Image interpretation vs. workflow interruption: Quantified, analyzed, strategized

Upon commissioning a business process improvement team to meticulously track interpretative uptime, a 13-radiologist group learned its members had been spending nearly as many hours navigating interruptions as reading images.

What’s more, they found the interruptions measurably decreased efficiency and increased reading time regardless of imaging modality.

Corresponding author Lamya Atweh, MD, and colleagues at Nationwide Children’s Hospital in Columbus, Ohio, share lessons learned from the exercise in a study published June 27 in Current Problems in Diagnostic Radiology [1].

For the study, the business observers sat behind or alongside the study subjects and logged their actions into one of three columns—study interpretation, active interruption (initiated by the radiologist) or passive interruption (initiated by someone else).

Tallying the results after 61 hours of observation conducted over a three-month period, Atweh and co-authors found image interpretation claimed not a lot more than half the rads’ combined clock (52%).

The rest—close to half the tracked hours—went to active interruptions (29%) or passive interruptions (18%).

More findings of note:

  • Around 50% of non-interpretive time involved in-person conversations or consults. Of these, 16% involved phone calls, 67% of which were incoming.
  • The longest uninterrupted span was 20 minutes.
  • Most of the time (85%), an interruption came within the first three minutes of an interpretation. These interruptions lasted one minute or less 70% of the time.

In addition, the authors cite previous research showing the negative effects interruptions can have on interpretation accuracy.

As for modality-specific findings, interruptions expanded read times by one minute for X-rays, two minutes for ultrasounds, six minutes for CTs and 10 minutes for MRIs.

In their discussion, the authors describe interventions their department has taken after quantifying interruption times and discussing the deleterious effects of workflow disruptions.

As part of a broader quality-improvement plan, for example, the department prioritized changing its physical environment, increasing use of a reading room assistant and optimizing trainee schedules. They also began planning for a new PACS with a study list manager and intra-department communicator, standardized acquisition and reporting protocols.

Those steps were only the start. The department has since addressed the challenge of anticipating, managing and mitigating interruptions on numerous fronts, as the authors detail in the study report.

The aggressive approach has been justified because interruptions “not only cost the radiologist whatever time it took to address the interruption but also cost additional total time to finalize the report dictation,” Atweh et al. comment. “Interruptions may increase duplication of work with search patterns that need to start again from the beginning.”

More:

This study highlights the challenges radiologists face in workflow management. Activity patterns identified by this study throughout the day reflect workflow and may be utilized for planning non-interpretive functions in order to reduce interruptions during interpretative times.”

Read the full study here.

Dave Pearson

Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.

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