2015 Patient-Centric Imaging Awards

Pop quiz. A leader whose work helped change the world greatly for the better once said, “I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results.” Who was it?

Answer: the founder of modern nursing, Florence Nightingale. And when she spoke, she didn’t have to spell out for whom she sought results. She was “patient-centric” to the core of her being without ever stopping to think there might be any other way to care for the ill, the injured and the otherwise infirm.

Times have changed a lot since the 19th century, but human nature never does. It’s even easier now than it was then to get distracted by the hows of healthcare—the tools and technologies, the protocols and regulations, the resources and the lack thereof—and lose sight of the why. The latter being the patient.

In recent times, radiology as a profession has happily refocused on this patently obvious yet easily overwhelmed aspect of its mission. Population health is vital. Improving care while reducing costs is critical. But it’s really all about the patient, as RSNA’s Radiology Cares campaign, ACR/RSNA’s RadiologyInfo.org and Strategic Radiology’s My-Radiologist.com all attest just by being there.

The 2015 Patient-centric Imaging Awards honor imaging teams that have clearly distilled their words as well as their feelings into actions that bring results. In making our selections this year, we were especially watchful for bold, proactive initiatives that combined spirited team building with creative problem solving and innovative opportunity capitalizing—all on behalf of the patient.

We weren’t disappointed. To see why, check out the winners in their own words.

[[{"fid":"21073","view_mode":"media_original","type":"media","attributes":{"height":320,"width":620,"alt":" - Lakeland Health, St. Joseph, Mich.","title":"Lakeland Health","class":"media-element file-media-original"}}]]

Lakeland Health in St. Joseph, Mich.

Organization type: Small to medium nonteaching hospital

Project: Patient-based radiation safety program

“We have been very excited about our physicians’ willingness to jump on board with the program,” Angelica Padilla, Lakeland Health’s director of radiology, told HealthImaging. “The feedback has been very positive from both physicians and patients. The implementation of our EHR has given us the opportunity to provide safe patient care through this program.”

With the implementation of an EHR in 2012, Lakeland re-launched a multi-faceted radiation safety program to ensure the safety of young adult and pediatric patients receiving radiation exposure for benign diagnosis. Through collaboration with the radiology department and EHR team the, following process was created and presented to the medical staff for approval:

A Patient-Based Radiation Safety Committee was formed consisting of the Radiation Safety Officer (RSO), Chief Radiologist and Radiology Director. Alert thresholds were created based on the number of CT studies completed rather than measuring exact dosages because of the number of variables involved in this process. The following three base criteria were used for identifying at-risk patients:

  • Patient less than 40 years of age
  • Benign diagnosis
  • Five CT studies of the neck, chest, lumbar spine and abdomen or abdomen/pelvis

A weekly report was created to capture additional information for patients who matched these criteria, including previous CT scan types and dates, past diagnosis and patient history. The report also includes CT studies from external organizations based on the study type and body region entered when imported into Lakeland’s EHR.

An initial review of the report is done by the Director of Radiology to identify potential candidates for the radiation safety program based on their medical and surgical history. These candidates are then reviewed by the Radiation Safety Committee to determine entrance into program. If a patient meets the criteria for the program, a Best Practice Advisory (BPA) is added to the patient chart within the EHR. The patient’s primary care physician will also receive a letter indicating the patient’s inclusion in the program.

When an additional CT scan is ordered for this patient the ordering provider will receive a BPA alert stating, “This patient is being followed by the Patient Based Radiation Safety Committee. Please consider a non-ionizing exam such as MRI or ultrasound for this patient or consult with a radiologist.”

The BPA does not prevent the ordering of CT scans and can be bypassed. It does, however, trigger a review of the need for the exam. If the patient continues to have additional scans and reaches a threshold of 10 CTs, three additional safety measures are taken.

  1. The patient and provider will receive a certified letter notifying them that the 10 threshold has been met and of possible risks and benefits associated with CT studies.
  2. The provider will be asked to consult a radiologist before additional imaging is ordered.
  3. The RSO will also be made available for consultation with both the patient and provider.

Once a patient is enrolled in the radiation safety program, a BPA is attached to the electronic chart which automatically alerts any provider ordering additional CT studies for this patient. Using the EHR, a report is created to determine how many times a BPA has fired for each patient enrolled in the program and what response was taken by the ordering provider as a result.

Since this program was introduced, 115 at-risk patients have been identified for monitoring and 51 CT studies have been cancelled or changed to a different exam with lower radiation exposure for these patients. This program is highly reproducible with any EHR system.

[[{"fid":"21074","view_mode":"media_original","type":"media","attributes":{"height":320,"width":620,"style":"line-height: 1.538em;","alt":" - Shaukat Khanum Memorial Cancer Hospital and Research Center","class":"media-element file-media-original"}}]]

Shaukat Khanum Memorial Cancer Hospital and Research Center in Lahore, Pakistan

Organization type:  Small to medium nonteaching hospital

Project: Child-friendly initiative

“The very idea of modifying the whole gamma camera room was very exciting and challenging at the same time,” says Amjad Rashid, assistant manager of nuclear medicine. “This was finally accomplished with the help of many people, including volunteers from Art College who helped convert dream into reality. At the end of the day the priceless smiles on children’s face and appreciation of their parents make all the hardship and efforts worthwhile.”

Dynamic renal scans of nuclear medicine require the patients to lie down still for half an hour, which is not possible for the anxious and stressed-out young children, hence making sedation imperative. The sedation not only exposes the children to untoward and undesirable side effects but also put extra burden on the healthcare system. We present our departmental transition to a child-friendly ambiance, which started with adornment of gamma camera and injection rooms with beautiful depictions of cartoons, animals and wild life. To keep the children engaged, a digital screen is installed where children can watch cartoons while being imaged. Our technologists are also trained to be friendly and funny with the children.

Our objective was to compare the impact of children-friendly environment in terms of reduction in number of children requiring sedation.

For materials and methods, hospital information system was used to filter out two groups of young children undergoing dynamic renal scans. The first group consists of the patients from May 2012 to April 2013, the time period before introduction of children friendly environment. The second group consists of the patients after implementation of changes from May 2013- April 2014. The patients more than six years old were excluded from the audit.

The first group consists of 612 patients, out which 169 were under two to six years old. Total patient who underwent sedation were 79 (47 percent). The second group consists of 672 patients, out of which 77 were under two to six years. Out of 77 patients, 35 (45 percent) underwent sedation. Moreover, out of 77 patients, 16 (21 percent) initially booked to undergo sedation avoided sedation and being scanned while enjoying environment and kids’ entertaining videos.

In conclusion, the [implementation of our] child-friendly ambiance has made a significant difference by preventing 21 percent of children from undergoing sedation.

[[{"fid":"21075","view_mode":"media_original","type":"media","attributes":{"height":320,"width":620,"alt":" - Children's Hospital of Georgia / Georgia Regents Medical Center","class":"media-element file-media-original"}}]]

Children's Hospital of Georgia / Georgia Regents Medical Center

Organization type:  Large/teaching hospital (>300 beds)

Project: Enhancing pediatric imaging experience      

“The most rewarding part is seeing the children smiling and laughing in the Radiology department,” says James Rawson, MD, chair of radiology and imaging. “They are sad to leave! No matter how many projects I work on, I am always amazed at the impact of the patient and family advisors. The outcome always exceeds expectations. When the first step is talking to the patient and the family, great things happen.”

In 2013, we began the redesign of the Pediatric Radiology section in the Children’s Hospital of Georgia in Augusta, Georgia. In 1998, the Children’s Hospital of Georgia opened in Augusta. The entire hospital was built with patients--children and their families--as partners at the design table. From the outside of the building, it looks like some of the walls are made of Lego. The hallways are lined with dinosaur reliefs along the walls. The Children’s Medical Center won architectural awards and was recognized for its innovation in design. So when we chose to upgrade the radiology equipment in 2013 and redesign the pediatric radiology section, it was only natural to ask the experts-children and their parents. Since patient advisors have been a critical part of radiology projects at Georgia Regents Medical Center for nearly two decades, this was embraced by all involved with the project. To make sure we understood the patient’s perspective, staff was placed on stretchers and got on to the imaging tables. So in addition to technological imaging advances, major changes were made to the patient experience.

For general x-rays, we transitioned from CR cassettes to wireless DR and replaced art on the wall with “mood lighting’ chosen by each child. Children chose what color they want the room to be and the technologist changed the room lighting to reflect the child’s request. A different type of patient experience was planned for fluoroscopy. The new fluoroscopy rooms were equipped with new low dose techniques and new lighting and sound technology. As part of preparing for the fluoroscopy study, the child chooses room color as they would for an x-ray. However, in fluoroscopy they get to choose the sounds they want to hear during the exam, such as waves from the beach. By giving the child the opportunity to choose color, lighting and sound themes, we put them in control of their experience.

The principles applied to cross sectional imaging. In addition to the new 256 detector CT scanner, we installed a miniature scanner. Children choose a character (e.g. robot, elephant, alligator) and bring them to the small scanner. The child puts “their patient” on the table and slides the table through the small scanner. Since each character has an RFID chip inside, the scanner comes to life when the character slides through explain what is happening. So children get to learn about their test by “scanning toys” in a scanner.

We got rid of the term “waiting room” and instead moved to “patient lounges”. If you ask a child what they want to see and do in a patient lounge, you get a burst of creativity. Our pediatric patient lounge had an interactive video wall. As children touch kernels of popcorn, the kernels “pop” into popcorn only to return kernels which can be popped again. A different image is a reflection in a puddle. When children walk by it, they cause ripples in the image.

When you want to improve patient experience, you start by asking the patient.

[[{"fid":"21076","view_mode":"media_original","type":"media","attributes":{"height":320,"width":620,"alt":" - Howard County General Hospital","class":"media-element file-media-original"}}]]

Clockwise, from left: Noreen Burns, Julianna Ejedoghaobi, Tamara McKnight, Carolina Perez, Jackie O'Neale, Patti Rabette (project lead), Angela Baxter, Kim Losiewski, Catherine Long, Danielle McQuigg, Jessica Daniels, Camile Sam, and Mallory Kymingham. (Not pictured: Stephanie Whiteman and Bert Jackson.)]

Howard County General Hospital

Organization type: Small to medium nonteaching hospital (<300 beds)

Project: Improving efficiency of inpatient throughput in a community hospital MRI unit

“The most rewarding part of this project—aside from the obvious fact that we were able to reduce the time and thus improve the patient experience—was the collaboration between the different departments,” says Patricia Rabette, manager of CT and MRI. “Due to the volume and everyday pressures placed on staff, we all usually only think about how something is affecting us individually, or affecting just our own department. Working together on this project really showed us that everyone in the process wants to provide the best, most efficient care to our patients and that, in order to do that, we need to be aware of what everyone in the process does affects everyone else.”

In-patients were often waiting an extended amount of time to get their MRI completed. Based on scores and comments on patient satisfaction surveys and feedback from providers the long wait times lead to patient and physician dissatisfaction. The project goal was to decrease the amount of time from when an MRI order is placed for an inpatient until the MRI scan is started by 50 percent.

At our hospital we currently have one scanner, a Siemens Avanto 1.5. The project scope included the MRI Department, patients and staff of 2P (Med/Surg), the transport department and the executive leadership of the Director of Med/Surg Nursing. The benefits of reducing the order to begin exam time include improve patient safety, decrease length of stay, improve patient satisfaction and improve efficiency. The baseline data consisted of 37 exams with an average time of order to begin MRI exam time of 9.13 hours.

The team met regularly and using lean tools conducted a process overview, held a brainstorming session, which we created a cause and effect diagram, and worked with our EMR vendor to create a detailed screening form which assisted nursing staff in completing the screening form on the unit, prior to sending the patient to MRI.

We also worked with transport staff to help them understand the significance even a slight delay can have on the overall MRI schedule and throughput. Based on that knowledge transport was more willing to work with us to improve throughput.

Post intervention data from the pilot unit included 32 exams during a 10 week period which showed that the average order to begin exam time decreased to six hours for a 35 percent decrease.

We have not yet reached our goal of 50 percent but we are currently working with hospital leadership to implement our processes hospital wide. We are confident that we will continue to see the time decrease.

One of the greatest things we accomplished was working together and understanding the barriers that each area encountered during the process of getting a patient to the MRI department.

[[{"fid":"21077","view_mode":"media_original","type":"media","attributes":{"height":320,"width":620,"style":"line-height: 1.538em;","alt":" - Department of Radiology at Weill Cornell Medical College at New York-Presbyterian Hospital ","class":"media-element file-media-original"}}]]  

Department of Radiology at Weill Cornell Medical College at New York-Presbyterian Hospital

Organization type: Large/teaching hospital (>300 beds)

Project: WiCare (Weill Cornell Imaging Consultation and Radiologic Expertise)

“Many patients have responded with comments expressing how helpful, informative and calming it was to be able to speak with a radiologist about their breast density and mammogram results,” Courtney Sullivan, registered radiologist assistant, told HealthImaging. “Seeing this progress during consultation and knowing that we can give patients a piece of mind is most rewarding.”

As a result of patient advocacy, an increasing number of states now require radiologists to inform patients if they are found to have dense breast tissue. Notifications are intended to provide patients with important information regarding the increased risks associated with having dense breast tissue and additional options that are available. Despite these notifications, however, there are currently no evidence-based guidelines to support recommendations for additional screening options, and also no guarantee of insurance coverage varying from state to state. As a result, breast density notifications often lead to confusion for both patients and their referring physicians. While laws are presently mandated at the state level, a proposal has been made to make breast density notification a federal standard demonstrating that the topic of breast density is only going to become more prevalent.

The Department of Radiology at Weill Cornell Medical College at NewYork-Presbyterian Hospital recognized that there was a need for increased education about breast density, and from that developed a consultation service for patients and referring physicians. WiCare (Weill Cornell Imaging Consultation and Radiologic Expertise) was implemented in January 2013 when the New York State breast density legislation was passed and continues to be an active resource. The consultation service consists of one RRA (Registered Radiologist Assistant) and 12 breast radiologists that work together to ensure that patients and physicians have the resources to make well informed decisions.

Through an analysis of the initial experience with WiCare during the first year, it was found that consultation was successful in increasing patient education, confidence and perception regarding breast density, ultimately facilitating the communication between patients and their providers. After undergoing consultation, over 70 percent of patients felt sure of what the best choice was for them and over 78 percent of patients felt that they had enough support to make a decision.

Since implementing breast density consultations, WiCare has begun to expand consultation efforts to other areas in radiology offering a range of services that include imaging ordering assistance for referring physicians, resident-driven imaging rounds, and post imaging care. The key to effective consultation is quality and efficiency, and with current fee for service payment models this has continued to be a concern in terms of the radiologist time and productivity. Different from radiology consultation services attempted in the past, WiCare utilizes the RRA role allowing the radiologist to spend the most efficient quality time with patients and physicians for all consultation activities. With the ultimate goal of creating an environment that is patient-centered, all elements of the consultation service encourage communication in the shared decision making process between patients, physicians and radiologists to increase quality of care.

[[{"fid":"21078","view_mode":"media_original","type":"media","attributes":{"height":320,"width":620,"alt":" - patient care","class":"media-element file-media-original"}}]]

RIS Imaging in Lakeland, Fla.

Organization type:  Private practice

Project: Enterprise imaging platform to support men’s health

“My father had prostate cancer, so this work is near and dear to me,” David Marichal, RIS Imaging’s CTO, told HealthImaging. “We did not have this technology when he was first diagnosed. Thankfully, he is 70 and doing fine. But when I look back at how my father had to have his prostate cancer diagnosed and then treated, it seems like the dark ages compared to where we are today.”

Radiology and Imaging Solutions (RIS Imaging) in Lakeland, Fla., supports central Florida’s largest urologic oncology specialty group and a Prostate Cancer Center of Excellence program. RIS Imaging recently implemented technological enhancements to automatically and rapidly connect images and results from radiology procedures with these specialty providers. The rapid turnaround time provides three benefits to their male patient population: early diagnosis, convenient timing of procedures to minimize return trips and peace of mind.

Women’s health programs have long been successful at RIS Imaging and with statistics showing that prostate cancer is the second leading cause of cancer deaths in men, RIS Imaging enhanced their services for men’s health by implementing an Enterprise Imaging Platform to facilitate early diagnosis of prostate cancer for better patient outcomes. The platform leveraged existing investments in place including prostate MR imaging which can potentially identify specific areas within the gland that are suspicious and require additional evaluation. In the case where something suspicious is identified, the specialist may order a biopsy. The MR images are used to create a 3D model of the prostate which guides the specialist in real-time using ultrasound to the precise location of the lesion to biopsy. This method gives the specialists the tools to get the biopsy done quickly and accurately, leading to a less painful procedure with a better recovery time for patients.

Benefits of the existing investments were fully realized when the Enterprise Imaging Platform by Mach7 Technologies was implemented. The platform is the enabling infrastructure to manage the workflow ensuring a rapid turnaround time. Images are automatically transferred from the reading radiologists to the specialists at the cancer center—saving time, resources and improving accuracy of the workflow.

The Prostate Cancer Center of Excellence program attracts patients from all over the southeast and with the rapid turnaround time facilitated by the Enterprise Imaging Platform, the MRI to 3D model US guided biopsy can be done in the same day. For patients that had to take time off of work and travel for their appointment, they can get the necessary tests conveniently done all in a single day. In addition, rapid results can give patients peace of mind. No longer do they need to wait for results and follow up.