Teleradiology: Relief for Brimming EDs

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To deal with increasing volume and to reduce wait times, many hospital emergency departments (EDs) as well as radiology groups are responding to staffing shortfalls and high patient volumes by signing on a teleradiology service provider for daytime or evening image interpretation coverage.

Patient ED visits are on the rise. In the last decade, the number of medical visits to physician offices and hospital outpatient and emergency departments increased by 26 percent from 1996 to 2006, faster than the growth of the U.S. population (which rose by 11 percent). It is not surprising that the average hospital ED wait-time to see a doctor has increased from approximately 38 minutes to nearly 56 minutes. Most ED visits occurred after business hours, defined as 8 a.m. to 5 p.m. on weekdays, with 63 percent of adults and 73 percent of children younger than age 15 arriving after business hours, according to new statistics from the Centers for Disease Control and Prevention (CDC).


Giving physicians a break



Joe Langdon, evening imaging services manager at 365-bed Vassar Brothers Medical Center in Poughkeepsie, N.Y., attests to high ED volume—the center will approach  150,000 imaging procedures by year’s end and is currently averaging approximately 100 CT studies per night in combination with ultrasound and nuclear medicine exams. On evening shifts, from 7:30 – 11 p.m., they see a volume of approximately 25 to 50 studies and for the midnight shift, approximately 14 to 18 patients each night.

With such a high volume, Vassar and its radiologists contracted with Imaging on Call (IOC) for ED coverage to relieve the burden on physicians a bit. “Instead of having people on call for CT, ultrasound and nuke med,” Langdon notes, “we wanted to have the ability to give physician’s relief, while providing them with the details they need in a timely, efficient way.”

Due to the increased ED volume, Vassar is sending images directly from the imaging modality to IOC. “All we have to do is verify the study is on the site, ready for rads to read,” Langdon says.

IOC’s average report turn-around time is 30 minutes. If a report isn’t back in a half hour or so, or is needed more urgently,  Langdon simply calls IOC’s workflow team, which investigates the reason and immediately processes the report or verbally conveys the result.

Teleradiology is helping the hospital run more efficiently, 24-hours a day. “It takes a lot of stress off the patient and physician in waiting for results and waiting to treat people,” Langdon says. “Physicians don’t have to wait anymore until someone comes in the next morning to read, and response times are now a lot faster than they have been in the past. Teleradiology has contributed to this.”


Fast reads, better outcomes


Teleradiology has eased the burden and enabled consistency of care at Fawcett Memorial Hosptial in Port Charlotte, Fla., allowing all after-hours studies to be read by a board-certified radiologist. The same teleradiology provider reads all ED studies, too. The ED treats approximately 22,000 patients each year, while the hos-pital’s annual imaging procedure volume ?is approximately 40,000 studies per year.

Fawcett Memorial contracted with Virtual Radiologic Corporation (VRC) to provide preliminary interpretations after-hours. After the two onsite radiologists turn in for the night, VRC radiologists take over, providing preliminary reads for all CT, ultrasound, nuclear medicine and MR studies within 30 minutes.

VRC has been instrumental to the hospital’s Joint Commission-accredited stroke program, says Director of Diagnostic Imaging Ellen Nicholas. When a patient calls EMS with symptoms of stroke, EMS alerts the hospital ED, which in turn, mobilizes CT techs and calls in a neurologist. As soon as the patient comes in, a CT study is done and sent to VRC for interpretation. “If a patient has not had a bleed, but has had a stroke, we look to see if he or she qualifies for medication treatment, which has to be initiated within three hours,” Nicholas says. VRC’s reports assist Fawcett’s physicians to make quick treatment decisions. “In these cases, time is brain, so we count on VRC’s short turn-around times—often as short as 15 minutes—to enable us to provide the best outcomes for our patients.”


24/7 help for the small community hospital


For Syringa General Hospital, a small, rural community-based hospital in Grangeville, Idaho, finding radiologists in the immediate area has always been a challenge. The 15-bed acute-care facility serves a town of approximately 3,500 people and another 9,000 in outlying areas, and performs approximately 6,000 imaging exams annually.

The solution for 24/7 coverage for the hospital, clinics and ED at Syringa was Franklin & Seidelmann Subspecialty Radiology (F&S), says Kyle Kellum, manager of imaging services.

It works like this. When an ED study needs to be read, it is sent off to F&S and viewable via an online portal system. Having the portal access allows the ED to view the studies and reports from any location, once they are ready, Kellum notes.

Exams can be changed from routine to STAT, and from STAT to hyper-acute as needed. For example, an aortic dissection case would be changed to hyper-acute. The average guaranteed report turn-around time for a routine exam is three hours and nine minutes; STAT reads are 20 minutes; and hyper-acute average turn-around time is 12 minutes.

Once an exam has been changed to hyper-acute, an F&S teleradiologist calls the ED physician to discuss. Once F&S has received all paperwork, a chest CT report for a pulmonary embolism can be back within 10 minutes, probably five or six on a consistent basis, says Kellum.

“One of the biggest benefits has been the referrals,” Kellum says. Since contracting with F&S about three months ago, the hospital has doubled its MRI procedure numbers simply due to the quality of the reports. Volumes across the board have shot up—for example, ultrasound is up about 8 percent; MRI is up about 47 percent; CT is up 21 percent and plain film has increased by about 11 percent.

“The value of teleradiology is that you don’t have to pay a radiologist to be here in a rural community,” Kellum says. “It is almost like our F&S teleradiologists are here anyway because any question on a report or protocol, they answer it immediately. The reports come back detailed and always have recommendations for the physicians regarding steps that should be explored next for the best care of the patient.”


Telerad on the rise


As U.S. EDs battle rising volumes and increased wait times, many facilities have found teleradiology can play a critical role in helping to alleviate some of the burden while improving workflow efficiencies. This increased utilization is not only prevalent in the United States but is spreading globally as a solution to staffing shortages and workflow challenges. According to Global Industry Analysts, a market research firm, the global market for PACS and teleradiology systems is projected to reach $4.4 billion by 2010—proving that teleradiology utilization is on the rise.