Analog to Digital Workflow Improvement: A Quantitative Study

This study tracked a radiology department’s conversion from utilization of a Kodak Amber analog system to a Kodak DirectView DR 5100 digital system. Through the use of ProModel(®) Optimization Suite, a workflow simulation software package, significant quantitative information was derived from workflow process data measured before and after the change to a digital system. Once the digital room was fully operational and the radiology staff comfortable with the new system, average patient examination time was reduced from 9.24 to 5.28 min, indicating that a higher patient throughput could be achieved. Compared to the analog system, chest examination time for modality specific activities was reduced by 43%. The percentage of repeat examinations experienced with the digital system also decreased to 8% vs. the level of 9.5% experienced with the analog system. The study indicated that it is possible to quantitatively study clinical workflow and productivity by using commercially available software

Chest radiography practice in critically ill patients: a postal survey in the Netherlands

BACKGROUND: To ascertain current chest radiography practice in intensive care units (ICUs) in the Netherlands. METHODS: Postal survey: a questionnaire was sent to all ICUs with > 5 beds suitable for mechanical ventilation; pediatric ICUs were excluded. When an ICU performed daily-routine chest radiographs in any group of patients it was considered to be a "daily-routine chest radiography" ICU. RESULTS: From the number of ICUs responding, 63% practice a daily-routine strategy, in which chest radiographs are obtained on a daily basis without any specific reason. A daily-routine chest radiography strategy is practiced less frequently in university-affiliated ICUs (50%) as compared to other ICUs (68%), as well as in larger ICUs (> 20 beds, 50%) as compared to smaller ICUs (< 20 beds, 65%) (P > 0.05). Remarkably, physicians that practice a daily-routine strategy consider daily-routine radiographs helpful in guiding daily practice in less than 30% of all performed radiographs. Chest radiographs are considered essential for verification of the position of invasive devices (81%) and for diagnosing pneumothorax, pneumonia or acute respiratory distress syndrome (82%, 74% and 69%, respectively). On demand chest radiographs are obtained after introduction of thoracic drains, central venous lines and endotracheal tubes in 98%, 84% and 75% of responding ICUs, respectively. Chest films are also obtained in case of ventilatory deterioration (49% of responding ICUs), and after cardiopulmonary resuscitation (59%), tracheotomy (58%) and mini-tracheotomy (23%). CONCLUSION: There is notable lack of consensus on chest radiography practice in the Netherlands. This survey suggests that a large number of intensivists may doubt the value of daily-routine chest radiography, but still practice a daily-routine strategy

Image perception and interpretation of abnormalities; can we believe our eyes? Can we do something about it?

The radiologist’s visual impression of images is transmitted, via non-visual means (the report), to the clinician. There are several complex steps from the perception of the images by the radiologist to the understanding of the impression by the clinician. With a process as complex as this, it is no wonder that errors in perception, cognition, interpretation, transmission and understanding are very common. This paper reviews the processes of perception and error generation and possible strategies for minimising them

The impact of routine chest radiography on ICU management decisions: an observational study

OBJECTIVE: To document the impact of routine daily chest radiographs on treatment decisions in a medical ICU. METHODS: The study sample consisted of 200 consecutive patients in an 11-bed medical ICU of a university-affiliated teaching hospital. During the study period, each patient's current and previous chest radiographs were reviewed in the ICU during morning rounds. A computerized digital video display system was used. Changes in therapy made as a consequence of this review were recorded. RESULTS: A total of 471 chest radiographs were reviewed. The patients' mean score on the Acute Physiology and Chronic Health Evaluation II (APACHE II) was 14.6 +/- 2.5, and the mean length of stay in the ICU was 3.6 days +/- 2.1 days (range, 11-24 days). A change in therapy was made on the basis of information obtained from review of the chest radiograph in 174 instances (37% of radiographs). The most frequent therapeutic interventions were use of a loop diuretic to treat pulmonary edema (26%), repositioning of an endotracheal tube (24%), and diagnostic studies to determine the cause of a new pulmonary infiltrate (16%). At least one change in therapy was made for 91 (66%) of the 138 intubated patients but for only 14 (23%) of the 62 nonintubated patients; this difference was significant. Differences among diagnostic groups were largely a reflection of the number of patients who were intubated. CONCLUSION: Routine daily chest radiographs may be justified in critically ill patients in a medical ICU because for a large proportion of these patients management decisions are made on the basis of information obtained from the chest radiograph. This observation may be applicable only to ICUs that have a high turnover of patients who are in the unit for a short time.</jats:p