Radiologists, clinicians and IT professionals agree - PACS is an enterprise solution. A truly successful implementation not only meets the needs of radiology but also benefits departments across the enterprise. One of the departments that can reap significant gains with digital image management is the emergency department (ED).
''Our ED was a strong proponent of PACS from day one because they could see what it would do for them," reports Susan Johnson, operations director/PACS administrator for Mercy Medical Center on Des Moines, Iowa. Hospitals that carefully account for the needs of the ED during the PACS implementation process realize substantial clinical and productivity gains.
|Digital Solutions and the ED|
|Here's how solutions at these ED-savvy sites stack up.
Arkansas Children's Hospital in Little Rock uses DR System's Dominator PACS combined with a MeditechHIS/RIS as its ED image management solution. In 2004, 39,000 patientsvisited the ED.
Catholic Medical Centerin Manchester, N.H., has relied on GE Healthcare's Centricity PACS asits enterprise solution since March. The PACS integrates with a MisysHealthcare RIS and IBEX PulseCheck ED information system. Annual EDvolume is 36,000 patient visits with approximately 30,000 imagingstudies.
Mercy Medical Center in DesMoines, Iowa, is a three-hospital system that installed Kodak PACSintegrated with an IDX RIS in 2002. The center operates the busiest EDin the state with a total ED imaging volume of 64,000 patients annually.
Rhode Island Hospital in Providence, R.I., is a level one trauma center serving a catchmentarea of one million people. This spring the hospital recently completeda $50 million ED upgrade and is filmless in the ED. ED imaging volumeis 90,000 adults annually, including 50,000 CT studies. GE CentricityPACS serves as the image management solution for the hospital.
Sutter Health is comprised of five hospitals in the Sacramento, Calif., area. The EDat one of the five sites, Sutter-Roseville, serves as the only traumacenter in a 100-mile stretch and averages 4,700 ED patient visitsmonthly. Each hospital is equipped with a Siemens PACS; Siemens MagicWeb serves as the ED solution in all five hospitals.
For starters, the real-time, on-demand viewing enabled by PACS can accelerate the clinical decision-making and treatment processes. PACS enables virtual consultations among multiple clinicians and sub-specialists to improve and speed clinical decision-making. Finally, the ED is not immune to the lost film plague, and PACS eliminates the issue.
"ED demands on PACS differ dramatically from other areas of the hospital," says Thomas Egglin, MD, chief of emergency radiology at Rhode Island Hospital and associate professor of radiology at Brown University in Providence, R.I. Successful image management in the ED hinges on a number of factors, and the needs of the ED should be addressed during the selection and implementation process. The hospital needs to determine optimal processes, which can vary by the type of ED and even within a single ED. Questions to answer include:
- How many workstations are needed? What are the optimal locations?
- What types of workstations and monitors are ideal?
- What are the procedures for PACS downtime?
- Is web distribution appropriate? How and where should it be implemented?
- How will ED physicians be involved in the process? What type of training is necessary for optimal use?
- Is the network solid enough to push images to the ED?
- How can complementary components such as voice clips benefit the ED?
This month, Health Imaging & IT visits with several hospitals across the country that have successfully tackled image management in the ED.
Trimming turnaround times
One of the primary drivers for PACS is reduced turnaround time; STAT turnaround is essential in the ED, and PACS can facilitate dramatic drops in turnaround time.
"Turnaround times have substantially improved with PACS," confirms Linda Womack, regional manager for imaging systems for Sutter Health in Sacramento, Calif. Womack oversees imaging systems for five Sutter Health hospitals, including Sutter-Roseville, a regional trauma center. In the film world, wet-read turnaround to the ED averaged 15 to 30 minutes. Now, images are instantly available via Siemens Medical Solutions Magic Web, and most are read by radiologists within 10 minutes. The interim steps of prepping jackets, completing paperwork and locating prior images are eliminated with digital image management.