Hot topic: Knowing your procedure room workflow
The “hot topic” at SIIM 2007 in Providence, R.I., yesterday was procedure room workflow. Speakers discussed the challenges at their facility, improvements they have made and how the industry can better meet their needs.

Keith Horton, MD, director of radiology informatics at Washington Hospital Center in Washington, D.C., discussed the switch from paper-based systems to HI-IQ. In 2000, an interfacing team was developed to streamline processes, which Horton said is very much still a work in progress. They started solely with quality assurance and gradually add on more modules, such as inventory management, scheduling, forms and data management and billing. This helps with Joint Commission compliance, increasing efficiency and productivity, increasing patient safety and quality and generating reports. The hospital used to use a whiteboard and paper cards, a system rife with problems. Now, a digital whiteboard is readily visible, replicates information, solves patient tracking issues, and includes a touch screen. The QA module facilitates the use of best practice standards developed from SIR. The 11 forms required for each patient have now been included in the electronic record module, which can be customized to look exactly like forms. Other features, such as a room utilization analysis tool, allow Horton and his team to review the use of a particular room and hours used for which procedures and how long it was idle.

Increasing efficiency is a continuing issue, Horton said. There are ongoing problems with staff buy-in, it is not mobile (without adding an entire platform), there are no alarms, it is not web-based and there are screen refresh issues.

Steven Horii, MD, from the department of radiology at the University of Pennsylvania Medical Center in Philadelphia, discussed the challenges associated with intraoperative ultrasound. The procedure is required to help surgeons find abnormalities, identify normal anatomy, and guide procedures. However, it is very disruptive to both the radiology and the surgery workflows.

Intraoperative ultrasound takes both a radiologist and a sonographer out of the radiology department. It can be either scheduled or unscheduled. While scheduled procedures require a fair amount of coordination, unscheduled procedures are “much more painful,” Horii said. The interaction of the two department workflows is highly variable and involves multiple people and services. It causes delays in both areas, leaving patients under anesthesia for a longer period of time and holding up other surgeries and radiological procedures. However, about 30 percent of the time, surgical procedures are altered because of what was found. So, both radiologists and surgeons will continue to tolerate the disruptions because of the procedure’s value.

Horii said that solutions are in the works, even being done at some facilities. For example, in some facilities, surgeons train so they can do the scans themselves. And, some vendors are working on developing surgical PACS, or S-PACS, designed to better accommodate the speed required to display real-time ultrasound.

Neil Halin, DO, chief of cardiovascular interventional radiology and co-director of advanced cardiac imaging at Tufts New England Medical Center in Boston, discussed the inherent challenges in procedure workflow. From the start, order generation and scheduling can be “a huge nightmare.” Even if the physician inputs an order via CPOE, there are frequent problems with entering the correct study for a particular patient.

Halin has 19 different monitors in a control room for three procedure rooms. He needs so many because the equipment from different vendors cannot be interfaced. He described a lack of integration, “islands of function” and vendor wars as barriers to overcome for better image and data display. “Everything is proprietary,” he said. “There are no common standards for controls, data presentation or networking.”

Aside from these problems, the technology itself is somewhat fragile. Some screens are touchscreen so people sometimes forget that others are not. Neither is very durable, Halin said.

Despite this, the solution to the need for physicians to access more data has been more monitors. Large-format, high-definition displays are now available. Halin said vendors need to integrate the display space and design a window that shows “what you need, when you need it,” whether that is the actual image or reports from prior studies. One or two large format, color screens would optimize the task at hand, decrease or perhaps eliminate the need to descrub and leave the room and improve the ability to collaborate with other clinicians.

Interventional radiology has largely been ignored by the IT revolution, Halin said. This area has significant needs in quality control, inventory control, and user interfaces to equipment and other data.