Radiology System Has Crucial Patient Safety Benefits


Research emerging from Cottage Health System (CHS) shows patients benefit when hospitals use an advanced picture archiving and communication system (PACS) for radiology images.

Cottage uses a sophisticated PACS that offers Internet access to radiological images and voice clip reports, which are dictated by radiologists who interpret the images.

Research on the patient safety benefits of Cottage's PACS was presented at the 2006 annual meeting of the National Patient Safety Foundation (NPSF). The PACS involved in the research is made by DR Systems, a San Diego developer of hardware and software for PACS and radiology information systems.

"Every hospital these days is looking for ways to improve patient safety," said Steven Fellows, executive vice president and chief operating officer of CHS. "These research results show that the PACS at Cottage is making a substantial difference.   It's contributing substantially to more accurate diagnosis and faster care for the patients we serve." Fellows is one of the three research authors of the presentation at the patient safety conference, May 10-12, in San Francisco.

The experts' poster presentation concerns a five-year longitudinal study (2001-2006) in which referring physicians, who rely on radiologists' interpretation of radiological images, assessed the patient safety benefits of the health system's PACS. The study included a quantitative survey taken in 2001 and a follow-up qualitative survey, with in-depth interviews of referring physicians conducted this year.

Voice clips are an unusual feature of Cottage's PACS. The radiologist dictates his or her impression of the exam, which is then immediately available as an audio file attached to the study.   These voice clips are accessed   by physicians treating patients, through the facility's internal computer system or remotely via the Internet. 

The voice clips provide the radiologist 's interpretation for all radiologic exams, including the more complex and important studies such as MRIs and CT scans.   These exams are valuable in diagnosing and treating patients in the emergency room and other critical-care situations.

Most PACS do not have this combination of voice clip with Internet-access capabilities.   In most U. S. healthcare facilities other than Cottage, physicians who rely on the radiologists' reports have to wait at least several hours - and sometimes days  --  before a full text report can be generated and distributed.

"Rapid access to both images and voice clips with the radiologist's report can make a tremendous difference clinically," said Michael Trambert, M.D., one of the three study authors. "These features really speed up diagnosis and treatment for critically ill patients, because it's fast and easy to get the information doctors need for decisions about care. Ideally, that information should always include the radiologist's expert opinion. Voice clips make it possible for a radiologist's report to accompany every exam that is viewed on the PACS."

 A PACS that lacks remote web access and voice clips can create a patient safety problem, Dr. Trambert said: "Without Web access and voice clips there's a greater chance for medical errors.   Especially if doctors are pressed for time, they are often forced to make decisions based on inadequate data -- such as the radiology images alone without the radiologist's medical interpretation." 

Dr. Trambert is lead radiologist for PACS reengineering at CHS and the Sansum-Santa Barbara Medical Foundation Clinic. Erin Leifer, M.H.A., a systems analyst for CHS, is also an author on the study.

Among key findings from the quantitative survey conducted by Cottage:

  • 69 percent of respondents found that web access to the PACS saved "significant time" in retrieving results from the Radiology Department.
  • 61 percent said that exam access in their office via the web "significantly improved" patient care.
  • 94 percent reported that voice clips were "valuable" or "very useful."

As an example of how combined web access and voice clips improved patient care, one physician recalled the case in which "we had a result 20 minutes later. It made the difference in a decision between whether the patient should go to the hospital promptly or not, and she did and is much better." 

The presentation at the national patient safety conference also covered additional patient safety benefits of the PACS at CHS. These include:

  • Voice clip/montage combination. The PACS generates a set of key images that summarize the exam. By viewing the montage while listening to the voice clip, referring physicians can quickly review results and make diagnostic and treatment decisions.  That arrangement expedites care for critically ill patients.
  • Virtual consultations via web access. All caregivers consulting on a case can access exams and voice clip reports simultaneously from wherever they are - the hospital, their office, home, or even while traveling.

Patient safety concerns, such as those addressed in the new Cottage research, gained new prominence with a report from the Institute of Medicine's (IOM) titled To Err is Human: Building a Safer Health System .   That report ushered in an era of increased focus on preventing medical errors and improving patient safety. The IOM noted that up to 98,000 deaths and more than 1 million injuries in hospitals were caused by clinical mistakes. Among the medical error categories were delays and errors in both diagnosis and treatment.


May 2006