Impact of a Reading Priority Scoring System on the Prioritization of Examination Interpretations.

OBJECTIVE: Our institution implemented a read priority scoring system to combat the known limitations of traditional methods for the prioritization of examination interpretations by radiologists. We aimed to determine the impact on report turnaround time (RTAT) and RTAT variability. MATERIALS AND METHODS: On examination completion, technologists entered a read priority score (1-9) using provided definitions. We retrospectively reviewed the median RTAT and RTAT variability (i.e., interquartile range length) for radiology examinations (n = 615,541; 2011-2014). We used Spearman correlation coefficients to determine the relationships between read priority scores and the median RTAT and the RTAT variability by year. We compared median RTAT and RTAT variability between early (2011) versus late (2012-2014) adoption phases using distribution-free random permutation tests. RESULTS: Ranked correlations showed yearly improvement, leading to a near-perfect ranking of median RTAT (r = 0.98, p < 0.001) and a perfect ranking of RTAT variability (r = 1.00, p < 0.001) by nine levels of priority. Eight of the nine priority levels showed a reduction in median RTAT between the early and late phases, and the three most urgent levels--that is, 1, 2, and 3--improved by 23%, 5%, and 70% (all, p < 0.001), respectively. Only one priority level (4, defined as outpatient urgent [8% of studies]) showed significant worsening by 15% (p < 0.001). The three most urgent levels of priority also showed improvements in RTAT variability (61%, 17%, 71%, respectively; all, p < 0.01). Only the lowest level of priority (9) exhibited a significant worsening in RTAT variability by 9% (p < 0.01). CONCLUSION: A reading priority scoring system with defined clinical scenarios yielded desirable prioritization of examination interpretations by radiologists as evidenced by appropriate and improved stratification of RTATs and RTAT variability.

Impact of a Four-Point Order-Priority Score on Imaging Examination Performance Times.

BACKGROUND: Many hospitals use a traditional categoric system (eg, STAT, ASAP [as soon as possible], routine) to prioritize orders for imaging examination performance. If left undefined, these categories contain ambiguity, which contributes to errant or misused categorizations, and ultimately, lost opportunity to optimally direct resources toward timely patient care. Our hospital implemented ordinal order-priority categories with specific definitions. We sought to determine the impact of this prioritization method on examination performance time and consistency. METHODS: A four-level numeric priority system with clinical definitions for each category was implemented in 2011 to replace a traditional model for hospital imaging orders. Retrospective analysis was performed on imaging orders for three years (2011-2013) after implementation, to assess the order-to-performance time (OTPT), defined as the time between order placement by the provider and examination completion by the technologist. Consistency was measured by the length of the interquartile range for the OTPT distribution. Comparison was made to orders from the preimplementation year (2010), as a control. RESULTS: The OTPT and OTPT consistency for performed examinations were both predictably stratified by order-priority level. Relative to control, we observed a reduction in the percentage of prioritized examinations, as well as modest general improvements in OTPT and OTPT consistency. CONCLUSIONS: A revised order-priority system with ordinal categorizations and clinical definitions accompanying each priority level at order entry yielded desirable prioritization of imaging examination performance by technologists, as evidenced by appropriate stratification of turnaround times and consistency by level of priority.