Objective: 
Devise a plan to optimize off-hours faculty and trainee staffing within the Department of Radiology
Measure the magnitude of patient safety gains in terms of report turnaround times (TAT) and critical results communication times (CRC)https://jdc.jefferson.edu/patientsafetyposters/1044/thumbnail.jp

Boroumand, MD, Gilda

Dave, PhD, MS, Jaydev K.

Roth, MD, MS-HQS, Christopher G.

English

Objective: 
Devise a plan to optimize off-hours faculty and trainee staffing within the Department of Radiology
Measure the magnitude of patient safety gains in terms of report turnaround times (TAT) and critical results communication times (CRC)http://jdc.jefferson.edu/patientsafetyposters/1044/thumbnail.jp

Name not available

Shedding Light on the Off-Hours Coverage Gap in Radiology: Improving Turnaround Times and Critical Results Reporting

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsHouse Staff Quality Improvement and PatientSafety Posters GME Quality and Safety5-31-2017Shedding Light on the Off-Hours Coverage Gap inRadiology: Improving Turnaround Times andCritical Results ReportingGilda Boroumand, MDThomas Jefferson University, gilda.boroumand@jefferson.eduJaydev K. Dave, PhD, MSThomas Jefferson University, jaydev.dave@jefferson.eduChristopher G. Roth, MD, MS-HQSThomas Jefferson University, christopher.roth@jefferson.eduFollow this and additional works at: http://jdc.jefferson.edu/patientsafetypostersPart of the Medicine and Health Sciences CommonsLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inHouse Staff Quality Improvement and Patient Safety Posters by an authorized administrator of the Jefferson Digital Commons. For more information,please contact: JeffersonDigitalCommons@jefferson.edu.Recommended CitationBoroumand, MD, Gilda; Dave, PhD, MS, Jaydev K.; and Roth, MD, MS-HQS, Christopher G., "Shedding Light on the Off-HoursCoverage Gap in Radiology: Improving Turnaround Times and Critical Results Reporting" (2017). House Staff Quality Improvementand Patient Safety Posters. Poster 64.http://jdc.jefferson.edu/patientsafetyposters/64Background • Delays in radiology reporting have direct ramifications on patient care & outcomes, patient safety, and costs • Per The Joint Commission, “Delay of treatment” ranked as the sixth most frequently reported sentinel event in 2016 • Traditionally, off-hours radiology coverage is disproportionately limited:  • Daytime subspecialty teams cover inpatient studies from 8AM–4PM • On-call residents and fellows provide off-hours coverage for some stat cases, but their primary responsibilities are ED studies • Limited radiology off-hours coverage poses threat to patient safety • Increasing volume of cross-sectional studies, increasing ED imaging utilization, and Joint Commission mandate on ED throughput have compounded the problem        • FY 2016: 72,322 of 133,766 studies performed between 4PM–8AM • Disproportionately high number of CT studies performed late afternoon through the evening • Many challenges to optimizing off-hours staffing  lack of funding, daytime service demands, resistance to change, etc. Objective • Devise a plan to optimize off-hours faculty and trainee staffing within the Department of Radiology • Measure the magnitude of patient safety gains in terms of report turnaround times (TAT) and critical results communication times (CRC) Intervention • As part of the Radiology Operational Excellence Program (ROE), a team of radiology faculty, trainees, and technologists was tasked with revising off-hours coverage through a 5-step Kaizen process • Multiple staffing changes implemented as of July 5, 2016: 1) Subspecialty team-based evening call shifts until 8PM • Neuroimaging, Body Imaging: staggered shifts, 12–8PM • General (plain film): extended shifts, 7:30 AM–8PM 2) Establishment of Emergency Radiology mini-fellowship • Senior resident ER coverage, 7 PM–12 AM • Decrease junior resident call burden 3)  Change Emergency Radiology faculty hours to extend early AM attending coverage 4) Extend resident Night Float shift by 1 hour • With the exception of resident Night Float (not pictured) and faculty General shifts, work hours were not increased  Intervention (cont’d) Structure Measures • Replaced subspecialty teams for isolated residents/fellows • Added faculty members to evening coverage Process Measures • Obtained from analytics software using data from the radiology information system • Evaluated pre & post implementation metrics: • Radiology imaging turnaround times (TAT) • Percentage of studies exceeding departmental benchmark of 6 hrs TAT Outcome Measures • Critical results communication (CRC) times for pneumothorax (PTX) and intracranial hemorrhage (ICH) pre & post plan implementation  • Survey results: faculty, resident and technologist perceptions              Conclusions • Better matching of radiology staffing with inpatient imaging workflow patterns improves turnaround times and critical results reporting • Expect improved reporting of imaging findings to translate into fewer delays in patient care and improved patient safety • Further improvements/future directions  enterprise solution, optimizing inter-disciplinary communication, addressing hospital operational inefficiencies References 1. The Joint Commission. Summary data of sentinel events reviewed by The Joint Commission. Published January 13, 2017.  Available at: https://www.jointcommission.org/assets/1/18/Summary_4Q_2016.pdf. Accessed May 10, 2017.  2. Zygmont ME, Itri JN, Rosenkrantz AB, et al. Radiology research in quality and safety: current trends and future needs. Acad Radiol 2017;24(3):263-72. Shedding Light on the Off-Hours Coverage Gap in Radiology: Improving Turnaround Times  and Critical Results Reporting Gilda Boroumand MD, Jaydev K Dave PhD MS, Christopher G Roth MD MS-HQS  Department of Radiology Results ED* (after 6 PM) Neuroradiology  & General Abdominal Imaging Pre-implementation Neuroradiology Abdominal  Imaging General ED* (after 7 PM) Post-implementation 0%10%20%30%40%50%60%70%80%90%100%Percentage of Inpatient Imaging Reports 4-8PM  Exceeding 6 Hour TAT  X-RayCTMRIUS0200400600800100012001400Inpatient Imaging Median TAT, 4-8PM (min) MRIX-rayCTUSResults (cont’d) 02004006008001000120014001600TJUH Inpatient CT Volume, 2016 0200040006000800010000TJUH Inpatient Imaging Volume, 2016 Subspecialty Coverage Subspecialty Coverage 0.00%10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%Pneumothorax ICH< 1 Hour 20152016Inpatient Critical Results  Communication: Percentage of  Reports Meeting Goal TAT Faculty Resident/fellow Legend 051015202530351 2 3 4 5PrePostOn a scale of 1-5 (1 = poorly and 5 = optimally), how well are inpatient studies covered off hours?  Faculty Survey 

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Shedding Light on the Off-Hours Coverage Gap in Radiology: Improving Turnaround Times and Critical Results Reporting

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