Can initiatives such as teleradiology or PACS decrease patient waiting times for radiology services? It's possible, although the literature isn't conclusive, according to research published online in the Journal of Digital Imaging (JDI).
In a literature review, U.K. researchers found that a range of different service-delivery initiatives in radiology had mixed results for lowering patient waiting times, based on their analysis of three measures: the time intervals between referral and examination; report turnaround time; and time between referral and finalized radiology report.
"Our study found that the evidence base for [service-delivery initiatives] in radiology is weak," said Bernard Olisemeke of the Heart of England National Health Service (NHS) Foundation Trust in Birmingham, U.K., and the University of Birmingham.
Patient waiting time is a topical issue within the U.K.'s NHS. For example, certain clinical pathways have target waiting times; the cancer pathway has an 18-week target from referral to the start of treatment, Olisemeke told AuntMinnieEurope.com. Because most of these patients require some form of imaging, it's not surprising that the demand for imaging is on the rise, as is the pressure to reduce decreasing patient waiting times in radiology.
"Different strategies have been advocated, some of which are quite expensive," he said. "And as the hospital budget is becoming more and more constrained, radiology managers will be requiring more evidence of effectiveness of proposed interventions."
As a result, the researchers sought to synthesize the available evidence in this area, Olisemeke said. They searched five databases, including Medline, Embase, and the Cochrane Library, for any relevant articles published between 1995 and February 2013 that assessed the effect of service delivery initiatives on patients' waiting times within radiology departments. They used the Cochrane EPOC risk-of-bias tool to assess bias risk on studies that met specified design criteria (JDI, 3 June 2014).
A variety of approaches
The 57 studies found by the researchers included service delivery initiatives such as extended-scope practice radiographers (three studies); quality management (12 studies) approaches; productivity-enhancing technologies (29 studies) such as PACS, RIS, teleradiology, speech recognition, and computerized physician-order entry (CPOE); multiple interventions (11 studies); outsourcing (one study); and pay-for performance (one study).
The researchers noted that the overall research quality was poor, as many of the studies did not use control groups and test and/or report the statistical significance of their results. In addition, the studies were highly heterogeneous, making it inappropriate for meta-analysis, according to the authors. Only one of the 57 studies they reviewed met the quality criteria for a Cochrane Review.
Another problem is the inconsistent definition of the outcome measures. Patient waiting times were defined using a variety of timelines that made the comparison of studies highly restrictive, Olisemeke said.
The researchers offered some suggestions for improving study quality, including better study design and mapping of the definitions of patient waiting times in radiology to improve consistency and comparison of results.
"Having said that, there are indications that quality management methodologies when combined with productivity-enhancing technologies has a bright prospect," Olisemeke said.
Promising results
A number of service delivery initiatives did yield promising results for decreasing patient wait times, including extended-scope-of-practice radiographers; quality management approaches such as Six Sigma, Lean methodology, and continuous quality improvement; and productivity-enhancing technologies such as speech recognition reporting, teleradiology, and CPOE systems.
The researchers found mixed results from PACS and RIS on patient waiting times.
"However, we feel that the overall importance of these two systems to a large radiology department might outweigh any considerations of their empirical impact on reducing waiting times," the authors wrote. "The dynamics might be different for smaller departments processing only a few thousand cases per year."
Practice managers should understand that about 95% of studies evaluating interventions to improve patient waiting times in radiology use research designs that are known to overestimate effect size and should view the results of the studies cautiously.
"Secondly, in order to achieve optimum results with any intervention, it is essential that radiology practice management spend ample time to analyse and understand the cause(s) of increased waiting times in their departments," Olisemeke said. "Only then are they able to choose appropriate and well-targeted interventions. For example, increased report turnaround time due to the shortage of radiologists is unlikely to improve with the implementation of speech recognition reporting."
The study highlights the need to combine quality management methodologies with productivity-enhancing tools, Olisemeke said.
