Augmenting the Impact of Technology Adoption With Financial Incentive to Improve Radiology Report Signature Times

Andriole, Katherine P.; Prevedello, Luciano M.; Dufault, Allen; Pezeshk, Parham; Bransfield, Robert; Hanson, Richard; Doubilet, Peter M.; Seltzer, Steven E.; Khorasani, Ramin

doi:10.1016/j.jacr.2009.11.011

« Previous Next »Journal of the American College of Radiology
Volume 7, Issue 3 , Pages 198-204, March 2010

Augmenting the Impact of Technology Adoption With Financial Incentive to Improve Radiology Report Signature Times

Katherine P. Andriole, PhD
- Center for Evidence-Based Imaging, Brookline, Massachusetts
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Corresponding author and reprints: Katherine P. Andriole, PhD, Brigham and Women's Hospital, Department of Radiology, Center for Evidence-Based Imaging, 20 Kent Street, Brookline, MA 02445
Luciano M. Prevedello, MD
- Center for Evidence-Based Imaging, Brookline, Massachusetts
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
Allen Dufault, MBA
- Center for Evidence-Based Imaging, Brookline, Massachusetts
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
Parham Pezeshk, MD
- Center for Evidence-Based Imaging, Brookline, Massachusetts
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
Robert Bransfield
- Center for Evidence-Based Imaging, Brookline, Massachusetts
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
Richard Hanson
- Center for Evidence-Based Imaging, Brookline, Massachusetts
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
Peter M. Doubilet, MD, PhD
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
Steven E. Seltzer, MD
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
Ramin Khorasani, MD, MPH
- Center for Evidence-Based Imaging, Brookline, Massachusetts
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts

Purpose

Radiology report signature time (ST) can be a substantial component of total report turnaround time. Poor turnaround time resulting from lengthy ST can adversely affect patient care. The combination of technology adoption with financial incentive was evaluated to determine if ST improvement can be augmented and sustained.

Methods

This prospective study was performed at a 751-bed, urban, tertiary care adult teaching hospital. Test-site imaging volume approximated 48,000 examinations per month. The radiology department has 100 trainees and 124 attending radiologists serving multiple institutions. Over a study period of 4 years and 4 months, three interventions focused on radiologist signature performance were implemented: 1) a notification paging application that alerted radiologists when reports were ready for signature, 2) a picture archiving and communications systems (PACS)-integrated speech recognition report generation system, and 3) a departmental financial incentive to reward radiologists semiannually for ST performance. Signature time was compared before and after the interventions. Wilcoxon and linear regression statistical analyses were used to assess the significance of trends.

Results

Technology adoption (paging plus speech recognition) reduced median ST from >5 to <1 hour (P < .001) and 80th-percentile ST from >24 to 15 to 18 hours (P < .001). Subsequent addition of a financial incentive further improved 80th-percentile ST to 4 to 8 hours (P < .001). The gains in median and 80th-percentile ST were sustained over the final 31 months of the study period.

Conclusions

Technology interventions coupled with financial incentive can result in synergistic and sustainable improvement in radiologist report-signing behavior. The addition of a financial incentive leads to better performance than that achievable through technology alone.

Key Words: Report signature times, turnaround times, speech recognition report generation, technology adoption, imaging informatics