Abstract
Introduction: The aim of the study was to improve acute diagnostic workflow by provision of a dedicated sonographer-lead after hours ultrasound (US) service. Methods: Data on patients referred for the four most common referrals was obtained retrospectively over a 3-month period both prior to, and during, a 6-month sonographer-lead after hours US service. The primary outcome measure was mean time from referral to US exam. The secondary outcome measure was the mean number of days between US referral and discharge. Results: There was a statistically significant decrease in the mean referral to exam time of three of the four referral groups and a statistically significant decrease in the number of days between US referral and discharge in the post-intervention group compared with the pre-intervention group. Discussion: There was a clear early indication of improvement in patient safety and ability to provide effective and efficient care. Our recommendation is to use this data to provide the basis for application for funding for a permanent sonographer-lead after hours US service.
| Original language | English |
|---|---|
| Pages (from-to) | 23-30 |
| Number of pages | 8 |
| Journal | Sonography |
| Volume | 4 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Mar 2017 |
| Externally published | Yes |
Keywords
- ultrasound
- general
- after-hours care
- quality improvement
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In: Sonography, Vol. 4, No. 1, 03.2017, p. 23-30.
Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Auckland district health board radiology service improvement
T2 - An after hours ultrasound service pilot study
AU - Gerrie, Samantha
AU - Sim, Jenny
AU - Winstone, Tim
AU - Milne, David
AU - Modahl, Lucy
AU - Bagnall, Carol
AU - Curin, Raewyn
AU - Metcalfe, Julia
AU - O'Carroll, Nicola
N1 - Funding Information: Provision of quality healthcare is an aspect of healthcare important to ADHB and one that requires ongoing review with potential for improvement. The Ministry of Health has funded this pilot study as part of the ADHB Radiology Service Programme specifically focusing on improving acute diagnostic flow. Radiology service improvement programmes are a common component of overall radiology service provision with a common theme of improving workflow in an effort to reduce waiting times. We have used provision of a dedicated after hours sonographer-lead ultrasound service as the main method of improvement in workflow and reduction in waiting times. One major centre used flexible radiologists and addition of sonographers as a way to improve outpatient services with a consequent decrease in waiting times and an increase in patient satisfaction. However, they make the point that this is only feasible with adequate staffing levels, which is not the case at ADHB with our current sonographer shortage. There are two major findings in this study. The first is a statistically significant decrease in mean referral to exam time in three of the four cohorts in the post-intervention group compared to the pre-intervention group. No statistically significant difference in mean referral to exam time was seen in the renal colic group. This is thought most likely based on a different pattern of referral between the groups. Specifically, in the preintervention group, all referrals for investigation of renal colic were for CT that has a faster turnaround time than ultrasound where the radiology registrar is doing the ultrasound scanning and reporting. Interestingly, during the after hours ultrasound pilot, referral patterns changed for investigation of renal colic from all CT referrals to predominantly US referrals. This is thought most likely because of the increased availability of ultrasound after hours and the desire of both referring clinicians and radiology registrars to use non-radiation modalities where possible in this younger patient demographic. This change in referral pattern decreases unnecessary irradiation thereby increasing patient safety. The second major finding is a statistically significant decrease in the number of days from scan to discharge in the post-intervention group compared to the pre-intervention group. Increasing scan availability particularly over weekends (which was the focus of this study), in conjunction with hospital wide programmes to enable weekend discharges for eligible patients, means that some patients can be discharged over the weekend, especially if the scan is the only investigation the medical team are waiting for prior to discharge. Cost analysis is not part of this pilot, but earlier discharge as a result of a decrease in referral to exam time not only frees up hospital beds at a time when our hospital is running at full capacity but would also clearly have an impact on overall hospital stay cost per patient. One would also reasonably postulate a more positive patient experience because of earlier discharge. A Cochrane systematic review of discharge planning in 2013 showed that individual patient discharge planning decreased length of stay and increased patient satisfaction. The main limitation of the study is the small sample size. Because of the severe shortage of sonographers, ADHB was unable to provide US support during weekdays after hours, resulting in small sample sizes. In addition, time constraint dictates that only 3 months of data was collected for each group. With the data collected in consecutive time periods, the authors were unable to exclude potential confounding factors because of different seasons and associated potential different patient presentation profile. While this pilot study has provided us with important preliminary information regarding current after hours ultrasound workflow, further studies are needed to quantify the precise cost saving and the extent to which patient safety and patient experiences have been enhanced and further ways to improve service provision. Use of Sigma Six or Lean management techniques to look at individual steps within the overall process may be of benefit in the search for further potential targets for quality improvement. Publisher Copyright: © 2017 Australasian Sonographers Association
PY - 2017/3
Y1 - 2017/3
N2 - Introduction: The aim of the study was to improve acute diagnostic workflow by provision of a dedicated sonographer-lead after hours ultrasound (US) service. Methods: Data on patients referred for the four most common referrals was obtained retrospectively over a 3-month period both prior to, and during, a 6-month sonographer-lead after hours US service. The primary outcome measure was mean time from referral to US exam. The secondary outcome measure was the mean number of days between US referral and discharge. Results: There was a statistically significant decrease in the mean referral to exam time of three of the four referral groups and a statistically significant decrease in the number of days between US referral and discharge in the post-intervention group compared with the pre-intervention group. Discussion: There was a clear early indication of improvement in patient safety and ability to provide effective and efficient care. Our recommendation is to use this data to provide the basis for application for funding for a permanent sonographer-lead after hours US service.
AB - Introduction: The aim of the study was to improve acute diagnostic workflow by provision of a dedicated sonographer-lead after hours ultrasound (US) service. Methods: Data on patients referred for the four most common referrals was obtained retrospectively over a 3-month period both prior to, and during, a 6-month sonographer-lead after hours US service. The primary outcome measure was mean time from referral to US exam. The secondary outcome measure was the mean number of days between US referral and discharge. Results: There was a statistically significant decrease in the mean referral to exam time of three of the four referral groups and a statistically significant decrease in the number of days between US referral and discharge in the post-intervention group compared with the pre-intervention group. Discussion: There was a clear early indication of improvement in patient safety and ability to provide effective and efficient care. Our recommendation is to use this data to provide the basis for application for funding for a permanent sonographer-lead after hours US service.
KW - ultrasound
KW - general
KW - after-hours care
KW - quality improvement
UR - http://www.scopus.com/inward/record.url?scp=85147464823&partnerID=8YFLogxK
U2 - 10.1002/sono.12094
DO - 10.1002/sono.12094
M3 - Article
AN - SCOPUS:85147464823
SN - 2054-6750
VL - 4
SP - 23
EP - 30
JO - Sonography
JF - Sonography
IS - 1
ER -