PACS workstations in the Emergency Department: Impact on workflow in radiology and emergency medicine

A study of timings of different events from the scheduling of an Emergency Department (ED) examination to the final reporting of it and review by the ED physician showed some expected and unexpected findings. Both computed radiography (CR) on film and CR using PACS were studied. The move of daytime reading of ED radiographs out of the Radiology reading area in the ED to a reading room in Radiology lengthened the time from when the request was sent to the time when the images were reviewed by the ED physician (1.02 hours to 1.29 hours). Despite anecdotal reports of increased reading time at workstations, the radiologists' use of PACS for reading ED radiographs resulted in a slight improvement in the time between the examination completion and report dictation (0.43 hours to 0.3 hours). Recently, we have found that there may be a workload effect on this time and this is presently being analyzed. The time from the sending of the request for an examination to the first review of the images by the ED physician was shortened with implementation of a PACS workstation in the clinical area of the ED (1.35 hours to 0.92 hours). A surprising finding was the impact the change to PACS had on the time between sending the request and the technologist's completion of the requested examination. The time increased with PACS from 0.45 hours for film-based CR to 0.8 hours for PACS. Several studies are ongoing to determine the causes of this increase.