Modality Worklist Proxy. Techs no longer have to set up the scanner.
“This accomplishes two objectives,” stated Chang. The new model cut set up time from five to 20 minutes to less than one second and it improves quality as it eliminates the occasional tech error. The team further boosted time savings by programming the injector.
Another system-wide benefit of the approach is that it levels the playing field among academic medical centers and community hospitals. Typically, community hospitals steer clear of complex protocols. But with protocol automation a community hospital can offer even the most complex protocols without additional staff training. The end results include increased quality, fewer repeat studies and less overutilization and radiation dose.
The closed loop initiative applies the same principles to other workflow steps including pushing CT angiography (CTA) reconstructions and paging 3D techs. An Intelligent DICOM Router automatically routes studies to the appropriate destination such as PACS or the 3D server.
The end results are compelling. For a standard CT exam such as an abdominal pelvic CT, the closed loop model produced a 66 percent reduction in tech time, from 30 minutes to 10 minutes. The results are similar for complex exams such as CT angiographies; tech turn-around time fell from 45 minutes to 16 minutes, a 65 percent reduction, shared Chang.
“Techs deserve to be optimized. It is possible to improve efficiency by integrating electronic-based workflow in the scanning suites,” summed Chang.
The University of Chicago team completed the project with support from Philips Healthcare and Medrad. Chang said he expects the companies to commercialize the process.
Meanwhile Chang is considering the next stage of the process. He hopes to implement air traffic control for CT add-ons. This step would implement electronic tracking of transport delays and enable automated paging based on anticipated delays.