Experience with radiology workflow and PACS: effects on technologist and radiologist task times

Purpose To evaluate the changes in workflow, in the radiology department, after switching from a film-based image management system to a picture archival and communication system (PACS). Materials and Methods Data from the radiology information system on non-routine chest exams taken on patients admitted to the medical intensive care unit (MICU) were downloaded from a seven month period when analog images were interpreted on multiviewers, a ten month period when computed radiography (CR) hard-copy images were interpreted on multiviewers, a four month period immediately after the conversion to image interpretation on workstations, and another six month period started after the workstations had been in use for 5 months. The elapsed time from exam request until exam completion and the elapsed time from exam completion until report dictation were compared for the non-routine chest exams taken during the 4 periods. Results The median elapsed time from request until completion increased from 34 minutes during both the analog film period, and the CR hard-copy period, to 40 minutes during both the workstation periods (p < .0001). There was also a significant increase (p < 0.0001) in the median elapsed time from exam completion until image interpretation by a radiologist during the first workstation period (Analog Period = 1:54, CR = 1:57, PACS 1 = 2:34). This difference in elapsed time was not evident in the second PACS period (p > 0.05; PACS 2 = 2:06). When the individual radiologists were evaluated separately, however, the elapsed time until report dictation did not increase for all radiologists. Conclusions Our current digital PACS slowed workflow in radiology during the initial period following its implementation. In subsequent periods, however, the increase in elapsed time for the radiologist's interpretation was eliminated. The technologists' workflow during the study period did not improve. The lack of a fully functional RTS-PACS interface during the initial operation is the likely reason for this.