Optimizing Outpatient Oral Contrast Use in Abdominal CT-A Radiology Pandemic Response Initiative to Reduce Patient Time in the Waiting Room and Reduce Costs, While Improving Patient Experience.

Purpose: The aim was to reduce outpatient wait time and improve patient experience by optimising oral contrast use. Methods: Our multidisciplinary stakeholder collaboration implemented two simultaneous interventions: (1) Creation of 'oral contrast policy', limiting recommended indications. (2) Creation of a new shorter oral contrast regime (30 vs 60 min). We conducted a retrospective service evaluation of oral contrast use in outpatient (OP) abdominal CT at baseline and post-intervention. Patient wait times were measured and per-patient cost-savings were reported. An image quality review was performed by 2 blinded abdominal radiologists. Patient experience was evaluated with a standard voluntary survey. Statistical analysis was performed comparing baseline and evaluation outcomes using Chi-square or Fisher Exact test for categorical variables and Student's t-test or ANOVA for continuous data. Results: Over 1-month periods, OP CT scans were assessed in baseline (pre-pandemic) n = 575, baseline (pandemic) n = 495 and post-intervention n = 545 groups. Oral contrast use reduced from 420/575, 73.0% at baseline to 178/545, 32.7% post intervention. The turn-around time reduced by 15.8 minutes per patient from 70.3 to 54.5 minutes, P < .001 (Interventions 1 and 2). The diagnostic quality did not differ between the oral contrast regimes (Intervention 2, P = 1.0, P = .08). No repeat CTs were needed due to lack of oral contrast (Intervention 1) or poor opacification (Intervention 2). There was oral contrast cost reductions of 69.1-78.4% (P < .001). Patients reported their overall experience was improved post-intervention (Interventions 1 and 2). Conclusions: Optimising the CT oral contrast service through judicious use and a shorter regime, reduced patient wait times, improved patient experience and preserved diagnostic quality.

Cardiac Link: a retrospective cohort study evaluating a clinical pathway for expedited cardiology referral.

BACKGROUND: Outpatients presenting with chest pain often face long wait times for cardiology consultation and subsequent investigation for obstructive coronary artery disease (CAD), during which adverse cardiovascular events may occur. Our objective was to describe the design of Cardiac Link, a coronary computed tomography angiogram (CCTA)-guided rapid-access program, and evaluate its effect on cardiology consultation wait times in patients who present to primary care physicians with stable chest pain. METHODS: We conducted a retrospective cohort study at Women's College Hospital, Toronto, Ontario, Canada, between 2017 and 2020 involving eligible patients from the Family Practice Health Centre who underwent CCTA after presenting with stable chest pain or equivalent symptoms. Referring primary care physicians decided on a patient-by-patient basis to opt into the Cardiac Link program when requesting CCTA. Our primary outcome was measure of time from CCTA to cardiology consultation, and our secondary outcomes were measures of time to diagnosis from primary care consultation and CCTA booking time. RESULTS: Our analysis included 148 patients (Cardiac Link n = 98, non-Cardiac Link n = 50). Mean age of the patients was 58.4 (SD 11.2) years and 72% (107/148) were women. We found that the Cardiac Link group had a shorter time from CCTA to cardiology consultation (median 7 [interquartile range {IQR} 6-20] d v. median 100 [IQR 40-138] d; p = 0.01), shorter time to diagnosis (median 33 [IQR 22-55] d v. median 86 [IQR 40-112] d; p < 0.001) and shorter CCTA booking time (median 18 [IQR 11-31] d v. median 65 [IQR 24-92] d; p < 0.001) compared with the non-Cardiac Link group. INTERPRETATION: We determined that the Cardiac Link program reduced cardiology consultation wait times for symptomatic patients who were suspected of having CAD. Our study shows the viability of CCTA-guided rapid-access programs to expedite specialist consultation and reduce unnecessary referral for patients presenting to primary care physicians with stable chest pain.

Improving MRI Access: A framework for optimizing MRI scheduling templates.

INTRODUCTION/BACKGROUND: Within radiology departments, alignment of available imaging capacity with demand across different patient groups helps ensure that all patient populations are receiving timely and equitable care. The objective of the MRI Schedule Optimization project was to implement a 5-step framework to review and update the current MRI schedule templates at the Joint Department of Medical Imaging (JDMI) to ensure optimal alignment with demand across patient populations. METHODS: The project, governed by clinical and clerical stakeholders and operational leadership (Owners), followed a 5-step process: (1) Analysis of baseline data related to MRI demand and current schedule composition (2) Current state assessment of MRI operations via interviews and observations (3) Updating of schedules to align with demand (4) Review of process improvement opportunities (5) Go-live planning and evaluation. RESULTS: Current state analysis revealed that misalignment of the original schedule with demand was as high as 11% for some divisions. Updated MRI schedules were implemented with a maximum variance from demand of 3%. The updated schedules also allocated 27 additional inpatient slots to respond to inpatient demand. In addition, several process improvement opportunities were identified and implemented to streamline scheduling processes, day of exam workflows and inpatient workflow management. DISCUSSION/CONCLUSION: The MRI Schedule Optimization project followed a structured framework to comprehensively review and realign the MRI schedules at JDMI to the needs of our patient population by improving access and identifying process improvement opportunities. This scheduling framework can be applied to perform similar schedule update exercises at any radiology department.

Bridging the Gap Between Radiology and Primary Care: Expansion and Sustainability of a Medical Imaging Call Center Model.

OBJECTIVES: The Medical Imaging Call Centre (MICC) was an initiative carried out by a hospital-based academic imaging department with the aim to provide navigational services and radiologist consultations to community-based primary care physicians (PCPs). The strategies used to expand and sustain the initiative over a 3.5-year period after an initial pilot are described. METHODS: The strategy to evolve the MICC had internal and external components. Internally, processes were refined to ensure satisfaction of stakeholders. Externally, a robust engagement strategy focused on recruiting and engaging callers was implemented. Metrics including call volumes, unique callers, and call type were monitored to track utilization and further inform the engagement strategy. A reduction in avoidable use of the emergency department (ED) was determined by tracking pre- and post radiologist consultation decisions reported by callers. RESULTS: During the evaluation period, 2,297 calls were made. There was a 39% increase in the average number of monthly calls in the last 6-month period (61) compared with the first 6 months (44). Call types that involved PCP-to-radiologist communication for patient management consultation also increased over time. A 98% ED avoidance rate (215 of 220) was reported for calls in which PCPs initially indicated that they would be sending their patients to the ED for urgent imaging if the MICC were unavailable. DISCUSSION: The MICC was successful in connecting community-based PCPs with hospital-based subspecialized radiologists. Results indicate that an active engagement strategy is necessary and can lead to changes in patient management that will decrease the burden on other specialists.