One of the truisms in management is that a small percentage of the workload takes a disproportionately large amount of time to complete. In diagnostic imaging, so-called “hung” studies—cases that are stalled in the system—represent an almost insignificant proportion of total imaging volume, yet their disposition requires significant effort to resolve.
A group from the University of Maryland School of Medicine, department of diagnostic radiology in Baltimore, created a web-based application using open-source software tools that can alert radiologists to the existence of undictated cases.
“Efforts to reduce time elapsed between imaging acquisition and dictation of results are challenged in an institutional setting by lapses in communication between technologists, radiologists, administrators and business staff,” said Max Warnock, a senior research developer, who presented the results of the development effort at the 93rd scientific assembly and annual meeting of the Radiological Society of North America (RSNA) last month in Chicago.
“Imaging studies sometimes hang in the system, stalled by confusion over which action is required next,” he said.
Warnock observed that at his institution, such cases account for less than one percent of all studies; however, he noted that such cases undoubtedly inflate overall average turn-around times and may have adverse effects on patient service.
The team at the University of Maryland developed their tool using Ruby on Rails, an open-source, free web-application framework. According to Warnock, they sought to facilitate a process for their RIS to provide an hourly listing of all undictated studies, these were then data mined and inserted into a MySQL database.
The application then automatically generates a table listing of the number of undictated studies according to their age and parses them into a sub-disciplinary section.
“The undictated worklist tool provides a snapshot of the status of the entire department’s undictated study status in a single web page,” Warnock said.
Radiologists, technologists and data correctionists are able to use the application to see individual study information using specially designed tools. Warnock said these tools include the capability to launch the study in the PACS and view associated data in a report repository.
The application also automatically suggests which reports may be associated with which study to the department’s data correctionists. In addition, Warnock said that a link is provided through which the radiologist can submit missing image or quality control issues.
According to Warnock, since implementation of this tool, the department’s report turn-around time has dropped from 30 hours to 20 hours, almost entirely as a result of aligning efforts on the less than one percent of studies that previously would have caused delays.
“The tool has established a new line of communication that promises to reduce to near zero the possibility of studies being lost in the system,” he noted.
The development team is currently focusing on additional systems integration so that the tool can serve as a nexus through which staff can identify issues that can be improved to enhance the overall quality of patient care, Warnock said.