EXPEDITING THE TURNAROUND OF RADIOLOGY REPORTS - USE OF TOTAL QUALITYMANAGEMENT TO FACILITATE RADIOLOGISTS REPORT SIGNING

OBJECTIVE. The purpose of this study was to determine whether total qu ality management techniques could be used to speed radiologists' perfo rmance on the task of signing reports. SUBJECTS AND METHODS. Total qua lity management represents a group of tools that can be used to improv e the functioning of complex processes in the workplace. The steps inv olved in our total quality management project were as follows: (1) com mit to improving radiologists' performance, (2) commission an interdis ciplinary study team, (3) propose hypotheses for the causes of signing delays, (4) identify the key issues constraining performance (Pareto analysis), (5) intervene to correct systematic problems in a test syst em, (6) evaluate the results of intervention on radiologists' report s igning performance, and (7) hold the gains achieved by the interventio n. An interdisciplinary study team identified five key obstacles to pr ompt signing of reports: (1) radiologists' absence from the department when reports were available for signing (e.g., nights and weekends), (2) dysfunctional hand-off between transcriptionist and radiologist, ( 3) requirement that a fellow or resident sign before a staff radiologi st, (4) lack of a system for signing by proxy (if primary radiologist is away), (5) perceived lack of impact of signed report on clinical de cision making. RESULTS. Interventions included (1) providing home comp uter terminals, (2) implementing a buddy system for proxy signing, (3) eliminating the requirement for a signature from a fellow or resident , (4) teaming groups of radiologists with specific transcriptionists, and (5) streamlining transcription service. When these enhancements we re used in a test system, the mean time required to sign reports decre ased 59% from 26.0 +/- 8.4 hr (mean +/- standard error) in the baselin e period to 10.6 +/- 2.9 hr (in the enhanced period, p = .05). CONCLUS ION. We conclude that total quality management methods can accelerate radiologists'signing of reports.