Facilitating Image Sharing for Patients Transferred to a Tertiary Care Center Through Process Assessment and Identification of Quality Indicators in Order to Improve Quality of Patient Care, Reduce Healthcare Costs, and Reduce Reimaging

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2017-04-03

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Patel, Roshni

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BACKGROUND: lifeIMAGE allows for images to be uploaded from a CD and permanently stored in PACS and also facilitates the transfer of images online via cloud-based sharing without the transfer of CDs. However, the current use of lifeIMAGE in imaging transfers remains poorly understood. Thus the aim of this study was to assess the current state of imaging transfers and ultimately to improve medical imaging handovers for patients transferred from outside hospitals to Clements University Hospital (UT Southwestern's tertiary care center) through the use of lifeIMAGE. METHODS: The Plan Do Study Act method of quality improvement was used for this project. Based on our process mapping, we created a two-pronged intervention: the first focusing on increasing online imaging transfers from outside facilities via Cloud Connection, and the second focusing on assessing and improving knowledge of uploading images from CDs. Baseline assessment included pulling data from lifeIMAGE analytics to assess the current use of lifeIMAGE, reviewing 9 months of transfer logs before the intervention, and conducting a resident survey before the intervention. INTERVENTION: The first component of the intervention involved improving the current transfer of images from outside hospitals via cloud-based image sharing, without the use of CDs. This involved reviewing transfer logs to identify which outside facilities to focus on, providing the facilities with a document explaining their options for transferring images via lifeIMAGE, and scheduling meetings with these outside facilities to work towards a collaborative effort for the online transfer of images. The second component of the intervention involved uploading images from CDs to lifeIMAGE. A survey of residents was conducted to determine healthcare providers' current practice related to medical imaging handover for patients transferred with a CD and to evaluate knowledge of uploading images. This was followed by presenting a brief PowerPoint tutorial on uploading images from CD to lifeIMAGE to Internal Medicine residents at noon conference and posting instructions on the IM Resident blog and website. RESULTS: Of the recorded transfers spanning 9 months (Dec 2015-Aug 2016) from 371 different outside facilities (after excluding hospitals within the UT Southwestern system), United Regional Health Care System Wichita Falls and Dallas VA Medical Center were the facilities that transferred the most patients to CUH: 93 (3.63%) and 52 (3.32%), respectively. 68.2% of the surveyed residents expressed that at least half of transferred patients present with a CD containing images, and 72.7% of residents expressed that repeat imaging was required in at least half of the patients because they were transferred without imaging. 61.4% of resident respondents did not know how to upload CD images to lifeIMAGE. Of the residents who knew how to upload CD images to lifeIMAGE, the majority of this group (82%) endorsed uploading images themselves. When asked to describe the current process after receiving a CD containing images, 34% of surveyed residents reported directly importing images from the CDs into lifeIMAGE; 30% of residents reported sending CDs to radiology to upload; 25% reported viewing the images on CDs without import them. CONCLUSIONS: Creating a workflow diagram and assessing baseline data through lifeIMAGE Analytics and through the resident survey improved documentation and understanding of the current state of medical imaging transfers at Clements University Hospital. This study identified that cloud-based image sharing is an underutilized capability of lifeIMAGE. It further helped narrow the scope of the intervention by identifying the two sending hospitals with the highest volume of image transfers so that we could work to increase utilization of cloud-based transfers at these institutions. Based on the resident survey data exposing knowledge as a major barrier, we presented a short tutorial to the residents during noon conference detailing how to upload images to lifeIMAGE and push the images to PACS and created a brief instruction guide that was emailed to the residents as well as posted to the IM Resident website and IM blog for future access. The survey data also indicated that the process for uploading imaging from CDs was highly variable among residents, supporting the need for an intervention to standardize practice. Future PDSA cycles will be needed to assess the impact of our interventions.

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