Design, implementation, and assessment of a radiology workflow management system

The objective of this article is to describe the development, launch, and outcomes studies of a paperless workflow management system (WMS) that improves radiology workflow in a filmless and speech-recognition environment.

The WMS prioritizes cases automatically on the basis of medical and operational acuity factors, automatically facilitates communication of critical radiology results, and provides permanent documentation of these results and communications. It runs in parallel with an integrated radiology information system (RIS)-PACS and speech-recognition system. Its effects on operations, staff stress and satisfaction, and patient satisfaction were studied.

Despite an increase in caseload volume after the launch of the WMS, case turnaround times, defined as the time between case availability on PACS and signing of the final radiology staff interpretation, decreased for all case types. Median case turnaround time decreased by 33 minutes (22%) for emergency department, 47 minutes (37%) for inpatient, and 22 minutes (38%) for outpatient radiology cases. All reductions were significant at a p value of < 0.05. Interruptions were reduced, consuming an estimated 28% less radiology staff time, after implementation. Patient perceptions of radiology service timeliness showed modest improvement after the WMS was implemented. Staff satisfaction showed no significant change.

There is room for improvement in radiology workflow even in departments with integrated RIS-PACS and speech-recognition systems. This study has shown that software tools that coordinate decentralized workflow and dynamically balance workloads can increase the efficiency and efficacy of radiologists. Operational benefits, such as reduced reading times, improvements in the timeliness of care (both actual and as perceived by patients), and reduced interruptions to radiologists, further reinforce the benefits of such a system. Secondary benefits, such as documenting communication about a case and facilitating review of results, can also promote more timely and effective care. Although use of the system did not result in a substantial improvement in staff perceptions, neither did it reduce their satisfaction, suggesting that these operational improvements were not achieved as a trade-off against the quality of the work environment.