Over the past several years, the utilization of teleradiology has become more prevalent within the medical community. The need for 24/7/365 coverage with timely turn-around-times and accurate interpretations have become the standard.
However, while teleradiology services are growing, some in the healthcare industry fear quality and customer service may suffer under the present growth levels. Chief among these concerns: Missing turnaround times (TAT).
Turnaround times refer to the time it takes for a scan to be received, read (aka interpreted), and the physician’s report returned to the facility. With teleradiology, emergent turnaround times are measured in minutes as opposed to hours and days with traditional, non-emergent radiology studies.
Effective turnaround times dramatically improves patient care, especially in critical areas such as emergency departments, urgent care, and stand-alone ER facilities. Ideally, there is a healthy balance between timely TAT and accurate reads in providing quality patient care. However, there are times when TAT delays may occur and disrupt this balance and the flow of your facility.
What causes these delays? Moreover, perhaps and more importantly, how can they be avoided in the future? In this blog post, we’re going to tackle the first question and, in a future article, we’re going to break down how to make sure your reports are delivered on time.
Cause #1: The Human Factor
The #1 cause for TAT delays occurs when a tech has several studies to send and, rather than addressing individually to completion, all studies are transmitted at once (in a batch). Waiting on prior reports for comparison and waiting on the tech worksheet (which provides essential patient data) are examples of what may hold up the technician from sending the exam to the Radiologist. This portion of the delay doesn't affect the TAT, although it does cause a delay in the receipt of the study for the radiologist to read.
Comparisons/Priors - Receiving comparison/prior reports is essential to provide accurate interpretations (especially for a CT Chest or Chest X-Ray) if sent "critical.” If a prior becomes available and they want it compared, the site will request an addendum. Delays can arise if the technician provides a late prior report. A plethora of details accurately noted help provide timely reports; e.g., identify if the findings are old or new, of any increase/decrease in size, whether the study is a CT or MRI, if the patient received contrast and if so, noting if there was a reaction of the tissues or anatomy to the contrast medium.
Tech Worksheet - The Radiologists require the worksheet to review their measurements, which also describes how the patient tolerated the exam. If there are images taken outside of protocol, the Radiologist needs to know the reason(s) why and take into consideration the technologist's notes or summations.
For CT - Documentation of the patient’s understanding of the contrast media, advised of the complications associated with contrast (with signature), any listed allergies, and a brief medical history.
For MR - Documentation of brief surgical history, implanted devices, understanding of the complications associated with the magnetic field, and any prior reactions to MRI contrast media.
Upgrading Exams to STAT or Critical - When an exam is transmitted as a routine or a STAT, then the site decides to upgrade the exam’s status to either STAT or Critical and this may cause the exam to become overtime (OT), or over the contracted turnaround time set for the status. Example: A non-emergent or “routine” CT Chest is sent over with a 24 hrs. TAT, an hour passes and the site decides they want it reported STAT (commonly read within 30 minutes). The exam is OT by 30 minutes by the time it is assigned to a Radiologist. There are many reasons this scenario is best to avoid. The stronger understanding the ED care providers have of the patient's potential severity, the less likely this occurs.
Incomplete Images - Not all images are sent to complete the exam.
X-Ray - Tech sends an order for a 3-view Knee and only sends 2-views. Within the X-Ray modality, there are a vast number of examples where situations like this occur.
CT - Tech sends the axial source images but forgets to transmit all the recons or part of the recons, 3D, any post-processing or manipulation of the data.
MR – Tech forgets to send the contrast images, a series that is part of the protocol, the recons (if applicable), 3D, post-processing, or manipulations of the data.
As with any profession, the more seasoned and professional the technologist the less likely instances noted above will occur. Our clients' and REAL Radiology's associates have a shared mission, and patient care excellence is the focus. Together, we work hard to eliminate these "unforced errors."
Cause #2: Multiple Injury or Post-Op Issue
For a multiple injury or trauma exams, you are dealing with large data sets that can take longer to read accurately.
Trauma patients sent over with 5 - 6 CT's at once - CT Head/ CT Cervical spine/ CT Thoracic spine/ CT Lumbar Spine/ CT Chest/ CT Abdomen/Pelvis - all the images and recons are sent over at one time. It is more time efficient and effective in receiving the reports promptly if the exams are transmitted as individual orders.
CT Head/ CT Angio Head/ CT Angio Neck - These are large data sets with reconstructions to review and interpret. The same goes for these exams, send separately to receive the reports back more efficiently.
CT Neck/ CT Chest/ CT Abdomen/Pelvis – Another example of large data sets with reconstructions to review and interpret. If it is possible to send these exams as the CT Neck and Chest separately, and then the Abd/Pelvis sent together, the Radiologists can be reporting one set of images while the next exam is downloading to be reported.
Most Trauma X-Ray sets are sent over at once – Same logic applies, if they can be separated into groupings that make sense, that is the preferable process and more efficient workflow for the Radiologists.
Cause #3: The Broken Model: Quick Growth, Slowed TAT
The final potential cause of TAT delays comes from teleradiology groups that are unable to keep up with increased demands from their facilities.
Causes may stem from the following:
The pursuit of business over the practice of medicine. Can refer to many dichotomies, including the absence of a patient-care-focus in the organization's mission and planning.
Investor-owned vs. physician-owned
The idea is that these groups must focus on profit as much as, or more, than patient care to appease capital partners and to provide a return on investment for shareholders.
Build to sell mentality - As with most industries, this can often be the worst situation. Add business on price (without having a system in place to sustain) to increase perceived value (to sell again to other investors). This model may work for the sellers, but it rarely works out well for the clients, their ED care providers or patients.
Quality medical reporting takes second place to business
Concerns such as contractual obligations, fast service, and profit
Essentially, medicine becomes a commodity under the broken models listed above. As practices grow larger, their ability to provide outstanding relationship-based service to their clients becomes more and more difficult.
The robust, strategically-built organizations in teleradiology do not have the symptoms of the broken models. These organizations have thoughtful growth plans in place that are girded with high-integrity, physician leadership, and physician accessibility.
A teleradiology redefined group has the highest retention rate of their physicians and clients. They also provide 24/7/365 customer and IT support and can provide dozens of client references. Rarely, a teleradiology group has 100% retention of its clients (emergent radiology groups and hospital clients). REAL Radiology is one of the few. Consistency is systemic of any business that delivers on its commitments (TATs and quality), and our clients share a mutual respect and focus on patient care excellence.