By Wayne Forrest, AuntMinnie.com staff writer

May 17, 2017 -- By training MRI technologists in advanced communication skills, outpatient imaging centers can improve equipment utilization, hourly scan rates, and patient satisfaction, all while avoiding the potential loss of business to competing facilities.

In a comparison of trained and untrained staff, researchers found that enhanced staff skills resulted in better service and patient experiences. In comparison, sites with technologists who didn't receive the training experienced more no-shows and reduced procedure volume, according to a study published online April 28 in the Journal of the American College of Radiology.

Dr. Amna Ajam
Dr. Amna Ajam from Ohio State University.

"We found that MRI sites that received training in interpersonal and communication skills performed better in terms of more scans completed and patient satisfaction scores," wrote lead author Dr. Amna Ajam, from Ohio State University Medical Center, in an email to AuntMinnie.com.

Training's upside

Previous research has shown that training MRI staff members in advanced communication and ways to calm patient anxiety often results in significant improvements in patient throughput and satisfaction.

The need for better staff education has become even more of a priority in recent years with the Affordable Care Act, which shifts reimbursement for services toward value-based care. In particular, the U.S. Centers for Medicare and Medicaid Services (CMS) has come to tie its payments, in part, to a healthcare facility's performance relative to quality of care and patient satisfaction.

"We believe that the topics addressed in our paper are relevant to many radiologists and imaging facilities because in everyday practice, we strive to be more efficient and also deliver quality service," said Ajam, who serves as assistant director of OSU's neuroradiology fellowship and an assistant professor in the department of radiology.

With MRI, a fair number of exams are delayed or end prematurely due to factors such as claustrophobia, anxiety, or excessive patient motion. The researchers therefore decided to test whether training technologists to help patients feel calmer and more relaxed would make imaging centers more efficient, in addition to providing a more comfortable experience for patients, she said.

Performance standards

In the study, MRI technologists at three OSU outpatient imaging centers were randomly chosen for training in advanced communication skills, while the staff at three other OSU facilities went unschooled and served as the control group (JACR, April 28, 2017).

The researchers analyzed imaging center performance beginning with the second quarter of the 2015 calendar year, which served as the baseline. The third quarter represented the first post-training quarter, with data collection continuing through the fourth quarter of 2015 and first quarter of 2016.

During the 12-month study period, 27,425 MRI scans were performed at OSU's six imaging centers, with 15,590 exams conducted at the three trained sites and 11,835 scans at the control facilities.

MRI scanners at the trained sites were available for imaging an average of 65 hours per week, compared with an average of 57.4 hours per week at the untrained sites. There were five available MRI scanners at the trained centers, compared with four MRI systems at the control sites.

As for the training itself, 18 technologists and facility managers received two eight-hour interactive classroom sessions on advanced communication and interpersonal skills (Comfort Talk, Brookline, MA). The topics included building rapport with patients, managing pain and anxiety without medication, and incorporating language and other behavior elements to help patients relax. The instruction was supplemented with online resources to reinforce these concepts and skills, and it was followed by two days of onsite supervision.

"The main efficiency metric was equipment utilization, which tells us of the available imaging time slots, how many were booked and resulted in completed studies," Ajam explained. "A related metric was hourly scan rates, which tells us how many scans were completed per scanner per hour during the time the scanner is open for business."

Utilization trends

In reviewing MRI scanner utilization, the trained imaging sites achieved an increase from 83% at baseline to 85% in the first quarter of 2016. By comparison, the untrained locations saw utilization decline steadily quarter to quarter, from 77% at baseline to 65% in the first quarter of 2016. While the increased utilization rate was not statistically significant, the decline among the untrained sites was noteworthy (p < 0.0001). A similar trend was seen when comparing hourly scan rates.

Impact of technologist training on performance metrics
  Baseline After training
MRI utilization -- trained sites 83% 85%
MRI utilization -- untrained sites 77% 65%
Hourly scan rate* -- trained sites 1.23 1.27
Hourly scan rate* -- untrained sites 1.15 0.97
No-show rate -- trained sites 5% 5%
No-show rate -- untrained sites 6.3% 7.3%
*100% MRI utilization rate equals hourly scan rate of 1.5

The achievements in efficiency for the trained MR technologists were mirrored in patient satisfaction ratings. Based on Press Ganey national benchmark surveys, the trained sites improved patient satisfaction from the 56th percentile at baseline to the 70th percentile at the end of the study period. Conversely, patient satisfaction at the untrained imaging centers deteriorated from the 66th percentile at baseline to the 44th percentile at the study's end point.

"One finding that is not necessarily unexpected, but is rather interesting, is that sites that ended up scanning more patients did so without compromising patient satisfaction," Ajam said. "Efficiency doesn't have to come at a cost of neglecting patients' needs, and, conversely, better patient satisfaction does not necessarily make us more inefficient."

Patient no-shows

During the study period, the patient no-show rate remained stable at the trained sites (approximately 5%). However, the rate increased at untrained sites from approximately 6.3% at baseline to 7.3% at the end of the period (p < 0.05).

The researchers speculated in the paper that the increase in no-show rates among the control sites "may have been due to expectations by patients to be accommodated quickly for new appointments when supply exceeds demand." In other words, greater competition in the area may have influenced patients' decisions to go elsewhere, if they could schedule a more timely appointment.

In case you were wondering, OSU did not leave the MR technologists at the untrained outpatient sites in the dark. Once the study ended, they received the same advanced communication skills classes and follow-up as their counterparts.

Ajam and colleagues plan to continue their research by exploring similar factors that could affect radiology practices, particularly issues related to patient satisfaction that were raised in this study.

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