Technological interventions, as well as financial incentives have been found to have the ability to result in synergistic and sustainable improvement in radiologist report-signing behavior and this cut-down on signature time can lead to improved patient care, said the results of a study published in the March edition of the Journal of the American College of Radiology.

Katherine P. Andriole, PhD, from the department of radiology at Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues said their study combined technology adoption with financial incentives and evaluated the results to determine if signature time improvement can be augmented and sustained.

“Radiology report signature time can be a substantial component of total report turnaround time,” wrote the authors. “Poor turnaround time resulting from lengthy signature time can adversely affect patient care.”

Performed at a 751-bed, urban, tertiary-care teaching hospital, the prospective study reviewed 48,000 of the imaging studies conducted per month within the radiology department, consisting of inpatient and outpatient exams. During the course of the four-year and four-month study, three radiologist signature time interventions were employed, explained the authors.

The incentives included:

• A notification paging application that alerted radiologists when reports were ready for signature;
• A PACS-integrated speech recognition report generation system; and
• A departmental financial incentive to reward radiologists semiannually for signature time performance.

Andriole and colleagues said that signature time was compared before and after the interventions and linear regression statistical analyses were used to assess the significance of trends.

Technology adoption, including paging and speech recognition, was found to reduce median signature time from over five hours, to less than one hour and 80th-percentile signature time from greater than 24 hours, to between 15 and 18 hours, the authors wrote.

In addition, the authors found that the addition of a financial incentive leads to better performance than that achievable through technology intervention alone, as the subsequent addition of a financial incentive further improved 80th-percentile signature time, down between four and eight hours, which were noted and sustained throughout the final 31 months of the study period, the researchers said.

Noting several limitations of their study, including not examining the impact of each technological intervention separately or the inclusion of a control group that received financial incentives but no technology interventions, the authors said that the findings of their study are consistent with those of prior studies of improvement in report turnaround time.

“It is conceivable, but unlikely in our opinion, that the financial incentive alone could have produced the same results as the combination of the financial incentive and technology adoption,” they wrote.

“Although radiology report signature time was significantly reduced after the technology interventions, we found that the addition of a financial incentive resulted in further significant improvements in signature time, which were sustained even after the financial incentive was discontinued,” said Andriole and colleagues. “Our findings suggest that a financial incentive can help synergistically improve the return on technology investments for radiology reporting.”