Emergency Imaging in Flux

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 Digital image management processes and advanced imaging systems are changing imaging across the enterprise. The trend is particularly apparent in the emergency department (ED). For starters, digital x-ray expedites patient care, helping clinicians improve throughput. And more departments are turning to other modalities, specifically clinician-based ultrasound, to achieve the common goal of all EDs—efficient, high-quality patient care. Others continue to fine-tune digital processes, developing systems to help manage discrepancies between ED and radiology image interpretations. The ED is not exempt from the explosion in imaging volume. In fact, volumes are increasing, particularly in the data-intense modalities: CT and MRI. On one hand, advanced imaging systems provide data key to accurate diagnosis and rapid treatment. On the other hand, however, increased use of CT and MRI can create backlogs and delay care. The upshot? Digital acquisition and review systems can improve the ED environment, but real progress requires training and planning.

Digital x-ray and the ED

Christiana Care Health System operates two hospitals in the Wilmington, Del., area. Christiana Hospital is a 780-bed acute-care hospital in Newark, Del. It houses a busy ED that sees approximately 80,000 patients annually. The 250-bed Wilmington Hospital has an ED volume in the 20,000 range. Last year, the health system outfitted both sites with Philips Medical Systems digital x-ray systems including two Digital Diagnost Dual Detector DR VMs and 23 computed radiography (CR) systems. ED physicians view images on Philips iSite PACS workstations located throughout the department.

“Digital imaging has improved our ED turnaround. Physicians can see images quicker and thus make [informed and accelerated] treatment decisions,” exp-lains Robert Garrett, administrative director of radiology. Christiana Hospital also has invested in complementary systems to boost efficiency and enhance patient care. For example, three years ago the ED deployed Patient Care Technology Systems EDTracker. The project entailed placing 300 infrared and radiofrequency (RFID) sensors throughout the ED and radiology departments. Now, all ED staff and patients wear a small RFID badge, so they can be tracked throughout the system.

Physicians and other care providers know exactly where patients are located and no longer need to chase patients to transport them to or from radiology. In addition, a stoplight feature monitors the number of patients arriving in the ED. That means when ED volume is high the radiology department can pull staff accordingly to better meet ED needs and maintain patient flow, says Garrett. Ultimately, the combined solutions produce an efficient ED with fluid imaging and patient treatment processes.

Still, Christiana Care plans to squeeze the last drops of efficiency out of its systems. The hospital plans to create an interface between iSite PACS and EDTracker to improve communication between the ED and radiology. “Right now, clinicians know when a patient has returned from radiology, but they don’t know when the radiologist has read CT or MRI studies,” explains Garrett. The interface will alert the clinician to the report, which is expected to expedite care.

Automated discrepancy tracking

The ED at The George Washington University Hospital in Washington, D.C., is primarily digital. The 35-bed ED sees 65,000 patients annually; it’s equipped with two PACS workstations where ED clinicians provide initial x-ray interpretation 24/7. Radiologists read CT, ultrasound and MRI studies; and clinicians read reports in the EMR.

One of the primary challenges in the ED, says Neal Sikka, MD, medical director of Outreach Programs at the George Washington University Department of Emergency Medicine, is the time lag between the initial ED interpretation of film study and the final interpretation in radiology. The lag may be six to 24 hours, which can make it challenging to resolve discrepancies between the initial and final interpretations. Sikka estimates that about 20 of the 200 images read daily contain discrepancies, but the majority of the discrepancies lack proper documentation and are not true clinical discrepancies. “True discrepancies that require follow-up represent only about 2 percent of studies,” Sikka says.

Technology helps remedy the issue. “Every interpretation is documented in the Picis ED PulseCheck record. Radiologists can notify the ED of a discrepancy via phone and