JAMIA: PACS potential great in ICU, but more research needed

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PACS has shown potential to positively impact practices in the intensive care unit (ICU), particularly with regard to efficiency, though actual evidence is limited and much about how PACS affects the intensive care setting remains to be investigated, according to a review of literature published online Feb. 9 in the Journal of the American Medical Informatics Association.

Authors Isla M. Hains, PhD; Andrew Georgiou, PhD; and Johanna I. Westbrook, PhD, all of the University of New South Wales in Sydney, acknowledged that the integration of PACS into units besides radiology has the potential to significantly change work practices in these other clinical areas. While much research has focused on workflow efficiencies associated with PACS in radiology, they noted that no synthesis of evidence investigating the effects of PACS on the ICU had been performed previously.

The authors searched a number of research databases, including Medline, Pre-Medline, Embase and others, for English-language publications between 1980 and September 2010. Eleven studies from the U.S. and U.K. were included, and all measured aspects of time associated with the implementation of PACS, such as time for a physician to review an image and overall image availability.

From the results, the authors concluded that the “potential for PACS to impact positively on clinician work practices in the ICU and improve patient care is great,” and PACS can impact practices in three main areas: efficiency, clinical decision-making and communication practices.

“The time from when an image was taken until the imaging information was accessed by an ICU physician was considered in six studies, with four reporting a decrease in this time following the introduction of PACS,” wrote Hains et al. One study (Andriole et al, SPIE, 1996:286–289) showed a one hour decrease in average time from image exposure to image review, and they noted similar decreases in other studies.

The increased efficiency resulted in quicker clinical decision-making in a few studies which found significant decreases in time to take an image-based clinical action. Andriole et al found that time to clinical action decreased from an average of three hours, 21 minutes, to two hours, six minutes. Another study (Kundel et al, Radiology 1996;199:143–9) reported that the decrease was a result of the reduced time to image review by the clinician.

A byproduct of PACS implementations in general has been the decreased communication between physicians and radiologists, and the review of ICU studies reinforces this as three studies found that PACS use led to a decrease in physician-radiologist communication. Kundel et al reported that only 26 percent of physicians received input on images from radiologists via the phone, direct contact or radiologist report after PACS implementation.

Most of the evidence suggested improvement in efficiency, though the studies involving the effect on clinical decision making and communication practices don’t reflect the most contemporary PACS technology and are insufficient to draw firm conclusions, according to the authors.

“Performance measures developed in previous studies remain relevant, with much left to investigate to understand how PACS can support new and improved ways of delivering care in the intensive care setting,” wrote Hains et al.