The Ruth and Raymond Perelman Center at the Hospital of the University of Pennsylvania in Philadelphia combines comprehensive outpatient imaging and clinical services.

Combined inpatient and outpatient imaging services are not necessarily patient-friendly. The mixed environment can be overcrowded and fraught with delays, which may ultimately impact referrals and the bottom line. The University of Pennsylvania (UPenn) overcame problems associated with the mixed environment and streamlined inpatient and outpatient imaging last year when it constructed the Ruth and Raymond Perelman Center, a $302 million, 500,000 square-foot facility designed specifically for outpatients.

“The center allows us to completely separate and provide unique imaging resources for our outpatients, while we provide services that are better designed for our inpatients,” explains Nick Bryan, MD, PhD, and professor and chairman of the department of radiology at UPenn.

Since the center opened last year, UPenn has realized multiple results including faster imaging exams, improved patient and report turn-around and patient-friendly scheduling. Workflow and patient care is improved for both referring physicians and UPenn staff as all images and test results are available in the EMR. Plus, patient satisfaction has swelled.

The mixed model at a glance

The mixed inpatient/outpatient model complicates scheduling. Common, but unpredictable, inpatient issues like emergency or prolonged scans can disrupt the outpatient schedule. At UPenn, it was difficult to accommodate same-day outpatient appointment requests, which resulted in downstream delays as patients often needed imaging results prior to an appointment with a referring physician. Both factors impacted patient and referring physician satisfaction.

Finally, inpatients tend to be more acutely sick and present with ventilators and IV tubes. “[The mixed population setting] intimidates outpatients,” opines Ann Costello, director of radiology administration.

Meeting outpatient imaging goals

The Perelman Center houses CT and MR imaging, nuclear medicine, PET, mammography and interventional radiology and also offers cardiology, pulmonary and oncology services and outpatient surgery. It completes 400 to 500 imaging exams daily.

The center has achieved one of its primary goals—same-day imaging and diagnostic services, which boosts efficiency and patient satisfaction. “It was a struggle to do it when we were all at the hospital together,” offers Costello. With 11 new rooms, 99 percent of patients can be accommodated with same-day appointments.

Same-day imaging and clinic appointments are very convenient for patients, as it minimizes time away from work, adds William Stavropoulos, MD, interventional radiologist, associate professor of radiology and associate chair for clinical operations at the department of radiology at UPenn. “Patients like it because they can get their imaging done in the morning and see me in the afternoon.”

With the advent of same-day services, UPenn strived to provide referring physicians with reports within one hour, so that the report could be available at the appointment with the physician. Prior to the opening of the center, average report wait time stretched to six to seven hours. Referring physicians now welcome the quick diagnostic response for more urgent patients, as well as for patients who would have a difficult time coming back for their study, Bryan adds.

Inpatient benefits

The changes in outpatient practices also are delivering improved inpatient service. More inpatients are now accommodated during regular work hours “without bumping patients, or extending work hours later into the evening,” says Emily Conant, MD, head of outpatient radiology at the Perelman Center. “Removing outpatients from the mixed environment has allowed us to become more efficient with inpatients,” she says.

Prior to the Perelman Center, inpatient work was sometimes pushed to the evening to allow the radiology department to accommodate more outpatients. A new decompressed inpatient schedule reduces late night inpatient CT scans, which, in turn, decreases off-hour salary premiums as the volume of exams conducted after hours has decreased by 50 percent, notes Costello.

Decreasing late night inpatient imaging improves care for inpatients, adds Bryan, as reduced technical and professional staffing in both radiology and patient wards made it more difficult to complete these exams in a timely manner. Plus, “patients didn’t like being awakened and moved about during night hours,” he offers.

One-stop shopping

In order for UPenn to reach its goals with the Perelman Center, the new building had to accommodate nearly all of UPenn’s outpatient clinics. “Patients not only receive their imaging exam at the center, they also see their physicians in same building,” Bryan explains. “Once they are in the building, they do not have to leave it for anything.”   Both UPenn hospital and the Perelman Center share a group of radiologists who divide their time among inpatient and outpatient duties. PACS facilitates the model.  

“The informatics technology made [working between the two centers] much more practical,” Bryan says. “It allows us to physically sit in one place with complete access to studies and interpret exams from anywhere within the system. We can easily consult with others, including referring physicians, no matter where we or they are located. We are helping each other from across the street, using common informatics,” he notes.

Another system that contributes to the success of the same-day service model is the outpatient EMR, adds Costello. “The communication between the two clinics is facilitated by having an EMR that we all have access to, and that is now connected to our RIS,” she says. For example, physicians can electronically request an imaging study via the EMR, and radiology staff immediately see, process and schedule the exam.

Beyond technology and design

Staff and patients agree that the separation of inpatient and outpatient services optimizes services. The center facilitates “a stronger focus on customer and patient services than typically is seen at other facilities,” according to Stavropoulos, which is reflected by outpatient satisfaction surveys. “After the center opened, we saw the largest increase in the patient satisfaction score in 11 years,” says Bryan. Since opening the Perelman Center, UPenn consistently reached a Press-Ganey score of 90.

Additionally, outpatient efficiency improved 5 to 10 percent and outpatient volume has increased 10 percent since the center opened, offers Bryan. He credits the outpatient EMR and the patient tracking system as well as RIS/PACS with the improved efficiency.

Current efficiency improvement projects focus on pre-registration. “We need to continue to tweak our reception processes, as patients still have to do some paper work,” Bryan explains. Conant predicts that protocoling the study and ensuring that it has been correctly booked and allotted for in the RIS, as well as triaging the patients’ paperwork before they come into the center will help UPenn meet its goal. The center also hopes to deploy a modified airport check-in kiosk staffed by patient greeters as its reception station to further streamline the registration process.

Although the Perelman Center has made tremendous strides in improving efficiency and patient care, it is a work-in-progress. As with any new project, staff plan to continue to tweak processes and workflow in order to fully take advantage of the new facility.