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How workload balancing significantly reduces ED report turnaround times

October 3, 2017

    One of the most common metrics used by imaging programs is report turnaround time: the time from when an exam is ready for a radiologist to read to the final report sign-off.

    While report turnaround time is an important metric to track (and benchmark) across all care settings, it is particularly important in the ED, where additional minutes can have a major impact on patient care. And when minutes matter, it is important to evaluate every aspect of workflow that contributes to this turnaround time.

    For report turnaround time, the clock begins ticking as soon as an exam is ready for the radiologist to read, meaning that time on the worklist can have an impact on overall turnaround time. Greensboro Radiology (GR) recognized that reducing time exams spent on the worklist was an opportunity for improvement, particularly when it came to ED exams. That's why they focused on workload balancing.

    Improving Greensboro Radiology's turnaround time through worklist changes

    GR's existing worklist system assigned radiologists to a specific worklist, such as ED or a subspecialty. The worklist assigned cases a priority based on ED/Stat, inpatient, and outpatient. While this helped to prioritize ED and other urgent cases, GR noticed that natural variation in volumes would sometimes lead to relatively few cases on subspecialty lists and high volumes on the ED list. These two worklists were not integrated, which meant that radiologists would have to switch between lists manually to respond to these volume shifts.

    GR introduced workload balancing as an additional feature to their worklist system. Now all radiologists read from a "common list" as well as their subspecialty list. GR also refined their exam priority system, assigning a specific target turnaround time to each exam as it appears on the worklist. Using exam escalation, the closer an exam's target time is to zero, the higher up the common worklist the exam moves. The system monitors these target times along with overall volumes and distributes cases to radiologists from both lists automatically. As exams on the common list near their target time, they are prioritized over the exams on the subspecialty lists.

    After introducing workload balancing, GR reduced their average ED report turnaround time by more than four minutes, a 57% reduction. Importantly, this improvement occurred without a sacrifice in inpatient or outpatient turnaround time.

    Greensboro's Average Report Turnaround Times Before and After Workload Balancing

    Worth Saunders, the CEO of Greensboro Radiology, says the benefits of workload balancing go beyond these turnaround time improvements: "We had some radiologists that were reading subspecialty cases all day long, complex cancer case after complex cancer case, and after a while that can really wear on a radiologist. Breaking up the day here and there for these subspecialty radiologists with different types of cases has been a very positive thing."

    Looking ahead: Leveraging artificial intelligence to improve report turnaround times

    For programs looking to improve ED report turnaround times, focusing on workload balancing is an important step.

    Another opportunity to decrease report turnaround times is to leverage, artificial intelligence, a field with increasing impacts on radiology, to identify and triage critical exams. Artificial intelligence companies are now working on solutions that will "pre-read" cases, even those not from the ED or marked as STAT, to check for critical findings. These cases can then be expedited to the top of the worklist to ensure they are read right away. If this expediting of cases is combined with a common worklist to ensure that a radiologist is assigned a critical case as quickly as possible, the result will be faster communication back to referring providers and improved patient care.


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