Tiny hospital uses teleradiology to improve service, turn times
Technology is cost-effective even for 39-bed facility
When patients at Trinity Hospital in Erin, TN, required X-rays, their wait for a diagnosis often translated into a two- to four-day ordeal. The 36-bed Columbia-owned hospital, located in a sparsely populated community approximately 80 miles from Nashville, could not afford to staff a full-time radiologist. Instead, Trinity relied on twice weekly visits from radiologists at Nashville’s Centennial Medical Center, Trinity’s parent hospital. Every Tuesday and Thursday, the radiologists provided X-ray services, and on Friday or Saturday, they read the films .
That system worked well enough as long as a radiologist was on-site when a patient needed an X-ray. But what about the patients who required an X-ray diagnosis after the radiologist left the facility? Those patients would have the scans taken and then would wait until the radiologist returned to receive a preliminary diagnosis.
Over time, that setup became untenable. Patients were anxious and frustrated waiting on their X-ray results. Meanwhile, Trinity found itself losing business to Clarksville Hospital, a facility about 40 miles away that provided faster turnarounds and better customer service.
"Columbia has so many rural hospitals, and they often don’t have enough volume for a [full-time] radiologist," explains Nethla Shires, RTCM, director of radiology at Trinity Hospital. "But we still had too many patients not to have radiology reports, and those patients wanted to know their results quickly, just like anyone else. And they didn’t want to hear excuses for why they would have to wait."
Bailing a sinking ship
Columbia weighed the possibilities. Trinity simply did not have the volume to justify bringing in a full-time radiologist, and using courier services for all X-ray film would create the potential for costly errors, such as mix-ups or film lost in transit. Instead, Columbia chose to adopt a teleradiology program that would help draw more patients back to the hospital.
"Columbia knew we had to have better service, so when they decided they wanted us to use the program, it was pretty much a done deal," Shires notes. "Before we knew it, we had it [in place]. And it’s been an incredible [arrangement] for us ever since."
In March 96, Trinity and Centennial were fitted with InTelenet, a high-speed telemedicine network system that links regional and rural health care facilities by phone lines. Trinity quickly set up space for all necessary equipment: fax machines, two hard drives, one standard sized monitor and keyboard, and a digitizer that scans the X-ray film all of which are hooked up electronically to four 14" x 17" monitors and an extensive database located at the Centennial site.
Radiology Consultants Inc. (RCI), the Nashville-based independent radiology group at Centennial Medical Center underwrote the approximately $130,000 cost of the system. The arrangement calls for the group to be repaid by receiving a fee for each digitized film read. If this arrangement proves successful and all preliminary reports bode well, then Columbia plans to arrange similar agreements at other rural hospitals. According to Trinity’s CEO, Jay Woodall, "the program has already paid for itself several times over."
Shires, along with one other full-time radiology employee, learned the ropes quickly and immediately saw results. "One day of training is all we got, but it turned out to be very user-friendly. It’s very quick, which has really increased our volume and turnaround time. And the patients love that they don’t have to wait," says Shires.
"We’ve gone from up to four days to less than 10 minutes for a preliminary report. Before, we’d have patients on top of patients waiting for a diagnosis report, and now we can get a preliminary [computerized axial tomography] report before we’re even finished with the exam and a hard copy within two hours. That’s very good for business," she adds. (See graph, above.)
So how does the system work? Radiology technicians at Trinity take the film, then scan it through the digitizer. The digitized file is sent by phone lines to Centenniel, where a radiologist accesses the patient’s file via a regional database, reads the film, phones in a preliminary report, then dictates a full report, which is transcribed and faxed back to Trinity.
To prevent erroneous reads, the system has two fail-safe methods. First, Trinity scans and sends a "protection film" with vertical, horizontal, and diagonal pixels that lets the radiologist at Centenniel align the receiver so that he or she knows that the image being received is the same one being sent. A Centennial radiologist also visits Trinity every Tuesday to review the actual films to make sure they match up with the diagnosis.
"It’s a very in-depth quality assurance system we have here," Shires notes. "We have a radiologist come every Tuesday. There are four others who rotate and fill-in when [needed]. We don’t make [errors] this way, and it’s pretty foolproof."
Despite the seemingly smooth process, Trinity’s swift move toward teleradiology has not been entirely hassle-free. Although turnaround time has improved dramatically, Trinitys skeleton crew struggles to keep up with the faster pace.
"We’re definitely faster with the patients, but that means there’s more film for us to scan, too. There are seven techs, and only two of us are here full-time, so the workload can get a little hectic," Shires notes. "If we had someone who could just scan for us all day, it would really help. But we don’t. And we’re doing sends from about 7:30 in the morning to 6:30 or 7:00 at night." (See graph, above.)
Trinity also set up an after-hours program for patients who require immediate attention. The RCI radiologists, who do not staff Centenniel around the clock, have equipped their homes with the same types of teleradiology phone ports and computer stations used at their hospital. Being networked to Centennial allows them to diagnose emergency cases almost immediately. In nonemergency cases, Trinity’s radiology technicians scan and transmit the digitized film, and Centennial doctors make a preliminary diagnosis during operating hours the following morning.
"It’s very convenient for the patient, and it keeps us from having to send patients away to other hospitals," Shires says. "The entire program has significantly increased the procedure count, and the radiologists that sponsored the program are quickly making up the money that went into it. We went from about 25 [X-rays] piling up in a day that couldn’t be read any sooner than a couple of days to putting through about 45 scans a day. And we get those back in minutes."
While Shires believes the teleradiology system can help other rural facilities improve patient satisfaction and quality care, she recommends other rural facilities look before they leap.
"Before anyone plans to get a system in place, they should get in touch with someone who already has the system set up and try to find [a facility] that will help sponsor the program," Shire adds. "It’s a lot of work, so knowing what to expect before you take the plunge will really help. Still, it may create a greater workload, but it’s definitely a great opportunity."
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