Reducing STAT portable chest radiograph turn-around times: A pilot study

Publication date: Available online 5 June 2017
Source:Current Problems in Diagnostic Radiology
Author(s): Pratik Rachh, Alexa Levey, Lemmon Andrew, Aurora Marinescu, William Auffermann, Daniel Haycook, Eugene A. Berkowitz
BackgroundOur health system orders a high number of STAT priority portable chest radiographs (pCXR) (62%) compared to Routine (35%) and Today (3%). Retrospective chart review of one thousand chest radiographs ordered with the STAT priority revealed that 38% of studies did not indicate clinical urgency. Given the high number or STAT priority pCXRs ordered, prioritizing acquisition and interpretation of true STATs has become challenging for technologists and radiologists, leading to process inefficiencies, long turn-around times (TATs), communication failures, and patient safety errors.MethodsA multidisciplinary team analyzed the current pathway for exam order to finalized report, identified failure modes of imaging order to completion process, and developed guidelines for what constitutes a true STAT exam. A new "urgent" order category meeting the definition of true STAT was designed, tested, and implemented over a nine month period in participating ICUs.ResultsSince study implementation, 108 "urgent" exams were ordered. Median TAT for a STAT examination from order entry to image acquisition dropped from 70 minutes pre-implementation to 16 minutes for urgent exams. Median TAT for exam completion to radiologist image interpretation dropped from 520 minutes pre-implementation to 14 minutes for "urgent" exams. Since implementation, "urgent" exams were found to be more concordant (70%) with the status of a critically ill patient than STAT exams (62%).ConclusionsThe complexity of large multi-specialty medical centers and lack of direct interaction of the radiologist with clinicians has led to under appreciation of the needs of ordering providers by radiology, and elucidated system limitations of radiology by ordering providers. By involving a team of frontline clinicians, our team standardized the process of identifying, ordering, procuring, interpreting, and communicating results of true STAT exams. The process created by our team now serves as a template for implementation in other locations and service lines of our hospital.



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