RESULTS Radiologists Add Value by Participating … · Radiologists Add Value by Participating in...
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BACKGROUND Ammar Sarwar, MD • Jonathan B. Kruskal, MD PhD Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA Radiologists Add Value by Participating in Patient Progression and Complex Care Management Rounds QS009-EB-MOB • Radiologist participation in Patient Progression Rounds is a novel way to contribute to reducing the length of stay • Radiologist on rounds improve visibility and demonstrate new ways in which imaging specialists can contribute to providing care • Radiologists can establishing relationships with clinical providers through active participation CONCLUSION • Of the 8 domains, 29 implementable opportunities were identified • Those with greatest impact included: – prioritizing attending orders – bypassing surgical consults for certain procedure requests – reducing use of oral contrast – radiologist on rounds facilitates procedure requests – flag inpatients on reading lists • The greatest delays were related to scheduling, performance and disposition of patients undergoing procedures • Additional roles that the radiologists played included: – interpreting studies during rounds – coordinating timely consults on complex cases – interpreting “outside” studies, thus avoiding duplicative imaging RESULTS PURPOSE Document how radiologists can contribute to progression rounds and safely reduce length of stay • Multi-disciplinary progression rounds – Weekly – ICU patients – In-patients at 48-72 hours post-admission • Participants: – Medicine team (attendings and trainees) – Surgeon – Radiologists – Nurses – Administrators Caring for patients across the continuum METHODS 1) Timely access to studies 2) Site of service 3) The scheduling and ordering processes 4) Study and procedure approval process 5) Sequence of testing 6) Policies, guidelines and protocols 7) Informatics and IT contributors Domains Goals 1) Improving throughput 2) Improving access 3) Reducing delays 4) Ensuring appropriateness • Longer length of stay usually occurs: – For patients requiring complex procedures – For patients having multiple co-morbidities – For difficult to manage conditions – For patients with complications during their hospital stay • Value-based payments are linked to: – length of stay – outcomes • Currently radiologists can directly reduce length of stay by – reducing report turnaround time • Value for imaging increases if: – Right test – Right time – Right patient • However, radiologists are currently not present at the point of order entry • Therefore, their ability to affect decision-making is limited for: – Right test – Right time – readmission rates – patient satisfaction • Radiologists can also potentially affect length of stay: – Rapid diagnosis in the ED to help initiate therapy • CT/MRI for stroke • Abdominal CT for acute abdominal conditions – Post-therapy imaging to guide management plan • Serial radiography for pneumonia or pulmonary edema • Post-surgical imaging for early recognition of complications – Pre-discharge imaging to prevent readmissions • Doppler ultrasounds for liver transplant patients COMPLEX PATIENT MANAGEMENT – Post-Study period COMPLEX PATIENT MANAGEMENT – Pre-Study period
Transcript of RESULTS Radiologists Add Value by Participating … · Radiologists Add Value by Participating in...
BACKGROUND
Ammar Sarwar, MD • Jonathan B. Kruskal, MD PhDBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Radiologists Add Value by Participating in Patient Progression and Complex Care Management RoundsQS009-EB-MOB
• RadiologistparticipationinPatientProgressionRoundsisanovelwaytocontributetoreducingthelengthofstay
• Radiologistonroundsimprovevisibilityanddemonstratenewwaysinwhichimagingspecialistscancontributetoprovidingcare
• Radiologistscanestablishingrelationshipswithclinicalprovidersthroughactiveparticipation
CONCLUSION
• Of the 8 domains, 29 implementable opportunities were identified
• Those with greatest impact included:– prioritizing attending orders– bypassing surgical consults for certain procedure requests– reducing use of oral contrast– radiologist on rounds facilitates procedure requests– flag inpatients on reading lists
• Thegreatestdelayswererelatedtoscheduling,performanceanddispositionofpatientsundergoingprocedures
• Additionalrolesthattheradiologistsplayedincluded:– interpreting studies during rounds– coordinating timely consults on complex cases– interpreting “outside” studies, thus avoiding duplicative imaging
RESULTS
PURPOSEDocumenthowradiologistscancontributetoprogressionroundsandsafelyreducelengthofstay
• Multi-disciplinary progression rounds – Weekly– ICU patients– In-patients at 48-72 hours post-admission
• Participants: – Medicine team (attendings and trainees)– Surgeon– Radiologists– Nurses– Administrators
CaringforpatientsacrossthecontinuumMETHODS1) Timely access to studies2) Site of service3) The scheduling and ordering processes4) Study and procedure approval process5) Sequence of testing6) Policies, guidelines and protocols7) Informatics and IT contributors
Domains
Goals1) Improving throughput 2) Improving access3) Reducing delays 4) Ensuring appropriateness
• Longer length of stay usually occurs:– For patients requiring complex procedures– For patients having multiple co-morbidities– For difficult to manage conditions– For patients with complications during their hospital stay
• Value-based payments are linked to:– length of stay– outcomes
• Currently radiologists can directly reduce length of stay by– reducing report turnaround time
• Value for imaging increases if:– Right test– Right time– Right patient
• However, radiologists are currently not present at the point of order entry
• Therefore, their ability to affect decision-making is limited for:– Right test– Right time
– readmission rates– patient satisfaction
• Radiologists can also potentially affect length of stay:– Rapid diagnosis in the ED to help initiate therapy
•CT/MRI for stroke•Abdominal CT for acute abdominal conditions
– Post-therapy imaging to guide management plan•Serial radiography for pneumonia or pulmonary edema•Post-surgical imaging for early recognition of complications
– Pre-discharge imaging to prevent readmissions•Doppler ultrasounds for liver transplant patients
COMPLEXPATIENTMANAGEMENT–Post-StudyperiodCOMPLEXPATIENTMANAGEMENT–Pre-Studyperiod
