The Deficit Reduction Act (DRA), competition and continuing focus on high quality patient care are all driving imaging departments and facilities to focus on pushing their productivity. From radiologists, technologists and other staff to equipment and scheduling, facilities are finding the best ways to get the most out of their valuable resources.
The Deficit Reduction Act has taken its toll and “we have reasons to believe that there will be further cuts,” says Kirk Lawson, administrator of the New York University radiology department. “Radiology is going to remain a potential target down the road in the next few years for further cuts.” As a large enterprise, NYU is surviving in spite of cuts. Also, as an independent, private center, “our volume, size and ability to be flexible lets us respond more easily.”
Nationally, hospitals are challenged to do more with less, he says. “I know that if I want additional staff, I have to know that I’m being highly productive and can justify new staff.”
NYU’s radiology department provides services for three hospitals in eight locations, and performs just over 300,000 studies a year. “As we get larger and have more locations, workflow gets more complicated.” The team offers the full gamut of interventional and diagnostic imaging studies and is highly subspecialized in MR, CT, cardiac CT, nuclear medicine and ultrasound.
The facility switched to the Workflow RIS from Siemens Medical Solutions last fall. After using their previous RIS for 11 years, the facility underwent a massive conversion, says Lawson, migrating forward 3.5 million studies. “We decided to convert data rather than start with a clean slate. That made the project more challenging.”
NYU also has a home-grown, internal department software called RadClinInfo—a web-based site begun in early 2000 that hosts a “cavalcade of important data for performance measurement,” Lawson says. Within the facility’s financial department is decision-support services that has its own staff. The group helps the institution look at both staff and supply productivity, Lawson says. “It’s an extremely important tool because it allows us to, by payroll, have graphic presentation of how staffing looks compared to volume.” Based on the payroll schedule, it’s updated every two weeks.
“We can get very granular in detail. If we don’t appear particularly productive in a payroll period, we can see what’s going on, such as whether it’s due to holidays or people covering overtime.” The same applies to procedure volumes—if they’ve dropped, Lawson can see if it correlates to a drop in hospital census. Administrators can respond on a continuous basis.
All of these tools play to the administration’s focus on “transforming us into a world-class care institution,” he says. “Embedded in that is productivity.” Hospital administration expects department leaders to utilize productivity tools and respond. Since expensive equipment is involved in radiology, any savings and making the maximum use of resources, including space, staff and equipment, are important.
Another vital element of productivity is phone reporting capabilities. NYU has a scheduling department within radiology that uses software to track the average abandoned call rate. “If it’s taking five minutes to get through scheduling, we’ll have a higher abandoned call rate,” Lawson says. The RIS conversion forced the facility to look at all processes to customize the system. That can cause setbacks in high transaction areas like scheduling. “We consistently have a high volume of encounters. Adding 30 seconds to each call has an immediate impact.”
The calls impact how effectively the scanner is utilized. Although there isn’t much empty scanner time, Lawson says the team recently whittled a five-day backlog down to four days. That reduction favorably impacts referring physician satisfaction, patient satisfaction and profitability.
On the hospital side, NYU works with the facility HIS and CPOE system. “We work with escort and expedite orders as efficiently as possible.” Escort services uses tracking software to triage and parse out the workflow, which serves as another metric. “For inpatients, productivity hinges on collaboration with escort. Discrepancies can result in empty scanner time.”
Staff and equipment metrics
Integration between the RIS and imaging systems also helps track productivity. “Information from the scanner populates our RIS,” says Lawson. The data include