[lostlogin]

I’m surprised reports were generated quicker when the radiologist worked with the X-ray tech.

Back when I did x-rays, a quick radiologist could report a set of films in about a minute.

I could X-ray 6 patients per hour (whilst doing data entry, billing, walking them to the room etc as well). I doubt I’d have been much more than twice as fast if the admin was skipped.

[amluto]

I recently accompanied a patient through an imaging lab. It was a room full of maybe 10 pieces of expensive equipment, and there was a big line of patients in a waiting room. There was one single technician, who handled one patient at a time, kept disappearing, and even when the technician was there, they spent more time convincing the machines to send the images to EMR than actually taking images.

I estimated that they could have gotten at least 4x the throughput (and 4x the utilization of expensive equipment!) if the process was streamlined. For this single patient, at least 45 minutes and probably more was wasted doing what boiled down to nothing of value.

While actually fixing this seems complex, in an emergency situation, I can easily imagine that skipping all the EMR integration and paperwork and just taking the pictures and having someone stand in the room and read the images would have gotten that 4x throughput improvement, even if the person reading the images would personally have lower throughput than if they were in their office.

(Maybe make the 4x into 8x if there could have been two technicians sharing one radiologist.)

[lostlogin]

>I can easily imagine that skipping all the EMR integration and paperwork and just taking the pictures and having someone stand in the room and read the images would have gotten that 4x throughput improvement

Yes. But 45 minutes later when someone wants to see the images ‘on that guy with the broken leg’ it becomes a nightmare. You need some labelling and a documentation system, and a unique identifier for each patient is a bare minimum. Using the RIS and creating an order isn’t that slow, and quickly becomes a time saver once you’ve got several patients.

[romwell]

>Yes. But 45 minutes later

45 minutes later that person (or someone else) could be dead because paperwork created a choke point.

The trade off here, again, is reducing overall efficiency (bandwidth) to get the results that are needed now ASAP (latency).

Once the mayhem is over, those patients can have new X-Rays done the next day, the records can be sorted out the next week, etc.

How would you even justify it?

I'm sorry, ma'am, I understand you're in pain and dying after being shot, but waiting a few minutes NOW will really save us some time filing paperwork going forward.

Note that it's not just about the patients getting the X-Rays; with 250+ people arriving at the same time, any delay propagates with cascading effects and delays care for everyone.

Even non-critical patients waiting for their turn creates an issue, since space is limited.

[alwa]

I read this to suggest that it was a flow thing more than a quantity thing.

By doing the readout on the spot, they could decide what was next for the patient before they even made it out of the machine, and the patient would roll directly off to get whatever attention the scan indicated.

I also thought I picked up an insinuation that they saved time by short circuiting all the convoluted EMR and billing kinds of systems, too. He mentions the radiologist reading the images directly off the “small screen” on the machine itself.

[kotaKat]

Digital x-ray has changed everything so much. Slap the Wi-Fi enabled plate under someone, click click, image already up on the screen and doc's reading it.

I (almost) broke my ankle and had to go to the ER to have it looked at and it was during a system downtime -- the doc did just that alongside the radiology tech from the machine's console instead of from a PACS workstation.

In a masscal event on one of these systems there's typically an 'emergency entry' option that lets you just input patients manually into the system and start shooting, so instead of the normal paperwork process they'll just image first and reconcile later.

[lostlogin]

It does get better when digital, but there is more to it than one might think when a good tech does it all in a few seconds and a couple of clicks. Positioning and adapting exposures isn’t always straightforward.

In terms of tracking imaging, you have to be able to track images back to a patient, and something identifying images needs to relate back. It’s a disaster otherwise and a complete waste of time. That ‘emergency patient’ function isn’t that helpful when it’s completely anonymous and there are several cases.

I’ve been a PACS admin for a brief time, and have seen enough to get twitchy.

[FireBeyond]

> In terms of tracking imaging, you have to be able to track images back to a patient, and something identifying images needs to relate back

The worst incident I have been on as a paramedic involved transporting 73 people from a train derailment. One of the simpler, but crude, methods we had as a fallback, was a sharpie and writing a number on foreheads, etc...

But we had MCI tags, which all have a unique number, would serve as a pseudo-MRN.

[aftbit]

Could you do more than one patient in ten minutes if they were lined up outside your door and shuffled on and off the machine by spare staff?

[lostlogin]

For sure.

And the most critical stuff is quick. I’m sure most techs could knock off a chest X-ray in 2 minutes, repeatedly.

As a student and doing all the paperwork correctly, I did 125 chest X-rays in a dedicated chest room in an 8 hour shift. That’s a 4 minute turn around.

However, all the patients were walking and talking. This makes a massive difference.

I failed the module on chest x-rays on first submission. I was supposed to log 120 over 3 years, showing progression.

Not enter 120+ from a single day. Resubmission was just paperwork, so not a big deal.

[romwell]

It's latency vs. bandwidth.

Reduced patient wait time (lower latency) was prioritized over how many X-Rays were processed per hour.

E.g. it wouldn't matter how fast the X-Ray specialist was working if the results were getting back to the patients in big batches, sent once an hour, because the patients might not live long enough to get them.