Orthopedic practices exist to provide high-quality care made possible, in part, by accurate imaging. Practices thrive financially when they are able to perform efficiently and effectively. Managing patient throughput in the imaging department is one of the most effective ways for orthopedic practices to increase patient satisfaction and revenues. Digital radiography (DR) technology not only is ideally suited to maximize throughput, but also to allow physicians to manipulate the images captured and to explore fine detail in ways that would be impossible with traditional analog imaging. Improved care is the probable result.

PATIENT THROUGHPUT

Fondron Orthopedic Group LLP, Houston, is a 25-physician practice that does every type of imaging examination except skull studies. It has operated three Swissray direct digital Radiography ddR units for the past 3 years. Kathy Kroupa, RT(R), supervisor of the radiology department and cast room/purchasing for the group, says, “We used to have six single-phase machines that were 20 years old, and we could image about 150 patients a day. Now, on Monday, Tuesday, and Wednesday, we can image 125 patients between 7 and 11 am alone, and we perform about 800 examinations a week. It takes about 3 minutes per examination. There is no way that we could have done that before.”

Julie Johnson, radiology manager of Alabama Orthopedic Clinic, Mobile, has had two Swissray ddR units in operation since January 2004. The practice had been growing, over a 5-year period, through the merging of several independent practices into the group, which has 18 physicians. When the decision to consolidate the practices at one site was made, equipment issues were a top priority. “We had seven analog units that were old and outdated,” Johnson says. “We did not want to move them with us. We looked at computed radiography, but we would still have had to use cassettes; it is just one more step. Our throughput time would have been longer. The main reason that we moved to ddR was throughput. We estimated that we could image more patients on these two units.” Johnson continues, “We averaged 160 patients a day with our seven analog machines. Now, we see as many as 206 patients a day, though our average did not change much.”

The Bone & Joint Clinic, Franklin, Tenn, is a recent recipient of ddR technology. CEO Duane Murray had two Swissray units installed in August 2004 as the sole imaging units for the 11-physician practice. The practice does spine, hand, foot, and ankle imaging. Six physicians are in the clinic each day. About half of the 250 to 300 patients seen daily have an imaging examination performed. “The motivator to go to ddR was anticipated growth. We had space constraints in terms of adding new equipment, so we needed something that would be space efficient and facilitate our growth. We benefited immediately from faster throughput,” Murray says.

Another recent installation was at Arlington Orthopedic Associates PA, Arlington, Tex. John Wagner, chief administrative officer of the practice, was betting heavily that ddR technology would help maintain or increase throughput once a number of individual group practices that had joined together over 7 years (comprising 17 physicians) moved into one building. One Swissray unit replaced the equivalent of two to three radiography rooms at Arlington Orthopedic. According to Carolanne Mitro, AART, senior technologist at the practice, it took only 3 days of training and practice to get up to speed. “We have improved productivity. We doubled our patient load when we went under one roof, and we did three times as many examinations. There is no film processing, and we do not have to make cassette changes.”

Efficiency improvements are not limited to the number of examinations completed. Images can be pulled up on any network computer, eliminating the time that it used to take for physicians to request and receive films and for the films to be filed and refiled. There are no more lost films, nor are there security issues associated with films being routed to unauthorized personnel.

COST SAVINGS

Two ddR units replaced seven analog units at Alabama Orthopedic Clinic, according to Julie Johnson, RT.

“We had nine technologists before,” Johnson says. “Now we have five working 32 hours a week and one at 40 hours a week. Over a 5-year period, the machines will pay for themselves in labor savings alone. We have also eliminated the $100,000 a year we spent on film.”

Kroupa says, “Our productivity is way up because we can see more patients in a day: from 25 to 40. At the end of 2004, two of our three Swissray units will be paid off.” Kroupa even recommends the Swissray units to smaller practices because of their economical space needs and reductions in film costs. A leasing program offered by Swissray, she understands, is designed to help physicians in smaller offices.

Murray sees opportunity cost as his practice’s main saving. “If we can add more examination rooms, we have more revenue-generating opportunities. The Swissray ddR technology has helped us ramp up new physicians to be productive quickly.” According to Wagner, “It was not just throughput that motivated us to look at ddR. We wanted to get rid of film, processing chemicals, film storage, processors, and file jackets in the new building.”

SAFETY AND SATISFACTION

Johnson says, “The Swissray system produces a better image. It reduces your retakes because you can adjust the computer. The physicians can pull up the images on computer, even at home, and are able to enhance and enlarge any part of the image they want.” Murray also comments on the more detailed extremity images and additional diagnostic tools on the computer.

“The patients love it,” Johnson says. “They do not have to lie on the cold, hard table. We image 95% of patients while they are standing. Patients in wheelchairs can be examined in their wheelchairs.” Kroupa adds, “Patients do not like to wait, and with our ddR units, they do not have to.”

Murray says that his practice’s patients are impressed and amazed by the ddR units. He adds that the technologists can tell that they are delivering less radiation to each patient because there is no need for retakes.

The Swissray ddR system relieves technologists of burdens that they normally experience when using analog systems (and other DR systems that retain some of the configurations of analog systems). According to Johnson, who considered other systems, “For most of them, you would have to have a table and upright bucky. Swissray had the one receptor with a C-arm. We do not have to lift patients on and off the tables,” Johnson continues. “We had problems with our shoulders and necks from the old machines. The Swissray units are really helpful to our bodies.” Kroupa agrees; she says, “There is less wear and tear on the body.”

Kerry Ladnier, RT(R), of Alabama Orthopedic Clinic, reports less technologist wear and tear with the ddR C-arm because they are not required to lift patients on and off of a table.

She also sees improvement in technologist satisfaction, expressed as a higher worker-retention rate. “The technologists found the soft ware easy to learn and use. We were up to speed in 2 or 3 weeks,” she says.

Murray says, “Within the first week of operation, physicians were saying, I’m disappointed when you hand me film.'” As proof that ddR is not just for the younger generation of physicians who have emerged into an increasingly filmless world, Murray says that the champion of ddR in his facility was a 66-year-old physician who had been in the practice for 25 years.

Jennifer Richardson, ARRT, technologist for Arlington Orthopedic, found the system easy to learn. “The computer software comes from Microsoft”,” she says. Familiarity with other Microsoft products made it possible, she adds, “to be up to speed after the first day.”

FACTORS TO CONSIDER

Many health care organizations have a significant amount of information technology in place; therefore, clinicians are much more familiar with using software and computer terminals to do their work. “We went to an electronic chart 3 years ago, so the comfort level with using computers is there,” Murray says. “As our physicians have become better consumers of technology, they have also become better students of it, with regard to its potential for productivity improvements.” There may, however, be reluctance by some physicians and technologists to abandon traditional imaging methods, particularly among those whose careers encompassed these traditional methods for a significant amount of time. “I was not familiar with ddR and reading images on a computer screen. I was intimidated at first,” Mitro says. Swissray trainer support helped Mitro get adjusted, and practices should prepare their less technology-savvy clinicians for change.

Site visits are another important component in the decision-making process. Wagner, a radiology technologist, and the practice’s operations director were able to make a site visit to a nearby installation and prove to themselves that the Swissray ddR system was the most adaptable of such systems to orthopedic-practice use.

Murray sees developments in digital radiology that call for scrutiny and choice. He recommends choosing a company that will be around for the long haul. “Swissray has a large installed base in orthopedics that made us comfortable considering, and finally going with, them.” Murray adds, “Get your best deal. The purpose justifies the investment. Throughput has been achieved for us.” Richardson concludes, “Everyone is going digital. That is a selling point for the practice, and how it will operate down the road.”

Marilyn Ferdinand is a contributing writer for Decisions in Axis Imaging News.