Managing radiology’s ‘complex, demanding and disruptive’ work environment

An observational study published in the Journal of the American College of Radiology revealed that non-image-interpretive tasks (NITs) such as phone calls and meetings take up a significant amount of time in reading rooms and divert attention away from image-interpretive tasks (IIT). This could have a potentially negative effect on quality metrics, the authors explained, and facilities wanting to solve this issue should investigate developing new workflow patterns.

Lead author John-Paul J. Yu, MD, PhD, University of Wisconsin School of Medicine and Public Health in Madison, Wis., and colleagues observed an academic neuroradiology reading room for 30 days in 2015. A rotation of six neuroradiology fellows were observed in four-hour shifts throughout the data collection period.

Overall, more than 53 percent of the fellows’ time corresponded to IITs, more than 37 percent corresponded to NITs, and more than 9 percent corresponded to “other tasks.”

“Radiologists practice in a complex, demanding, and disruptive work environment,” the authors wrote. “Although timely and accurate image interpretation remains the radiologist’s primary clinical deliverable, success in the modern reading room environment demands the ability to efficiently negotiate a variety of NITs.”

Yu et al. noted that trainees had to handle an average of 14.9 task-switching events (TSEs) per hour, and one trainee encountered 84 TSEs in just one four-hour shift.

“In context, these data suggest that a fellow in our main reading room can experience a TSE approximately every four minutes, reflecting the disruptive nature of the work environment,” the authors wrote.

The authors added that the “highly disrupted and complex nature of reading room workflow” was potentially having a negative impact on the trainees’ education.

“Diagnostic radiology remains rooted in an apprenticeship model of education in which the learner is actively engaged in practice with a mentor or an expert, and teaching at the workstation accounts for some of the most significant education a trainee will receive,” the authors wrote. “In highly disruptive, complex clinical settings, physicians have been shown to prioritize tasks directly related to patient care and truncate or abandon those tasks viewed as less critical. The relatively short median duration of discrete staff-out sessions and the absence of any significant time commitment to dedicated teaching independent of staff-out suggest that a highly disrupted workflow may be forcing our physicians and trainees to curtail the educational components of radiology’s apprenticeship model of training in favor of maximizing clinical productivity.”

Analyzing their data, Yu and colleagues took action and created a new “consult” position within their practice. This role, they said, keeps IIT and NIT workflows separate, which has potential to minimize TSEs, improve efficiency, and improve the overall morale of everyone involved.

The authors also observed that their study had some limitations. For example, the Hawthorne effect--being observed results in changes in behavior--may have been in play.  In addition, the various trainees had “different degrees of experience and comfort handling varying NITs.”

Previous coverage from Radiology Business about interruptions in radiology reading rooms can be read here.