Image Workflow in the ED

Twitter icon
Facebook icon
LinkedIn icon
e-mail icon
Google icon

 Emergency medicine professionals working in trauma centers must deliver prompt diagnosis and treatment to critically or acutely injured patients. Radiology has always been an integral part of emergency medicine. That’s why PACS and the streamlined image workflow it offers is having a huge impact on the way multidisciplinary trauma teams handle their most critical of patients.

The 343-bed Bronson Methodist Hospital in Kalamazoo, Mich., which is part of Bronson Health-care system, operates a Level 1 Trauma Center. At its pediatric intensive care unit, Bronson’s ED treats adult traumas as well as children. Nearly 230,000 medical imaging procedures are performed annually throughout the hospital and ED patients account for nearly a third of that volume, says Brook Ward, executive director of clinical and ambulatory services at Bronson.

“The bulk of the work that gets done on a trauma patient has to happen very timely, and in some cases, immediately,” explains Ward. “Physicians need radiology services to help diagnosis and determine what is wrong with their patient so they can take care of them either back in the trauma unit or directly in surgery. Radiology has to partner with the ED and be ready when a patient arrives to be able to provide images and interpretation as quickly as possible.”

Bronson moved operations to a brand new facility in 2000. For efficiency, Bronson constructed its inpatient radiology department adjacent to the ED (out patient radiology is right across the hall). Technologists will perform portable x-rays in the ER, but most trauma patients are quickly transported and imaged directly in radiology. For an extra dose of efficiency, Bronson installed PACS, Fusion Matrix PACS from Merge eMed. 

The advantages of having PACS in an emergency setting are many, says Ward. The radiology staff saves time because they do not have to handle film. Technologists no longer wait for films to be processed nor do they have to physically bring them to the radiologists’ reading room. Once the technologist completes a sequence of exams, the images are automatically saved in the PACS; ready to be viewed by the physicians. A physician also saves valuable time when needing to view historical films because they are now online.

In the past, trauma surgeons would ‘follow’ the films to the radiologist reading room for a consultation. With PACS, the trauma surgeon stays with the patient in the ER and calls the radiologist if he or she has a question on a diagnosis or treatment. “Physicians now expect to see radiology images within seconds of exam completion,” adds Ward. “I think PACS has changed the way physicians practice emergency medicine because their expectations have changed.”

CT in the ED

Norman Regional Health System serves healthcare needs throughout south central Oklahoma. Its flagship, 337-bed hospital recently opened a new ED equipped with state-of-the-art trauma equipment, on-site ultrasound, a new CT scanner, new x-ray rooms and a mini C-arm for orthopedic physicians. 

Norman’s busy ED treats approximately 60,000 acutely ill or injured patients annually. Physicians rely on advanced technologies, such as digital image capture and Philips Medical Systems’ iSite PACS, to improve workflow and deliver the highest level of care to trauma patients. According to Alana Praytor, RT, senior clinical application analyst (PACS), eliminating film — and the time and steps involved in delivering film to multiple doctors — greatly improves image workflow.

Superb image quality and faster scanning times have made CT a very popular modality in emergency medicine. A large amount of information can be acquired quickly with CT, says Praytor, and images can be reconstructed to get different views of anatomy without actually moving the patient. Head CT’s are performed frequently in the ED. With PACS in place, ED physicians, radiologists and a neuroradiologist can sit down at any PACS workstation or web-enabled PC and simultaneously view a patient’s history and images to confer about the case over the phone.

Norman’s new CT scanner is located adjacent to the ED. Praytor says about 12 to 14 CT scans are performed during the night, and even more patients are scanned during the day. The hospital’s CT staff has experienced a more streamlined workflow with PACS and especially since films do not have to be printed. “The CT technologists really appreciate having PACS because multislice CT scanners produce so many images,” says Praytor. “If you print