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Using Teleradiology to Solve Wait Time Issues in PEI

Rationale / Objectives

Recently, there has been dissatisfaction from both patients and care providers with the long wait times for diagnostic imaging in Prince Edward Island (PEI). Part of Canada's National Wait Times Initiative (NWTI) to help increase health care access, PEI's Diagnostic Imaging Services struck a committee and established a LEAN methodology workflow analysis to help solve three key issues: scheduling practices, issues around equipment and human resources, and radiologist staffing. Examples of lean tools that can be effective in addressing wait time issues include root cause analysis and value-stream mapping.

Project/Program Description & Major Achievements

PEI put into place initiatives to alleviate long wait times by addressing three key issues; improper scheduling practices, equipment and human resource problems and radiologist staffing. Prior to the creation of a provincial diagnostic imaging model, all seven PEI hospitals scheduled diagnostic imaging exams independently. This created discrepancy among the hospitals’ wait times. Through the reorganization of this system and use of the Radiology Information System to book appointments, patients are now offered the first available imaging in any of PEI hospitals. Key Initiatives included the addition of a general/MRI technologist, a focused clerical staffperson for MRI, an upgrade to the hardware and software of the MRI scanner, adjusted protocols & scanning parameters and extended hours. The length of time for performing exams was decreased by 25 to 30%, CT wait times diminished from 22 weeks to three weeks or less and MRI wait times gradually improved to approximately eight weeks.

Lessons Learned

Through the initiative, the committee learned lessons that helped to contribute to its success. It was found to be highly necessary to track data on the initiatives to see if the interventions were working as planned. Also, it was imperative that the improvement process remained flexible; and changes at all levels were accepted. Furthermore, improvement initiatives required dedicated professionals to provide their expertise in order to achieve the outcomes observed. 

Further Description

In the province of PEI, Diagnostic Imaging Services operates out of two acute care and five community hospitals; there are two CT scanners and one MRI scanner for a population of approximately 140,000. Teleradiology was introduced to the PEI health system in order to address radiologist shortages. To help address this need, PEI made an agreement with a radiology group in the Capital Region of Halifax, Nova Scotia. The Halifax radiologists would provide temporary services to PEI, to interpret some of their reports and studies. The physicians in PEI would also have access to the radiologists if additional consultation was required. The imaging from PEI was sent through a secure link to an on-site server in Nova Scotia. After the reports are transcribed, verified and signed, they are returned to PEI for distribution. Once the reports are complete, they are deleted from the NS server to ensure patient confidentiality. This partnership enables hospitals in PEI to increase the number of scans they perform and offer additional support to PEI’s radiologists while recruitment efforts are continued. This project has had a positive impact on wait times for appointments as well as wait times for X-ray reports. 

Major Achievements

Wait times from January 2009 to July 2011 decreased for CT scans from 22 weeks to three weeks or less in PEI. Additionally, MRI wait times decreased from 33 weeks to eight weeks for cases that are not urgent. In addition, staff satisfaction has increased with a more productive workday and the associated workflow functions better. 

Metric

Result

Details

CT scan wait times

decreased from 22 to <3 weeks

*From January 2009 to July 2011

MRI wait times

decreased from 33 to 8 weeks for non-urgent cases

n/a

Length of exam time

decreased 25-30%

n/a