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The Effectiveness of Service Delivery Initiatives at Improving Patients’ Waiting Times in Clinical Radiology Departments: A Systematic Review

Abstract

We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients’ waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre- and post-intervention and the post-intervention designs were used in 54 (95 %) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore meta-analysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivity-enhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis.

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Abbreviations

PEWT:

Pre-examination waiting time

RTAT:

Report turnaround time

TRWT:

Total radiology waiting time

SDIs:

Service delivery initiatives

ER:

Electronic requesting

DR:

Digital radiography

CPOE:

Computerised physician order entry

PACS:

Picture archival and communication system

EPOC:

Effective practice and organization of care

CR:

Computed radiography

ESP:

Extended scope practice

TR:

Teleradiology

PNS:

Pager-notification system

QM:

Quality management

HIS:

Hospital information system

WMS:

Workflow management system

SRR:

Speech recognition reporting

IT:

Information technology

EMR:

Electronic medical records

RCT:

Randomised controlled trial

ITS:

Interrupted time series

CBA:

Controlled before and after

RIS:

Radiology information system

QMMs:

Quality management methodologies

PETs:

Productivity-enhancing technologies

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Appendices

Appendix I Search Strategy Implemented on MEDLINE

Population Terms

#1 *diagnostic imaging/

#2 *radiology department, hospital/or *radiology/or *radiology, interventional/or *radiology information systems/

#3 *radiography, interventional/or *radiography, dental/or *radiography, panoramic/or *radiography, bitewing/or *radiography, thoracic/or *radiography, dental, digital/or *radiography, abdominal/or *radiography/or *radiography, dual-energy scanned projection/

#4 medical imaging.mp.

#5 or/1–4

Intervention Terms

#6 *“appointments and schedules”/

#7 health care rationing.mp. or *health care rationing/

#8 quality improvement.mp. or *“quality of health care”/or *total quality management/or *quality improvement/or *practice guidelines as topic/or *health services research/or *quality assurance, health care/

#9 *quality indicators, health care/

#10 *efficiency, organizational/or six sigma.mp.

#11 (speech or voice recognition).mp. [mp = title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

#12 reminder systems.mp. or *patient compliance/or *reminder systems/

#13 (organi?ation and innovation).mp. [mp = title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

#14 *workload/or *“personnel staffing and scheduling”/or staffing level.mp. or *personnel management/

#15 *“health services needs and demand”/or *decision support techniques/or capacity planning.mp. or *“utilization review”/

#16 extend* work* hour*.mp.

#17 24 h service.mp.

#18 *after-hours care/or after hour care.mp.

#19 *organizational innovation/or radiology planning.mp.

#20 *medical order entry systems/or *data collection/or computerized order entry system.mp. or *hospital information systems/

#21 exp *teleradiology/or exp *outsourced services/or outsource radiology.mp.

#22 *delegation, professional/

#23 (radiographer* and radiologist*).mp. [mp = title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

#24 radiographer* role*.mp. or exp *inservice training/or exp *staff development/

#25 (radiographer* and report*).mp. [mp = title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

Outcome Terms

#26 *health services accessibility/or *waiting lists/or wait* list*.mp.

#27 (wait* and time*).mp. [mp = title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

#28 *time factors/or turnaround time.mp. or *“time and motion studies”/

#29 exp *patient satisfaction/or exp *consumer satisfaction/or customer satisfaction.mp. or exp *“marketing of health services”/

#30 *patient compliance/

#31 or/6–30

#32 5 and 31

#33 limit 32 to (humans and yr = “1995 -Current”)

The numbers ‘#’ show the progression of the search (sequences), the search strings shown as ‘*…/’ are MeSH, those strings shown as ‘....mp’ are free text s. As there are a wide variety of service delivery interventions which may not be well indexed in the database, we adopted a more ‘sensitive’ (rather than ‘specific’) strategy by combining general terms related to radiology (lines 1–4) with any terms related to either service delivery interventions or outcomes of interest (lines 6–30), as shown in line 32 of the search strategy. Similar strategies were implemented on the other databases.

Appendix II

・ Characteristics and main findings of the included studies

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Olisemeke, B., Chen, Y.F., Hemming, K. et al. The Effectiveness of Service Delivery Initiatives at Improving Patients’ Waiting Times in Clinical Radiology Departments: A Systematic Review. J Digit Imaging 27, 751–778 (2014). https://doi.org/10.1007/s10278-014-9706-z

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Keywords

  • Systematic review
  • Humans
  • Radiology Department, Hospital
  • Radiology Information Systems/is [Instrumentation]
  • Radiology Information Systems/og [Organization & Administration]
  • Radiology Information Systems