Workflow tweaks can decrease distraction, improve satisfaction in reading room

Segregating reading room tasks into “image interpretative” and “non-image interpretive” workflows improved radiologists’ perception of disruptions and mental effort while increasing workplace satisfaction, according to a study published in Academic Radiology.

Physicians are often the bottleneck in an increasingly complex healthcare workplace. Radiology is a particularly demanding specialty, which may require an individual to work as an imaging expert, a physician and an educator all in the same day. These competing responsibilities can lead to costly workflow disruptions, especially in the reading room.

Some of the most frequent interruptions are phone calls and clinicians or technologists entering the room, according to lead author John-Paul Yu, MD, PhD, assistant professor at the University of Wisconsin (UW) School of Medicine and Public Health.

“There’s also intra-room distractions, such as someone needing help with a reading,” he said.

To limit disruptions and allow radiologists to read studies more efficiently, a team led by Yu designed a system of segregated workflows into separate groups: image-interpretative (IIT) and non-image interpretative (NIT). IIT was strictly defined as the act of interpreting the study, while NIT included phone calls, protocoling and questions from those coming into the reading room for consults.

“While radiologists were interpreting images they were considered protected and unavailable—as if they were in a separate room,” said Yu. “At the same time, the people we designated to maintain the NIT workflow handled all other interactions and communication in the reading room.”

The researchers used a pre- and post-intervention survey to measure levels of workplace interruption and satisfaction, based on NASA’s Task Load Index (TLX), a widely used assessment that captures individual perceptions of workload.

The results?

Prior to the intervention, 72 percent of radiologists reported disruptions as moderately or severely affecting their ability to read studies. After the implementation of the segregated workflows, 86 percent of radiologists reported mild or no negative effects.

“People were in general happier and more satisfied at work than they were without the workflow division,” said Yu. “Getting all the work done wasn’t as mentally taxing.”

Implementing the workflow was simple and cost-efficient. Researchers let frequent collaborators know that reading radiologists wouldn’t be available during reads, and signs placed near and around the reading room directed people to a specific PACS workstation where someone was assigned to handle NIT tasks. These uncomplicated changes had ripple effects in the department, improving operations for non-radiologists as well.

“After we terminated the pilot period, the lead MR technologist came to us and asked, ‘So when are we going back to that?,” said Yu. “Non-physicians knew exactly who they had to talk to in the reading room, because they knew who’s doing what.”

In an extension of this work, Yu is working with the UW IT department to develop a method of asynchronous communication between radiologists and support staff, intending to cut down on phone calls that might pull a radiologist out of their workflow. Instead of a scheduler calling a radiologist directly, they can post the query on an online clinical track board, where the radiologist can find an appropriate time to answer the questions.

"A lot of these things are very small tweaks to how we operate and communicate,” Yu said. “There is a lot of systems engineering that speaks to the utility and usefulness of strategies like this in our department.”