Emergency physician perceptions of radiology before and after the installation of an electronic work-queue display

Abstract

Study objectives: Radiology tests are a key component of emergency care. Retrieval of radiology results by emergency physicians may require significant effort and can be complicated by futile retrieval attempts when results are not complete, especially in the use of digital radiology. In our emergency department (ED), an electronic test queue, similar to an airport arrival display, is available for laboratory studies, although final laboratory results are obtained by the emergency physician from a separate information system. Previous studies have shown that implementing a laboratory queue display improves emergency physician work, communication, and perceptions. Before the study, radiology did not display the testing queue of studies, and it was difficult to obtain confirmation of study scheduling, expected study performance time, study completion, and preliminary interpretations. After programming developments, radiology produced a display similar to that of the laboratory, although not functionally identical. The purpose of this study is to compare emergency physician perceptions of radiology services before and after the radiology testing queue was displayed and to determine whether testing queue information alone is sufficient to change emergency physician perceptions of radiology. We hypothesize that emergency physician perceptions and satisfaction will improve when the radiology testing queue is displayed. Methods: The study was conducted in a university Level I trauma center with 90,000 annual visits and a 3-year emergency medicine residency with 30 residents. Radiology ED services are completely digital, with the exception of ultrasonography. Emergency physicians were surveyed for perceptions and overall satisfaction with radiology services (Likert scale 1 to 7, 7=best). Emergency physicians were initially surveyed before the installation of a radiology queue display (September 2003). A follow-up survey of the same emergency physicians took place (April 2004) after the radiology queue display had been functioning for 2 months. All emergency medicine residents and faculty working were eligible for the initial survey. Data were analyzed using dependent t tests. Results: Initial surveys were returned by 43 (64.2%) of 67 emergency physicians. Follow-up surveys were returned by 25 (81%) of 35 available emergency physicians. Data analysis showed that there was no significant interval change in emergency physician awareness of radiology tests being processed (4.88 versus 5.04, 95% confidence interval [CI] –1.09 to 0.77), awareness of tests completed (3.44 versus 3.96, 95% CI –1.26 to 0.22), or awareness of results available (3.12 versus 3.12, 95% CI –0.77 to 0.77). Furthermore, there was no measurable difference in perceived quality of communication of results (3.34 versus 3.58, 95% CI –1.04 to 0.56), perceived turnaround time (2.59 versus 3.16, 95% CI –1.26 to 0.12), reliability of results, (4.00 versus 4.44, 95% CI –1.24 to 0.36), or overall service to the ED (3.56 versus 3.88, 95% CI –1.04 to 0.38). Conclusion: Displaying the work queue electronically for radiology studies does not appreciably improve physician awareness of test status, nor does it improve physician perceptions of reliability or overall quality of radiology service to the ED. Although providing information about test queues has been shown with laboratory status to change emergency physician work and perceptions, a similar process for radiology is not sufficient to improve emergency physician perceptions.