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