The impact of a picture archiving and communication system (PACS) upon an intensive care unit

Objective: The aim of the study was to assess the effect of the introductio n of PACS (Picture Archiving and Communication System) upon image availabil ity in an Intensive Care Unit (ICU) and the consequent impact upon the beha viour of the ICU physicians, in terms of the initiation of image-based clin ical actions. Design: A before and after study was used to compare the spee d of image availability prior to, and following, the implementation of a ho spital-wide PACS. Setting: The research was part of an economic evaluation of PACS at Hammersmith Hospital, West London. Patients and participants: Al l ICU patients who were X-rayed during two pre-PACS and one post-PACS data collection periods were included within the study, Measurements: The times of: the X-ray request; acquisition: availability on ICU; and of any image-b ased clinical action taken by the ICU physician were recorded by radiograph ers and ICU physicians. Results: PACS significantly reduced the time betwee n request and image availability on ICU for routine X-rays but did not have ally measurable impact upon the time clinical actions were initiated by IC U physicians. The data on non-routine images were statistically inconclusiv e. Conclusions: This study shows that PACS significantly improves the speed of delivery of routine images to the ICU, but it appears that the instigat ion of image-based clinical actions is determined by other organisational f actors in ICU, such as ward rounds: rather than the availability of the ima ge for viewing. Further work is required on non-routine X-rays to clarify t he impact of PACS on physician behaviour in clinically urgent situations. ( C) 3000 Elsevier Science Ireland Ltd. All rights reserved.