Mapping Turnaround Times (TAT) to a Generic Timeline: A Systematic Review of TAT Definitions in Clinical Domains

<p>Abstract</p> <p>Background</p> <p>Assessing turnaround times can help to analyse workflows in hospital information systems. This paper presents a systematic review of literature concerning different turnaround time definitions. Our objectives were to collect relevant literature with respect to this kind of process times in hospitals and their respective domains. We then analysed the existing definitions and summarised them in an appropriate format.</p> <p>Methods</p> <p>Our search strategy was based on Pubmed queries and manual reviews of the bibliographies of retrieved articles. Studies were included if precise definitions of turnaround times were available. A generic timeline was designed through a consensus process to provide an overview of these definitions.</p> <p>Results</p> <p>More than 1000 articles were analysed and resulted in 122 papers. Of those, 162 turnaround time definitions in different clinical domains were identified. Starting and end points vary between these domains. To illustrate those turnaround time definitions, a generic timeline was constructed using preferred terms derived from the identified definitions. The consensus process resulted in the following 15 terms: admission, order, biopsy/examination, receipt of specimen in laboratory, procedure completion, interpretation, dictation, transcription, verification, report available, delivery, physician views report, treatment, discharge and discharge letter sent. Based on this analysis, several standard terms for turnaround time definitions are proposed.</p> <p>Conclusion</p> <p>Using turnaround times to benchmark clinical workflows is still difficult, because even within the same clinical domain many different definitions exist. Mapping of turnaround time definitions to a generic timeline is feasible.</p

Does improved access to diagnostic imaging results reduce hospital length of stay? A retrospective study

<p>Abstract</p> <p>Background</p> <p>One year after the introduction of Information and Communication Technology (ICT) to support diagnostic imaging at our hospital, clinicians had faster and better access to radiology reports and images; direct access to Computed Tomography (CT) reports in the Electronic Medical Record (EMR) was particularly popular. The objective of this study was to determine whether improvements in radiology reporting and clinical access to diagnostic imaging information one year after the ICT introduction were associated with a reduction in the length of patients' hospital stays (LOS).</p> <p>Methods</p> <p>Data describing hospital stays and diagnostic imaging were collected retrospectively from the EMR during periods of equal duration before and one year after the introduction of ICT. The post-ICT period was chosen because of the documented improvement in clinical access to radiology results during that period. The data set was randomly split into an exploratory part used to establish the hypotheses, and a confirmatory part. The data was used to compare the pre-ICT and post-ICT status, but also to compare differences between groups.</p> <p>Results</p> <p>There was no general reduction in LOS one year after ICT introduction. However, there was a 25% reduction for one group - patients with CT scans. This group was heterogeneous, covering 445 different primary discharge diagnoses. Analyses of subgroups were performed to reduce the impact of this divergence.</p> <p>Conclusion</p> <p>Our results did not indicate that improved access to radiology results reduced the patients' LOS. There was, however, a significant reduction in LOS for patients undergoing CT scans. Given the clinicians' interest in CT reports and the results of the subgroup analyses, it is likely that improved access to CT reports contributed to this reduction.</p

HIS-based electronic documentation can significantly reduce the time from biopsy to final report for prostate tumours and supports quality management as well as clinical research

<p>Abstract</p> <p>Background</p> <p>Timely and accurate information is important to guide the medical treatment process. We developed, implemented and assessed an order-entry system to support documentation of prostate histologies involving urologists, pathologists and physicians in private practice.</p> <p>Methods</p> <p>We designed electronic forms for histological prostate biopsy reports in our hospital information system (HIS). These forms are created by urologists and sent electronically to pathologists. Pathological findings are entered into the system and sent back to the urologists. We assessed time from biopsy to final report (TBF) and compared pre-implementation phase (paper-based forms) and post-implementation phase. In addition we analysed completeness of the electronic data.</p> <p>Results</p> <p>We compared 87 paper-based with 86 electronic cases. Using electronic forms within the HIS decreases time span from biopsy to final report by more than one day per patient (p < 0.0001). Beyond the optimized workflow we observed a good acceptance because physicians were already familiar with the HIS. The possibility to use these routine data for quality management and research purposes is an additional important advantage of the electronic system.</p> <p>Conclusion</p> <p>Electronic documentation can significantly reduce the time from biopsy to final report of prostate biopsy results and generates a reliable basis for quality management and research purposes.</p

The impact of PACS on clinician work practices in the intensive care unit: a systematic review of the literature

Objective To assess evidence of the impact of Picture Archiving and Communication Systems (PACS) on clinicians' work practices in the intensive care unit (ICU). Methods We searched Medline, Pre-Medline, CINAHL, Embase, and the SPIE Digital Library databases for English-language publications between 1980 and September 2010 using Medical Subject Headings terms and keywords. Results Eleven studies from the USA and UK were included. All studies measured aspects of time associated with the introduction of PACS, namely the availability of images, the time a physician took to review an image, and changes in viewing patterns. Seven studies examined the impact on clinical decision-making, with the majority measuring the time to image-based clinical action. The effect of PACS on communication modes was reported in five studies. Discussion PACS can impact on clinician work practices in three main areas. Most of the evidence suggests an improvement in the efficiency of work practices. Quick image availability can impact on work associated with clinical decision-making, although the results were inconsistent. PACS can change communication practices, particularly between the ICU and radiology; however, the evidence base is insufficient to draw firm conclusions in this area. Conclusion The potential for PACS to impact positively on clinician work practices in the ICU and improve patient care is great. However, the evidence base is limited and does not reflect aspects of contemporary PACS technology. Performance measures developed in previous studies remain relevant, with much left to investigate to understand how PACS can support new and improved ways of delivering care in the intensive care setting.8 page(s

Back to the future of IT adoption and evaluation in healthcare

This is a time of expansion, hope and change in the area of Health Information Technology (HIT). In this study, we provide an in-depth perspective into the adoption and diffusion of IT in healthcare based on a review of the current literature and upon expert panel assessments of adoption and diffusion issues, achievements to date, challenges facing key e-health technologies and future possibilities. These data are synthesised in the form of a research framework showing the main three areas of e-health (Electronic Medical Records, Clinical and Administrative systems and Telehealth) on three levels (individual, organisation and system). Current adoption and diffusion challenges and future possibilities are systematically presented via this research framework to inspire practice and research with both an individual and collective view of the key health systems currently confronting the healthcare sector

Factors affecting the acceptance and meaningful use of picture archive and communication systems by referring clinicians in private practice

A Picture Archive and Communication System (PACS) is a health information technology that facilitates the electronic storage, transmission, presentation and processing of digital medical-imaging datasets. The benefits of PACS have been well-documented. It provides a means to replace traditional film-based workflows and their inherent limitations. Referring clinicians’ acceptance is a critical factor in the overall success of a PACS implementation; and given the financial implications of project failure, research into physician acceptance and meaningful use is crucial. Very few PACS acceptance studies have focused on the referring clinicians, and even less in the context of the private sector. Therefore, the problem that this research aims to address is: There is a lack of understanding on which factors influence PACS acceptance and the meaningful use thereof by referring clinicians in private practice. This explorative study follows an embedded mixed methodology approach in order to meet the research objectives, favouring a qualitative method of inquiry with the support of a quantitative strand. Electronic questionnaires were distributed to private practice referring clinicians to probe the aspects related to PACS acceptance and its meaningful use. The conceptual framework, as devised by Paré and Trudel (2007), was used as a theoretical lens to categorize and discuss the research results in terms of Project, Technological, Organizational and Behavioural factors that affect PACS acceptance and its meaningful use. The findings showed good acceptance rates, which is in line with other research conducted in this field, including research done in the public sector. Technical and Organizational factors were the most prevalent. An extension of the above-mentioned theoretical framework was proposed to assist in maintaining positive results after the project Implementation phase has been completed. This research expands the Information Technology PACS body of knowledge – by identifying both the technical and the non-technical factors that are crucial in private practice referring doctor acceptance and meaningful use. By addressing these factors, institutions can improve the likelihood of PACS project success in private practice settings. Maximising referring doctor acceptance and meaningful use could also give private practices a competitive advantage over their competitors

Factors affecting the acceptance and meaningful use of picture archive and communication systems by referring clinicians in private practice

A Picture Archive and Communication System (PACS) is a health information technology that facilitates the electronic storage, transmission, presentation and processing of digital medical-imaging datasets. The benefits of PACS have been well-documented. It provides a means to replace traditional film-based workflows and their inherent limitations. Referring clinicians’ acceptance is a critical factor in the overall success of a PACS implementation; and given the financial implications of project failure, research into physician acceptance and meaningful use is crucial. Very few PACS acceptance studies have focused on the referring clinicians, and even less in the context of the private sector. Therefore, the problem that this research aims to address is: There is a lack of understanding on which factors influence PACS acceptance and the meaningful use thereof by referring clinicians in private practice. This explorative study follows an embedded mixed methodology approach in order to meet the research objectives, favouring a qualitative method of inquiry with the support of a quantitative strand. Electronic questionnaires were distributed to private practice referring clinicians to probe the aspects related to PACS acceptance and its meaningful use. The conceptual framework, as devised by Paré and Trudel (2007), was used as a theoretical lens to categorize and discuss the research results in terms of Project, Technological, Organizational and Behavioural factors that affect PACS acceptance and its meaningful use. The findings showed good acceptance rates, which is in line with other research conducted in this field, including research done in the public sector. Technical and Organizational factors were the most prevalent. An extension of the above-mentioned theoretical framework was proposed to assist in maintaining positive results after the project Implementation phase has been completed. This research expands the Information Technology PACS body of knowledge – by identifying both the technical and the non-technical factors that are crucial in private practice referring doctor acceptance and meaningful use. By addressing these factors, institutions can improve the likelihood of PACS project success in private practice settings. Maximising referring doctor acceptance and meaningful use could also give private practices a competitive advantage over their competitors

Introducing PACS to the late majority. a longitudinal study

10.1007/s10278-008-9160-xJournal of Digital Imaging23187-94JDIM

Evaluating the impact of service delivery initiatives on patients’ waiting times in diagnostic radiology: a mixed methods study

This thesis describes the impact of service delivery initiatives (SDIs) on patients’ waiting times within radiology departments. A systematic review of the literature (71 studies included) found the following broad type of SIDs: extended scope practice, quality management, productivity-enhancing technologies, outsourcing, pay-for-performance and multiple interventions. Ninety-six percent of the studies used either the pre- and post-intervention without control or the post-intervention only designs; but these designs are fundamentally weak and prone to bias. Furthermore, this thesis also described a case-study for the evaluation of the impact on patients’ waiting times of a 320-slice computed tomography (CT) scanner, speech recognition reporting and extended-working-hours within the Birmingham Heartlands Hospital (Heart of England NHS Foundation Trust), Birmingham. The evaluation combined the interrupted time series (ITS) design and qualitative interviews with healthcare professionals in a mixed methods approach. The mixed methods approach leverages the strengths of the quantitative and qualitative methods, so that the triangulation of the findings of one research method might be strengthened when supported by the findings of the other research method. The thesis used a distinctive implementation of ITS segmented regression which accounts for the changing trends of patients waiting times – an approach referred to as ITS ‘segmented spline’ regression