Interruption or Opportunity?
Radiologists must handle (and embrace) interruptions throughout the workday.
Thinking that the phone rang “way too much,” John-Paul J. Yu, MD, PhD, neuroradiology fellow at the University of California, San Francisco (UCSF) Medical Center, and his colleagues tracked the number of telephone calls the center’s on-call radiologists completed during a 90-day period in 2012. The information revealed that on-call radiologists handled a deluge of calls during that window — 10,378 to be exact.
That meant that on-call radiologists managed an average of 72 telephone calls and spent almost two hours on the phone during a typical 12-hour overnight shift.
Telephone calls are just some of the scores of interruptions that throw radiologists off their traditional workflows every day. These interruptions involve consulting with referring physicians, answering patients’ questions, and assisting staff colleagues. While these tasks are integral to patient care, they can distract radiologists from their primary responsibilities of interpreting imaging studies.
As radiologists integrate into patient care teams and provide clinical care, such interruptions are expected to become more prevalent. “The idea of Imaging 3.0™ is to take those things that we have previously called distractions and now consider them part of the normal workday,” says Arjun Sharma, MD, musculoskeletal and imaging informatics radiologist at Suburban Radiologists SC in Hinsdale, Ill.
To thrive in the value-driven paradigm, Geraldine B. McGinty, MD, MBA, FACR, chief contracting officer at Weill Cornell Medical College, says radiologists must embrace interruptions as part of their workflow. “We have to be adaptable, because the work that’s associated with these so-called interruptions is incredibly important to who we are and the value we deliver,” says McGinty, also chair of the ACR Commission on Economics.
Striking a balance to deliver high-quality imaging interpretations and value-added service can be tricky. The inclination is to minimize all distractions. But Roger S. Eng, MD, MPH, FACR, president of Golden Gate Radiology in the San Francisco Bay Area, says interruptions involving referring physician and patient consultations should be encouraged. “Our core purpose is to help patients, and having a dialog with referring physicians and imparting our expertise is critical to that purpose,” Eng says.
While not all interruptions can or should be eliminated, Sharma says he takes time at the close of each day to preview his next day’s schedule and address any potential interruptions in advance. For instance, if he detects an inaccuracy in an exam order, Sharma calls the referring physician immediately to resolve the issue.
But most interruptions aren’t predictable. For that reason, Yu says his department appoints a clinical fellow each day to answer referring physicians’ questions about ordering exams, help technologists with scans, and handle similar tasks on the group’s behalf. “Within the reading room, we break it down further by appointing a fellow to assist clinicians as they arrive for consults, freeing the others of that responsibility,” says Yu, now an assistant professor of radiology at the University of Wisconsin-Madison.
Radiologists can also leverage technology to diminish interruptions. Email, text messaging, cell phones, and electronic medical records make it easier for radiologists to communicate with referring physicians and staff than ever before. To make radiologists even more efficient, Sharma envisions connected radiology portals that aggregate employee directories and other department resources into a centralized location. “The informatics infrastructure should be designed to reduce the time it takes to address distractions,” he says.
Back at UCSF, Yu and his team tackled the center’s on-call-rotation interruptions. They installed an electronic health record, set up an in-house radiology call room near the emergency department’s physician workspace to use during busy periods, and assigned medical students to answer phone calls and triage imaging requests for the on-call radiologist.
Yu says interruptions have obviously decreased. “Anecdotally, we have noticed a decrease in the telephone call volume overall, which is likely due to the combination of interventions we have instituted,” he says.
By Jenny Jones, Imaging 3.0 content specialist