PACS powers productivity improvements

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One of the primary cost justifications for implementing a PACS is the expectation that its deployment will result in a productivity increase for the clinical specialty. A five-year retrospective analysis conducted at one of the largest academic hospitals in the United Kingdom and published in the July issue of Clinical Radiology, delivers hard data affirming this contention.

The study results revealed that since PACS and digital dictation was introduced at St. George’s Hospital in London, “reporting times have decreased by between 27 percent and 36 percent (depending on the modality) and our productivity (measured as number of films reported per whole-time equivalent radiologist) has increased by 18 percent,” the authors wrote.

The 1,055-bed facility, which is a member of the National Health Service Trust, serves a catchment area of 330,000 lives and also functions as a tertiary referral center. A Philips Healthcare PACS (Easy Access Enterprise 10.1) was installed in June 2003 and supports all modalities including plain film x-ray, CT, MRI, ultrasound and nuclear medicine images. RIS functions, which are not fully integrated with the PACS, are handled by iSOFT’s RadCenter version 4.5.

To compare reporting times pre- and post-PACS, the same quarter (Feb. 1 through April 30) was studied for the two years preceding PACS and the 3 subsequent years. “These months were chosen to allow for the initial transition period from hard-copy films to PACS, when reporting times were likely to be artificially raised in the first six months,” the authors noted.

Once the five-year data set was established, the researchers parsed the information by modality (x-ray, MRI, CT, ultrasound and nuclear medicine), referral source (inpatient, outpatient, general practitioner and emergency room), and interpreting clinician (attending and consultant radiologist). The data was sorted by workload per month, the number of studies read per month per clinician and the mean reporting times. An absolute number of examinations performed were calculated as well as the number and percentage of unreported studies.

Prior to the PACS implementation, radiologists were interpreting 8.768 plain film studies and 3,103 specialty modality studies on a monthly basis. Post-PACS deployment, the group saw its workload increase to 10,835 plain film and 4,222 specialty modality studies per month.

The number of studies per month per radiologist also saw a concomitant increase. Pre-PACS, 336.6 studies were interpreted per month; post-PACS, 406.9 studies were interpreted per month.

The researchers noted that unreported studies of plain-film exams saw a 20 percent decrease, from 5 percent to 4 percent overall, with the deployment of PACS. Mean reporting times saw a significant decrease, 36 percent, with the implementation of PACS.

“The mean reporting time pre-PACS versus post-PACS were 6.8 versus 5 days and 4.2 versus 3.1 days, for plain radiographic and specialist modality studies, respectively,” the authors reported.

By segmenting their analysis on a per-modality and per-referrer basis, the researchers also were able to identify areas that required workflow improvement.

They advised that any assessment of the effect of PACS on reporting times should be across the board. “This enables identification of subsets of films where reporting times may actually increase after PACS implementation. This, in turn, enables scrutiny of the individual workflow pathways. Reasons for increased times can be identified and the necessary remedies effected,” the authors wrote.