Everybody’s waiting in the hospital, including the doctors

The way doctors receive their radiographic results recently went automated at Happy’s hospital. What happens if I order a scan and I have a critical radiology finding that needs to be reported to me quickly? Do I get a phone call and verbal notification? Nope. Apparently, none of my patients are important enough to get a verbal notification of a critical finding in their radiology reports.

Why is that? The radiologists needed a verification system to indicated they had notified the ordering physician of an abnormal critical finding. And they had too many problems waiting on hold or waiting for a physician to call back. And they couldn’t remember to go back and dictate they discussed the report with the ordering physician once they’ve moved on to reading other studies. So automated radiology reporting went live without any consideration for the the work flow interruptions of the doctors on the front lines of patient care.

It’s all about waiting. I suspect the radiologists were tired of waiting. I don’t blame them. We’re all tired of waiting. There are IT solutions available for minimizing waiting. This solution is not the right one.

Half my day is consumed with waiting. I’m waiting for a nurse to pick up the phone after they page me. I’m waiting for the primary care physician to leave a patient’s room after I call them to talk with me about their patient I’m discharging. I’m waiting for the subspecialists or their representatives to call me when I have a request for their consultative services. I even have to wait for the radiologist to answer their phone when I have questions about their dictated report. The entire hospital environment is built around unpredictability. We must all be flexible with our time. Unfortunately, in a volume is money driven mentality, any time waiting is time not earning.

I appreciate that time is money concept. Unfortunately, we’ve passed waiting for the radiologists onto waiting for every other doctor in the hospital They have devalued my time at the expense of their time. That’s not an acceptable solution. We need to find solutions that do not trade one evil for another. That’s what information technology solutions must do. This solution is not the right solution.

We have chosen to implement a poorly discriminating radiology system that does not work in its current form for any physician work flow that involves contact with patients. It was introduced without rigorous field testing for work flow compatibility. I’ve experienced the system once. That’s all I need to say it does not work and it is placing my patients at risk when I am pulled away from patient care to navigate an automated reporting system.

If a patient scan needs to be notified as an abnormal finding, I now get a stat page to a number that must be picked up within sixty seconds or the telephone line hangs up on me. And if I don’t answer the page , it pages me again and again and again. For the number I am paged to I have no way of differentiating between the automated reporting system and every other out of hospital call I receive, such as an actual physician trying to transfer a patient to my service.

With my one and only experience thus far with this system, I was in the middle of caring for a critically ill intensive care unit patient when I was paged to a number that indicated a stat page. On the other end of this phone call was a woman trying to give me an 1-800 number to call and obtain a critical radiology report. This was during normal radiologist working hours.

That’s unacceptable. I told her I didn’t have time. I hung up on her. My patient was dying and I had more important things to do than navigate an automated system. A critical finding should require a verbal notification. I later found out a copy of the radiology report was faxed to my office. The radiology report indicated a normal finding. I was interrupted and told to navigate the automated reporting system because a partner of mine requested a call back on the report. I was interrupted from caring for my critically ill patient to verify I had received notification of a normal x-ray report.

That’s unacceptable.

One a side note, at Happy’s hospital we also have a Night Hawk radiology in place for when our in-house radiologists have gone home. The Night Hawk service means someone anywhere in the world may be reading the CT scan of my patient with abdominal pain. If the report comes back with free air, I don’t get a call from the radiologist. The radiology report is faxed directly to the patient’s floor where the nurse is responsible for notifying me. I am not sure if the radiologist calls to notify the nurse of a critical finding or not. If they don’t, they should.

I have a solution to this madness. Quit putting nurses in the middle. They have too much other stuff to worry about. Quit making physicians drop what they’re doing and call numbers to learn about normal radiology reports. What we need at Happy’s hospital, I think, is a 24 hour a day manned critical finding centralized reporting system. In this process the radiologist, both in-house and Night Hawk, would be required to identify and segregate all critical radiology findings that required immediate action by the ordering physician.

These identified reports should be filtered by fax and verbal notification to an always manned 24 hour centralized radiology monitoring area where all critical radiology reports would be centralized for immediate action and notification to the ordering physician who could then request to speak with the reading radiologist or request a copy of the real time voice recognized transcribed report be faxed to a requested number or verify that the report is actively accessible in the hospital’s electronic data base.

This manned system solves all the problems of waiting and leaves a paper trail that keeps everyone legally happy, and keeps my patients safe by not interrupting my work flow to unacceptable levels. We do this with telemetry cardiac monitoring. We don’t have a cardiologist sitting in front of the telemetry system 24 hours a day notifying doctors of abnormal tele strips. We don’t need a radiologist calling every doctor about critical findings. We just need someone that can notify quickly so the physician on the receiving end it not waiting twenty times a day for radiology reports.

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