Impact of a diagnostic workstation on workflow in the emergency department at a level I trauma center (original) (raw)
Related papers
Journal of Digital Imaging, 1998
Picture Archiving and Communication Systems (PACS) make possible the viewing of radiographic images on computer workstations Iocated where clinical care is delivered. By the nature of their work this feature is particularly useful for emergency physicians who view radiographic studies for information and use them to explain results to patients and their families. However, the high cost of PACS diagnostic workstations with fuller functionality places limits on the number of and therefore the accessibility to workstations in the emergency department. This study was undertaken to establish how well less expensive personal computerbased workstations would work to support these needs of emergency physicians. The study compared the outcome of observations by 5 emergency physicians on a series of radiographic studies containing subtle abnormalities displayed on both a PACS diagnostic workstation and on a PC-based workstation. The 73 digitized radiographic studies were randomly arranged on both types of workstation over four separate viewing sessions for each emergency physician. There was no statistical difference between a PACS diagnostic workstation and a PC-based workstation in this trial. The mean correct ratings were 59% on the PACS diagnostic workstations and 61% on the PC-based workstations. These findings also emphasize the need for prompt reporting by a radiologist.
Journal of Digital Imaging, 2002
The purpose of this study was to evaluate the effect of a switch to a filmless image management system on the time required for technologists to produce radiographic images in the emergency department (ED) after controlling for exam difficulty and a variable workload. Time and motion data were collected on patients who had radiographic images taken while being treated in the emergency department over the 3½-year period from April 1997 to November 2000. Event times and demographic data were obtained from the radiology information system, from the hospital information system, from emergency department records, or by observation by research coordinators. Multiple least squares regression analysis identified several independent predictors of the time required for technologists to produce radiographic images. These variables included the level of technologist experience, the number of trauma-alert patient arrivals, and whether a filmless image management system was used (all P < .05). Our regression model explained 22% of the variability in technologist time (R 2 Adjusted, 0.22; F = 24.01; P < .0001). The regression model predicted a time saving of 2 to 3 minutes per patient in the elapsed time from notification of a needed examination until image availability because of the implementation of PACS, a delay of 4 to 6 minutes per patient who were imaged by technologists who spent less than 10% of their work assignments within the ED, and a delay of 18 to 27 minutes in radiology workflow because of the arrival of a trauma alert patient. A filmless system decreased the amount of time required to produce radiographs. The arrival of a trauma alert patient delayed radiology workflow in the ED. Inexperienced technologists require 4 to 6 minutes of additional time per patient to complete the same amount of work accomplished by an experienced technologist.
Human Factors: The Journal of the Human Factors and Ergonomics Society, 2019
Objective: This study traces the evolution of perceptions and use of computed tomography (CT) by radiology technicians in the emergency department (ED) of a hospital in Italy across a 7-year period. Background: The sociotechnical context of the CT room of an ED has been neglected by scientific research—potentially impacting safety. Method: Two studies were performed, one in 2011 and one in 2018. Six CT technicians were involved in each. Structured interviews were performed to gather information on perceptions related to the evolution of the use of CT according to nine different factors—e.g. the level of complexity, and mental workload. Observations were performed on duration of exams, the flow of people, conversations, and any critical issues. Results: The CT technology is appreciated, used effectively and with confidence by CT technicians. From 2011-2018, the execution times of the exams have decreased but not the proportion of time dedicated to the patient. Expectations for future...
The transmission and interpretation of emergency department radiographs
Annals of Emergency Medicine, 1982
Twenty-five radiographic studies representative of the spectrum of trauma cases that might present to an emergency department were selected from actual cases presenting at Brooke Army Medical Center (BAMC) in San Antonio, Texas. The studies were then transmitted from a local television studio via satellite back to BAMC and three other Army hospitals. A panel of 29 physicians (11 radiologists, 7 emergency physicians, and 11 others from various specialty areas) viewed the images on commercial grade television sets and attempted to make a diagnosis. The diagnostic accuracy of the radiologists (86%) was significantly better than that of the other two groups (77% each). However, given the overall expense of a teleradiology network, this difference in accuracy-especially when translated into clinically significant errors-might not justify the establishment of such a network in terms of cost-effectiveness.
PACS and CR implementation in a Level I Trauma Center Emergency Department
Journal of Digital Imaging, 1998
Implementation of a picture archive and communication system (PACS) at a large teaching hospital is an expensive and daunting endeavor. The approach taken at the University of Alabama Hospitals has been to assemble an institution-wide system through focused integration of smaller mini-PACS. Recently a mini-PACS using Computed Radiography (CR) has been placed in the Emergency Department (ED) of a Levell Trauma Center completely replacing conventional screen-film radiography. This area of the hospital produces approximately 250 images per day and provides many challenging requirements: the need for rapid radiography; providing good image quality for difficult examinations with potentially uncooperative patients; reproduction of lost films to maintain availability of images to multiple consulting teams; and frequently unknown patient demographics. The PACS includes both vendor-supplied and in-house developed devices for image storage, distribution, and display. Digital images are produced using two photostimulable phosphor CR systems. Currently, all radiographic examinations are acquired digitally with production of a hard copy film as well as electronic distribution via the PACS. Interpretation of images is done primarily via hard copy with a goal of transition to soft copy interpretation. This paper discusses the functional requirements of the PACS and solutions to workflow issues arising in the ED.
Improving quality of communications in emergency radiology with a computerized whiteboard system
Clinical Radiology, 2010
In the past decades, there has been a steady increase in patient visits to emergency departments (EDs) in the US. According to the US National Hospital Ambulatory Medical Care Survey (NHAMCS), there were approximately 119.2 million ED visits (or 40.5 visits per 100 persons) during 2006. When compared with data of 1996, the ED visit rates have increased on an average of 32%. 1 Unsurprisingly, the number of imaging examinations obtained in the ED is also rising, particularly advanced imaging examinations, such as computed tomography (CT). This was confirmed by a study performed at a large academic medical centre reporting a range of 42.3% to 496.6% increase in CT utilization in the ED from 2000 to 2005. 2 Advances in computing technologies have enabled CT and magnetic resonance imaging (MRI) systems to rapidly acquire images in high resolution, resulting in improved diagnostic accuracy and increased use of such technologies in the ED. 3 This has placed additional stress on emergency radiology teams from accepting requisitions, performance of examinations, and communication between the radiology personnel taking care of emergency patients. The goal of the emergency radiology service is to provide optimal radiological care to all patients in a timely manner. Because several processes and personnel are involved to achieve this goal, the system is prone to errors and delays; in busy EDs, these can contribute to suboptimal patient care. Therefore, there is a need for a streamlined, real-time process that keeps the emergency radiology service an efficient, well-oiled machine.
Turkish Journal of Emergency Medicine, 2015
Objectives To compare the differences between conventional radiography and digital computerized radiography (CR) in patients presenting to the emergency department. Methods The study enrolled consecutive patients presenting to the emergency department who needed chest radiography. Quality score of the radiogram was assessed with visual analogue score (VAS-100 mm), measured in terms of millimeters and recorded at the end of study. Examination time, interpretation time, total time, and cost of radiograms were calculated. Results There were significant differences between conventional radiography and digital CR groups in terms of location unit (Care Unit, Trauma, Resuscitation), hour of presentation, diagnosis group, examination time, interpretation time, and examination quality. Examination times for conventional radiography and digital CR were 45.2 and 34.2 minutes, respectively. İnterpretation times for conventional radiography and digital CR were 25.2 and 39.7 minutes, respectively. Mean radiography quality scores for conventional radiography and digital CR were 69.1 mm and 82.0 mm. Digital CR had a 1.05 TL cheaper cost per radiogram compared to conventional radiography. Conclusions Since interpretation of digital radiograms is performed via terminals inside the emergency department, the patient has to be left in order to interpret the digital radiograms, which prolongs interpretation times. We think that interpretation of digital radiograms with the help of a mobile device would eliminate these difficulties. Although the initial cost of setup of digital CR and PACS service is high at the emergency department, we think that Digital CR is more cost-effective than conventional radiography for emergency departments in the long-term.
Time factors associated with CT scan usage in trauma patients
European Journal of Radiology, 2009
Introduction: While computed tomography (CT) scan usage in acute trauma patients is currently part of the standard complete diagnostic workup, little is known regarding the time factors involved when CT scanning is added to the standard workup. An analysis of the current time factors and intervals in a high-volume, streamlined level-1 trauma center can potentially expose points of improvement in the trauma resuscitation phase. Materials and methods: During a 5-week period, data on current time factors involved in CT scanned trauma patients were prospectively collected. All consecutive trauma patients seen in the Emergency Department following severe trauma, or inter-hospital transfer following initial stabilizing elsewhere, and that underwent CT scanning, were included. Patients younger than 16 years of age were excluded. For all eligible patients, a complete time registration was performed, including admission time, time until completion of trauma series, time until CT imaging, and completion of CT imaging. Subgroup analyses were performed to differentiate severity of injury, based on ISS, and on primary or transfer presentations, surgery, and ICU admittance. Results: Median time between the arrival of the patient and completion of the screening X-ray trauma series was 9 min. Median start time for the first CT scan was 82 min. The first CT session was completed in a median of 105 min after arrival. Complete radiological workup was finished in 114 min (median). In 62% of all patients requiring CT scanning, a full body CT scan was obtained. Patients with ISS >15 had a significant shorter time until CT imaging and time until completion of CT imaging. Conclusion: In a high-volume level-1 trauma center, the complete radiological workup of trauma patients stable enough to undergo CT scanning, is completed in a median of 114 min. Patients that are more severely injured based on ISS were transported faster to CT, resulting in faster diagnostic imaging.
Injury, 2009
Trauma remains a leading cause of morbidity and is the sixth leading cause of death in Hong Kong. 7 Management of the trauma patient is multifactorial, 2 but the concept of rapid accurate diagnosis and timely appropriate treatment are central to quality trauma care. Advances in imaging have led to computed tomography (CT) scanning playing a central diagnostic role for trauma patients. CT is fast, accurate and cost effective in providing clinically useful information in a single examination. A recent study showed that integration of high resolution CT scanning into the early diagnostic protocol markedly reduces the length of stay in the trauma room and facilitates rapid therapeutic intervention. In order to provide improved accessibility to CT for the trauma patients, a 16-slice multi-detector computed tomography (MDCT) was installed in the emergency department (ED) of Prince of Wales Hospital (PWH) of Hong Kong in December 2004. The CT room is less than 15 m from the doors of the trauma resuscitation rooms within the ED. The ED CT scanner is available for the investigation Injury, Int.
Emergency Medicine Journal, 2008
Background: Radiographs are vital diagnostic tools that complement physical examination in trauma patients. A study was undertaken to assess the performance of residents in emergency medicine in the interpretation of trauma radiographs. Methods: 348 radiographs of 100 trauma patients admitted between 1 March and 1 May 2007 were evaluated prospectively. These consisted of 93 cervical spine (C-spine) radiographs, 98 chest radiographs, 94 radiographs of the pelvis and 63 computed tomographic (CT) scans. All radiological material was evaluated separately by five emergency medicine residents and a radiology resident who had completed the first 3 years of training. The same radiographs were then evaluated by a radiologist whose opinion was considered to be the gold standard. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results: The mean (SE) age of the patients was 29 (2) years (range 2-79). There were no statistically significant differences in terms of pathology detection between the emergency medicine residents and the radiologist. The agreement between the emergency medicine residents and the radiology resident was excellent for radiographs of the pelvis and the lung (kappa (k) = 0.928 and 0.863, respectively; p,0.001) and good for C-spine radiographs and CT scans (k = 0.789 and 0.773, respectively; p,0.001). Conclusions: Accurate interpretation of radiographs by emergency medicine residents who perform the initial radiological and therapeutic interventions on trauma patients is of vital importance. The performance of our residents was found to be satisfactory in this regard.