Dynamic capacity allocation in a radiology service considering different types of patients, individual no-show probabilities, and overbooking.

BACKGROUND: We propose a mathematical model formulated as a finite-horizon Markov Decision Process (MDP) to allocate capacity in a radiology department that serves different types of patients. To the best of our knowledge, this is the first attempt at considering radiology resources with different capacities and individual no-show probabilities of ambulatory patients in an MDP model. To mitigate the negative impacts of no-show, overbooking rules are also investigated. METHODS: The model's main objective is to identify an optimal policy for allocating the available capacity such that waiting, overtime, and penalty costs are minimized. Optimization is carried out using traditional dynamic programming (DP). The model was applied to real data from a radiology department of a large Brazilian public hospital. The optimal policy is compared with five alternative policies, one of which resembles the one currently used by the department. We identify among alternative policies the one that performs closest to the optimal. RESULTS: The optimal policy presented the best performance (smallest total daily cost) in the majority of analyzed scenarios (212 out of 216). Numerical analyses allowed us to recommend the use of the optimal policy for capacity allocation with a double overbooking rule and two resources available in overtime periods. An alternative policy in which outpatients are prioritized for service (rather than inpatients) displayed results closest to the optimal policy, being also recommended due to its easy implementation. CONCLUSIONS: Based on such recommendation and observing the state of the system at any given period (representing the number of patients waiting for service), radiology department managers should be able to make a decision (i.e., define number and type of patients) that should be selected for service such that the system's cost is minimized.

Factors associated with No-Shows and rescheduling MRI appointments.

BACKGROUND: One of the major challenges facing global radiology services comes from delays connected to long waiting lists for magnetic resonance imaging (MRI) procedures. Such delays in diagnostic procedures could lead to poorer patient care outcomes. This study intended to estimate the rate of "No-Shows" or "Reschedule" MRI appointments. We also investigated the factors correlating No-Shows and Reschedule MRI appointments. METHODS: A cross-sectional study was conducted in Saudi Arabia using data obtained via MRI schedule reviews and self-administrated questionnaires. Clinical and demographic data were also collected from the study participants. Stepwise binary logistic regression was used to analyze the data. RESULTS: A total of 904 outpatients were asked to participate in the study, and we enrolled 121 outpatients who agreed to complete the study questionnaire. Of the 904 outpatients, the rate of No-Shows or Reschedule was 34.8% (95% Confidence Interval: 31.7-38.1%). Of the 121 outpatients studied, the rate of No-Shows or Reschedule was 49.6% (95% CI: 40.4-58.8%). Those of the female gender (OR = 6.238; 95% CI: 2.674-14.551, p-value = 0.001) and lack of education (OR = 2.799; 95% CI: 1.121-6.986, p-value = 0.027) were highly associated with No-Shows for the MRI appointments. There was no clarification of the MRI instructions (OR = 31.396; 95% CI: 3.427-287.644; p-value = 0.002), and family member drivers (OR = 15.530; 95% CI: 2.637-91.446, p-value = 0.002) were highly associated with rescheduling the MRI appointments. CONCLUSIONS: We noted higher rates of No-Shows and Rescheduling of MRI appointments in females, those with a lack of formal education, those who had not received the procedure instructions, and those who lacked transportation. We recommend setting targets and developing strategies and policies to improve more timely access to MRI, and thus reduce the waiting time.

Evidence-based radiology 5 years on-a single-centre review of image referral appropriateness.

BACKGROUND: The iRefer guidelines provide evidence-based recommendations on imaging and are designed to facilitate appropriate referrals and limit unnecessary radiation exposure. In 2017, a review at this institution assessed the appropriateness of imaging referrals. This study provides an update 5 years later on the referral appropriateness and aims to assess what impact the previous review has had on referral appropriateness. METHODS: A retrospective study of 945 referrals across GPs, ED, and inpatients was audited against the iRefer guidelines with costs and cumulative dose estimates calculated for inappropriate referrals considering salaries of those involved, the average time spent performing and reporting radiographs, and the median effective dose values. RESULTS: Results show a decrease in the volume of requests overall with the relative proportion of inappropriate requests rising significantly. Inappropriate requests for abdominal X-rays from GPs decreased from 72 to 37.5%, whereas inappropriate ED referrals increased from 38 to 46% and inappropriate inpatient requests remained static at 30%. The proportion of inappropriate GP requests for spinal radiographs significantly increased for cervical, thoracic, and lumbar spine radiographs, respectively (18 to 66%; 47 to 72%; 53 to 80%; p-value < 0.001). Inappropriate radiographs represent an increased financial and dose-based burden. CONCLUSION: The volume of radiograph requests reduced after over a 5-year interval; however, the relative proportion of inappropriate requests rose significantly. The iRefer guidelines provide a useful resource to ensure that imaging is used appropriately, effectively, and safely; however, more work is needed to ensure that requests are adhering to these guidelines.

Doctors' perspectives on the quality of medical imaging in public hospitals in eThekwini District.

Background: There is a paucity of literature on perspectives of referring doctors about the quality of medical imaging services and this study closes this gap in literature. Aim: This quality assurance (QA) study aimed to explore the perspectives of doctors on the quality of medical imaging services in selected regional hospitals within eThekwini District of KwaZulu-Natal. Setting: The study was conducted in four public regional hospitals. Methods: An exploratory descriptive qualitative research design involving 30 min-45 min of in-depth individual interviews was used. A purposive sampling technique was used to select research participants and hospitals to ensure adequate responses to the research questions. The sample involved nine participants and was guided by data saturation. Responses were recorded through notes and voice recordings and thematic analysis was used to analyse data. Results: Three main themes (timeliness of examinations, communication and radiology reports and image quality) and eight subthemes (waiting times, shortage of radiographers, workload, communication between doctors and radiographers, requisition forms, unavailability of radiology reports, clarity of images and image acquisition protocols) emerged from the data. Challenges experienced were exacerbated by high workload and shortage of radiologists and radiographers. Doctors in the data collection sites were mainly dissatisfied with services provided by the medical imaging departments. Conclusion: Regular engagements between medical imaging departments and doctors are important in enhancing the provision of quality care to patients. In-service training of radiographers and employment of additional radiographers and finding solutions to mitigate shortage of radiologists are recommended. Contribution: This quality assurance (QA) study focused on experiences of doctors while many other medical imaging QA studies in South Africa are equipment based. In-service training of radiographers is recommended to improve image quality and communication skills.

Patient satisfaction with radiology services in the UAE: A comprehensive analysis of care, comfort, service, and accessibility.

INTRODUCTION: This paper analyses patient satisfaction with radiology services in the United Arab Emirates (UAE). The study evaluates the care, comfort, service, and accessibility of the services and patient satisfaction with imaging procedures. METHODS: The research design employed a descriptive, cross-sectional approach, and data were collected through a survey consisting of eight sections. A total of 444 participants completed the survey, providing valuable insights into their demographics, appointment experiences, waiting times, staff attitudes and overall satisfaction. RESULTS: 70.4% of the participants stated that it was easy to make appointments, and 66.1% stated that they were satisfied with the efficiency of check-ins. 54.9% felt they waited the right amount of time to make an appointment, and 56.1% were satisfied with the time waiting to receive the imaging report. The findings indicate that waiting times and staff attitudes significantly influence patient satisfaction, while demographic factors, such as nationality, education, and age, do not significantly impact them. The study concludes that healthcare providers should prioritise efficient appointment scheduling, reduce waiting times and foster positive patient-staff interactions to enhance patient satisfaction. The open-ended feedback provided by the participants also offers valuable suggestions for improving service quality. CONCLUSION: This study is a foundation for future research and provides healthcare organisations with valuable insights to enhance patient satisfaction in UAE radiology services. IMPLICATIONS FOR PRACTICE: Healthcare providers should focus on patient satisfaction to improve retention and loyalty, attract new patients and enhance their reputation.

An evaluation of the impact of the Coronavirus (COVID 19) pandemic on interventional radiographers' wellbeing.

BACKGROUND: Interventional radiographers have substantially contributed to patient care during the pandemic by providing imaging guidance during minimally invasive procedures. The aim of this research is to quantify the impact of the pandemic on an interventional radiographers' wellbeing during the COVID-19 pandemic. METHODS: Ethical approval was obtained at the outset of this study. An explanatory sequential mixed methods approach, using questionnaires and interviews, was used to explore and evaluate interventional radiographers' wellbeing; physical, mental and social. An electronic self-administered questionnaire was administered to interventional radiographers and a semi-structured interview was conducted on two respondents. RESULTS: Responses were received from 40 interventional radiographers. Physical, mental and social wellbeing of interventional radiographers deteriorated since the onset of COVID-19. All forms of wellbeing were negatively impacted during the pandemic with mental wellbeing (82.5%) the most impacted, closely followed by physical (75%) and social wellbeing (50%). Half of responding interventional radiographers reported being "highly stressed" while working during COVID-19. Physical activity levels decreased, caffeine consumption increased and consumption of a healthy diet decreased. Almost all interventional radiographers (95%) had anxiety about passing the virus onto family or friends and 60% of noted a deterioration in relationship with friends. Three key themes identified included the importance of teamwork, the physical demand and mental impacts of working in interventional radiology during the pandemic. CONCLUSIONS: The COVID-19 pandemic has had a negative effect on interventional radiographers' wellbeing. The implications of staff having a diminished sense of wellbeing is that productivity is likely to have been reduced and potentially related burnout can lead to illness. This research highlights the need to focus on identifying methods of addressing the shortcomings in support services and identifying the specific needs of interventional radiographers to improve their wellbeing.

Evidenced-based radiology? A single-institution review of imaging referral appropriateness including monetary and dose estimates for inappropriate scans.

BACKGROUND: There has been a year on year increase in imaging requests at our academic institution. The iRefer guidelines are produced by the Royal College of Radiologists in the UK and are designed to prevent inappropriate imaging and radiation exposure. They have been available to general practitioners and hospital physicians in Ireland since March 2015. AIMS: Our aims were to determine the proportion of inappropriate imaging referrals pre- and post-guideline introduction and to calculate the cost and dose estimates for inappropriate scans. METHODS: A retrospective review of 1124 radiographs was performed with reference to a validated audit template. Emergency department, in-patient, and general practitioner referrals were reviewed. Cost and cumulative dose estimates were calculated for inappropriate referrals taking into account salaries, average time spent performing/reporting radiographs, and median effective dose values. RESULTS: The introduction of the iRefer guidelines has not significantly affected the proportion of inappropriate radiograph referrals at our institution, 42% pre-introduction and 43% post-introduction. We identified 784 inappropriate referrals across 6 radiograph subtypes, imparting a total median effective dose of 65.1 mSv to patients. The time spent performing inappropriate abdominal and spinal radiographs in 2017 yielded an estimated cost of €8036.40. CONCLUSION: A significant amount of inappropriate radiographs continue to be requested and performed, exposing patients to needless ionizing radiation and wasting staff members time at a financial cost. Interventions are needed to decrease inappropriate referrals.

Forecasting the demand for radiology services.

Since the demand for health services is the key driver for virtually all of a health care organisation's financial and operational activities, it is imperative that health care managers invest the time and effort to develop appropriate and accessible forecasting models for their facility's services. In this article, we analyse and forecast the demand for radiology services at a large, tertiary hospital in Florida. We demonstrate that a comprehensive and accurate forecasting model can be constructed using well-known statistical techniques. We then use our model to illustrate how to provide decision support for radiology managers with respect to department staffing. The methodology we present is not limited to radiology services and we advocate for more routine and widespread use of demand forecasting throughout the health care delivery system.

What resources are used in emergency departments in rural sub-Saharan Africa? A retrospective analysis of patient care in a district-level hospital in Uganda.

OBJECTIVES: To determine the most commonly used resources (provider procedural skills, medications, laboratory studies and imaging) needed to care for patients. SETTING: A single emergency department (ED) of a district-level hospital in rural Uganda. PARTICIPANTS: 26 710 patient visits. RESULTS: Procedures were performed for 65.6% of patients, predominantly intravenous cannulation, wound care, bladder catheterisation and orthopaedic procedures. Medications were administered to 87.6% of patients, most often pain medications, antibiotics, intravenous fluids, antimalarials, nutritional supplements and vaccinations. Laboratory testing was used for 85% of patients, predominantly malaria smears, rapid glucose testing, HIV assays, blood counts, urinalyses and blood type. Radiology testing was performed for 17.3% of patients, including X-rays, point-of-care ultrasound and formal ultrasound. CONCLUSION: This study describes the skills and resources needed to care for a large prospective cohort of patients seen in a district hospital ED in rural sub-Saharan Africa. It demonstrates that the vast majority of patients were treated with a small formulary of critical medications and limited access to laboratories and imaging, but providers require a broad set of decision-making and procedural skills.

Radiology Consultation in the Era of Precision Oncology: A Review of Consultation Models and Services in the Tertiary Setting.

The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.

Severe Gastrointestinal Haemorrhage: Summary of a National Quality of Care Study with Focus on Radiological Services.

PURPOSE OF STUDY: To identify the remediable factors in the quality of care provided to patients with severe gastrointestinal (GI) bleeding. METHOD: All hospital admissions in the first four months of 2013 with ICD10 coding for GI bleeding who received a transfusion of 4 units or more of blood. Up to five cases/hospital randomly selected for structured case note peer review. National availability of GI bleeding services data derived from organisational questionnaire completed by all hospitals. RESULTS: 4563/29,796 (15.3%) of GI bleeds received 4 or more units of blood with a mortality rate of 20.2% compared to 7.3% without blood transfusion. 30.8% of GI bleeds received a blood transfusion. 32% (60/185) of hospitals admitting acute GI bleeds lacked 24/7 endoscopy. 26% (48/185) had on-site embolisation 24/7 with a further 34% (64/185) accessing embolisation by transfer within a validated formal network. Blood product use was inappropriate in 20% (84/426). Improved management, principally earlier senior gastroenterologist review and/or endoscopy, would have reduced blood product use in 25% (113/457). 14.5% (90/618) had a CT scan which identified the site of bleeding in 32% (29/90). 7.8% (36/459) underwent an Interventional Radiology (IR) procedure but a further 6.3% (21/33) should have had IR. 6% (36/586) underwent surgery with 21/36 for uncontrolled bleeding. In 20/35 IR was not considered despite the majority being suitable for IR. Overall 44% (210/476) received an acceptable standard of care according to peer review. CONCLUSIONS: 26 recommendations were made to improve the quality of care in GI bleeding, with six principle recommendations.

Comparison of the Ministry of Health's tariffs with the cost of radiology services using the activity-based costing method.

INTRODUCTION: Efficient use of resources in organizations is one of the most important duties of managers. Appropriate allocation of resources can help managers to do this well. The aim of this study was to determine the cost of radiology services and to compare it with governmental tariffs (introduced by the Ministry of Health in Iran). METHODS: This was a descriptive and applied study that was conducted using the retrospective approach. First, activity centers were identified on the basis of five main groups of hospital activities. Then, resources and resource drivers, activities, and hospital activity drivers were identified. At the next step, the activities related to the delivery of radiology process were identified. Last, through allocation of activities cost to the cost objects, the cost price of 66 services that were delivered in the radiology department were calculated. The data were collected by making checklists, using the hospital's information system, observations, and interviews. Finally, the data were analyzed using the non-parametric Wilcoxon test, Microsoft Excel, and SPSS software, version 18. RESULTS: The findings showed that from the total cost of wages, materials, and overhead obtained, the unit cost of the 66 cost objects (delivered services) in the Radiology Department were calculated using the ABC method (Price of each unit of Nephrostogram obtained $15.8 and Cystogram obtained $18.4). The Kolmogorov-Smirnov test indicated that the distribution of data of cost price using the ABC method was not normal (p = 0.000). The Wilcoxon test showed that there was a significant difference between the cost of services and the tariff of radiology services (p = 0.000). CONCLUSIONS: The cost of delivered services in radiology departments was significantly higher than approved tariffs of the Ministry of Health, which can have a negative impact on the quality of services.

Supply and demand for radiographers in Lithuania: a prognosis for 2012-2030.

BACKGROUND: This is the first ever study on the planning of the supply and demand for radiographers in Lithuania. The aim of this study was to analyze the supply and demand for radiographers in the labor market with respect to their number, structure, and services, and to provide a prognosis for the period of 2012-2030. MATERIALS AND METHODS: Supply was calculated using two scenarios with differing duration of studies, annual student drop-out rates, rates of failure to start working, the annual number of new entrants into the labor market, and emigration rates. Annual mortality rates, the number of first-year students, and retirement rates were evaluated equally in both scenarios. Two projections of the demand for radiographers, based on the population's differing (by age and gender), need for outpatient radiology services, computed tomography, and magnetic resonance scans. Subsequently, the supply and demand scenarios were compared. RESULTS: Evaluation of the perspective supply and demand scenarios - which are the most probable - revealed a gap forming during the analyzed period, the predicted specialist shortage will reach 0.13 full-time equivalents per 10,000 population, and in 2030-0.37 full-time equivalents per 10,000 population. CONCLUSIONS: Considering the changes in education of radiographers, the socio-demographic characteristics of the staff, and the increasing need for radiographers' services, the supply of radiographers during the next two decades will be insufficient. To meet the forecasted demand for radiographers in the perspective scenario, the number of students choosing this specialty from 2013 on should increase by up to 30%.

Social radiology: Where to now?

Radiology is a relatively high-cost and high-maintenance aspect of medicine. Expertise is constantly required, from acquisition to its use and quality assurance programmes. However, it is an integral part of healthcare practice, from disease diagnosis, surveillance and prevention to treatment monitoring. It is alarming that two thirds of the world is deficient in or lacks even basic diagnostic imaging. Developing and underdeveloped countries need help in improving medical imaging. Help is coming from various organisations, which are extending hands-on teaching and imparting knowledge, as well as training trainers to increase the pool of skilled practitioners in the use of imaging equipment and other aspects of radiology services. The scene for social radiology is changing and set to positively impact the world in the (near) future.