Hospital emergency departments face more patients even as more and more EDs shut down, and organizations are doing everything they can to attract physicians and patients. New services, advanced technology and faster throughput are a winning combination for many of them, and digital radiography fits the bill — for office and clinic use, too.
The Institute of Medicine (IOM) studied in-depth the shortcomings and challenges facing American emergency care and released several reports last year. A major contributor to the problem is the increasing number of patients — a 26 percent increase in 2003 over the previous decade to almost 114 million patients — while losing 703 hospitals and 425 EDs during the same time frame. The IOM also found that 40 percent of hospitals report ED overcrowding on a daily basis.
DR to meet demand
Hospitals are looking for ways to increase their efficiency even as they offer more and more services. Christiana Hospital in Wilmington, Del., has undergone a $126 million expansion that included 17 additional emergency department bays, six new operating rooms, three additional radiology labs and a new learning center. For a busy emergency department at its maximum capacity, DR offered the quick turnaround time needed. The facility went all-digital last fall, according to Bob Garrett, administrative director. He installed two DR units from Philips Medical Systems in May 2006. The facility’s ED originally had three rooms but because of the expansion, “we were starting to feel the crunch.”
By adding a fourth room and DR, he says they could keep up with demand. That addition also meant that there would always be three rooms available during construction. Two rooms wouldn’t have been able to handle the workload. Garrett says the team was very fearful of what would happen if there was a problem in one of the two existing rooms. “That would have been too risky.” Focusing on throughput got the equipment approved by the administration.
“I think the ED physicians really appreciate the availability of the images,” Garrett says. Besides images being available more quickly, Garrett says he doesn’t have to hear about misplaced films anymore.
Image quality comparable to CR was a big selling point for Garrett. “We like the fact that image quality was very consistent across both CR and DR,” he says. Different image quality would have been a longstanding issue for his radiologists. “We would have continually heard about it. It’s easier to avoid the problem altogether.”
Edward Hospital in Naperville, Ill., installed DR in its emergency department in January 2006, choosing the ddR Formula Plus from Swissray. The hospital’s administration realized that going digital would improve turnaround time and recognized the importance of that in the ED, says Jeffrey Girardot, MD, a vascular/interventional radiologist and chair of the department of radiology. Girardot likes the system because it uses one detector for both upright and supine imaging. “Other companies’ equipment need two detectors,” he says. Swissray also offers 17x17-inch plates compared with the 17x14-inch plates most manufacturers offer. Girardot says those three extra inches are very helpful for larger patients. He also appreciates the spatial resolution of 3.7 to 3.9 line pairs per millimeter. “It’s really good as far as resolution.”
For maximum efficiency, Edward first limited use of the DR equipment to superusers. They then taught the remaining technologists once they were comfortable with the equipment.
DR aids in growth
Facilities expanding their services find DR a good solution to add to the mix. Mary Black Health System in Spartanburg, S.C., opened the $16.3 million, four-story, 109,500 square foot Steadman Hawkins Clinic of the Carolinas on its campus last fall — an expansion of the existing Steadman Hawkins Clinic in Vail, Colo., renowned for sports medicine. The clinic includes a new imaging center. Prior to the new facility’s opening, Mary Black used CR from Fuji but “we wanted to go with more efficient technology when opening the new facility,” says Felipe Patino, Jr., director of diagnostic services. Since the new building is geared to specialists in orthopedic health, “we needed something that could be tailored to their needs.” The technologists were already familiar with Fuji’s software, so bringing in Fuji DR “meant a really low learning curve,” says Patino. “We could quickly get them on board which was a plus.” Patino bought one Fuji Dual SpeedSuite and bought a Shimadzu DAR8000 with Canon plates system that works with the fluoroscopy equipment he needs for some cases. “At the moment, most of the techs gravitate to the Fuji system. They tell me it’s because of the ease of use,” he says.
The 30 orthopedists in the sports medicine practice send their larger patients that they cannot image with CR to the clinic. Patino has noticed that the doctors like the DR quality better. The clinic is still adjusting to the new facility but had planned for growth. As the sports medicine group grows, they send the clinic more work. “We wanted to have something available for them that they didn’t already have,” he says. Plus, the Fuji table can accommodate bariatric patients and large athletes.
The clinic’s administration is very happy, Patino says. “The imaging center is doing very well overall. And, being totally filmless makes for a great environment for staff and patients.”
Springfield Clinic, in Illinois’ capital, has opened one new building and just broke ground on another facility almost as large as its main building. The goal is to consolidate its physicians into one central location close to the hospital. The new multispecialty clinic offers about 60 physicians of numerous specialties.
To accommodate the clinicians, Frana Evans, director of radiology, looked into DR. Once she saw the speed and workflow DR offered compared to CR, there was no question.“
“We estimate we can perform three DR exams in the same time it takes to do one CR exam. The throughput was phenomenal and that’s what we needed,” she says.
Securing the equipment “was initially a hard sell,” she says. Then the clinic’s administrators saw that they could image as many patients with just two DR rooms and a CR room for backup.
The clinic wanted imaging capabilities for long bones, says Evans. All of the options involved a holder and three exposures, except for Kodak. Kodak’s option is one exposure with three cassettes. Rather than stitching exams together, Kodak offers one seamless image that “looks like it was shot with one single exposure,” Evans says. Physicians also can look at each of the three images individually. “We get the best of both worlds.”
Evans looked at the Kodak DirectView DR 9000 at an orthopedic clinic in Houston and was amazed by the versatility. “We could do everything with that unit.” She acquired the system for the clinic. She also saw the Kodak DirectView DR 7500 in the final planning stages. When she saw the option to have an upright detector behind the table, “I was sold,” she says. That gives the tech the capability of cross-table lateral work. Plus, it can be used horizontally for upper extremities. It also goes down to the floor for imaging standing feet. After several generations, Kodak’s DR equipment provides extreme flexibility.
The clinic’s orthopedic surgeons were the hardest to sell on DR, says Evans. “They had never seen DR work.” They didn’t believe her promise that the images would be available on viewing stations before their patients were back in the exam room. Their standard turnaround time was 20 minutes and Evans has been able to reduce that to less than 10 minutes in most cases. The doctors “have adapted better than I ever dared hope,” she says.
Portable potent for OR
Canon Medical Systems was the first vendor to introduce portable DR, which was the perfect fit for CHRISTUS Hospital-St. Elizabeth in Beaumont, Texas. The facility uses a Canon CXDI-50G Portable Sensor on a RadPro 40 kW Portable which has saved about 30 to 45 minutes of additional surgery time, says Janice Clark, radiology supervisor. “The hospital administrators were hesitant due to cost but once the unit was demonstrated in the surgical suite and the benefits were seen by the physicians, administration was sold on the idea,” she says. Their biggest selling point was reduced surgery times. That translates to fewer costs for patients, fewer supplies and fewer staff hours, as well as patients under anesthesia for less time — “a win-win for everybody.”
Once the tech determines whether the tech-nique and position are OK, the images are automatically released to the PACS. DR eliminates the need for hard copy film and imaging plates that have to be digitized. “New technology is making imaging radiology much easier and faster,” says Clark.
Neurologists use DR the most, followed by orthopedists, she says. “It’s a wonderful product to have. It saves time, costs, and it’s the new age of technology for imaging.” Since each unit costs about $250,000, Clark says the hospital will replace its seven $40,000 portable analog units as they near end of life.
Todd Stanley, director of radiology at Indiana University Hospital, has seen many of the same benefits from the AXIOM Aristos FX Plus from Siemens Medical Solutions used at his facility. He had four rooms for conventional radiography and now has three DR rooms. Before DR, the standard exam turnaround time was 60 minutes. It is now down to 20 minutes. He also was able to reduce FTEs. Stanley chose Siemens because the facility did not want to invest in two detectors, which are expensive to maintain. “We wanted one system that would do the most procedures.”
How to choose
As DR technology matures and popularity increases, the cost of DR is slowly coming down, says Stanley. Smaller vendors are getting into the market which helps drive down the price as well.
Lower prices should only increase the number of DR users. To select the best equipment for your needs, Stanley recommends looking at your overall workflow and how DR fits into your system.
“DR is a great technology if you put it in an area with high throughput,” says Garrett. “You’re spending a lot more than you would on CR but it certainly works well in high volume areas.” He suggests looking at where you will put DR equipment and how you will use it.
Girardot recommends going on site-visits and talking with both the technologists and radiologists who take and read images. Look at all the steps required to produce an image, including getting it into a PACS. And, look at all kinds of images taken with DR. “Compare apples to apples to see the benefits,” he says.
Patino says its best to visit facilities that are similar to yours. Then, look at where you want to capture the efficiency of the product. Also, involve physicians and technologists. Physicians need to know that quality won’t be compromised, he says. Be sure to take on your site visits the person who will be responsible for day-to-day operations.