Using RIS system log data cuts CT scan times, reduces staff overtime

Using a quality improvement program that incorporates routinely collected radiology information system (RIS) data can reduce CT exam turnaround times and shorten daily operations, researchers have reported.

The findings could translate to practical workflow improvements in radiology departments struggling with overtime and staff fatigue, noted a team led by Shingo Kayano, PhD, of Tohoku University Hospital in Sendai, Miyagi, Japan. The group's results were published June 15 in the Japanese Journal of Radiology.

"Log-based monitoring provides a practical mechanism for continuous feedback and refinement of CT workflows in routine clinical practice," the group wrote.

Use of CT has risen in Japan, in part due to an aging population and in part due to technological advances in CT imaging. But with this increased use comes challenges such as lengthy waiting times -- both for appointments and on the exam day -- which can contribute to patient anxiety and diagnostic delays.

"CT section staff, including radiologists, nurses, and technologists, face unique challenges: high patient volumes and complex procedures during the examination frequently lead to overtime work," the authors wrote. "This leads to physical and mental exhaustion, potentially degrading quality of work and well-being."

The investigators analyzed 150,540 weekday CT exams performed between 2018 and 2022. They used a Kaizen framework -- a "continuous improvement methodology with origins in Japanese manufacturing" -- to test five sequential workflow interventions between January and February 2021, guided by action logs extracted from a RIS. The team tracked exam volume, day of the week, and inpatient proportion.

The five Kaizen interventions included the following:

1. Consolidating high-efficiency examinations to improve room throughput;
2. Assigning the intravenous nurse primary responsibility for contrast preparation;
3. Redistributing appointment scheduling to reduce peak-time congestion;
4. Actively managing the waiting list based on real-time scanner availability; and
5. Introducing a shoes-on policy for ambulatory patients to cut out a time-consuming step at exam room entry and exit.

The team reported these results after putting the interventions into place:

• Daily median examination time fell from 351 seconds at baseline to 328 seconds, with a statistically significant immediate reduction of 17.4 seconds (p = 0.015).
• Patient entry and exit time -- that is, the interval between one patient's scan ending and the next beginning -- dropped from 216 to 198 seconds, with a significant adjusted immediate decrease of 16 seconds (p < 0.001).
• The last CT examination of the working day concluded an average of 12.5 minutes earlier than before the intervention (p = 0.011).

"Although causal attribution and downstream outcomes cannot be confirmed within [our study] design, the results suggest that routinely collected RIS logs can support performance monitoring and continuous quality improvement in CT operations," Kayano and colleagues concluded.  

Access the full study here.