RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1 / Name of the Candidate
And
Address / L.SRINIVAS REDDY
S/O L.VENKAT REDDY,HNO:17-71,SAMBASHIVA COLONY,SHADNAGAR,MAHABOOB NAGAR(DIST),ANDHRA PRADESH(STATE)
2 / Name of the Institution / ACHARYA INSTITUTE OF HEALTH SCIENCES, COLLEGE OF HOSPITAL ADMINISTRATION.
3 / Course of study / MASTERS IN HOSPITAL ADMINISTRATION.
4 / Date of admission to Course / 2nd SEPTEMBER 2010
5 / Title of the Topic- “ A STUDY TO REDUCE REPORT TURN AROUND TIME AT RADIOLOGY DEPARTMENT AT SELECTED HOSPITAL .”
6
. / BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY
Long turnaround times (TATs) are a source of disappointment and frustration for all our customers. It is becoming common to expect at least a 24 hour TAT for outpatients, a 4 hour TAT for inpatients and 1 hour for emergencies.These TATs can be difficult to achieve with traditional transcriptionists and radiologist final report editing. There are also growing expectations for particular styles of radiology reporting. In 1988, surveys of referring physicians found that while most clinicians were happy with most reports,rating them an 8 out of 10, 49% complained that reports sometimes did notaddress the clinical question and 40% thought that reports were sometimes confusing.3 Prose reporting vs. itemized reporting has also been studiedusing physician-preference surveys. A prose report describes the findings using standard paragraphs as if the radiologist is speaking to the referringphysician. An itemized report separates the findings into shorter phrasesand lists. Naik et al. reported a study of this kind that evaluated ultrasoundreports in 2001. Eighty-six percent of clinicians and 64% of radiologists prefer reditemized reports to prose reports. Only 2% of radiologists preferredprose with the remainder having no preference. When stratified for levelof detail, between 76% to 86% of physicians preferred a detailed, itemizedreport.4 Hospital administrators and referring physicians are empowered to be more demanding since it is no longer necessary to have an in houseradiologist for diagnostic reporting. If a competitor teleradiology group contracts to produce reports more quickly and with a standardized structure, hospitals and referrers may be willing to change radiologists. Patients have become more involved with managing their care due to the availability of medical information on the internet and digital medical records.
6.2 REVIEW OF LITERATURE
In 1994, Crabbe, Frank, and Nye identified a seven-step process from examination completion to final report. They did not include the time from order to completion of the examination or the time to distribute results. They proposed to complete the cycle twice per day for a maximum turnaround of 32 hours. Across four types of examinations, improvements were implemented that brought turnaround from a baseline of 101 to 52 hours for various examinations to 59 to 44 hours for the same tests.
Hanwell and Conway reported on a 1995 survey for the American Healthcare Radiology Administrators in which only 26% of the respondents monitored the time from radiologist signature to charting, and there was no monitoring of order to imaging or for receipt in the physician's office. They found that turnaround time (image to signature) for all examinations in hospitals of 400-499 beds was between 20 and 25 hours.
Seltzer et al set out to determine whether quality improvement tools could be applied to result reporting. In 1993, they reported that the mean time to sign reports dropped from 26 hours to just under 11 hours. Their subsequent work in 1997 targeted "providing final reports within 48 hours." In this study, the process is measured from examination completion to final report and they were able to drop from a baseline of 81 hours to 36 hours. They reported examination completion to dictation of 19 hours, dictation to preliminary report of 4 hours, and preliminary to final report of 13 hours. They noted that transmission of reports was not included.
The Medical Leadership Council in 1996 reported a study completed by the Premier Health Alliance and The University Hospital Consortium of 80 hospital departments.
While hospitals estimate a turnaround time of less than 24 hours, this does not seem to be the norm for most large facilities. Further, we conclude that the focus seems to be purely on image completion to radiologist finalization. This may make sense from a department perspective, as these are the components that the radiology department can control. However, if the patient does not get to the department, the process cannot begin. The studies we reviewed did not include this time frame as a component. In the minds of our ordering physicians, the process begins when they write the order, not when we finish the imaging. In our institution, transport and schedules are controlled by radiology; therefore, the time from order to image completion is a departmental responsibility
6.3 OBJECTIVES OF THE STUDY:-
1) To observe the factor influencing the delayed services
2) To recommend and approitate the service quality
MATERIALS AND METHODS:-
7.1 SOURCE OF DATA:-
a. PRIMARY DATA:-
Will be collected from the patients, doctors and administrative staff.
b. SECONDARY DATA:-
Will be collected through periodicals, books, journals, articles, reports, internet,
etc.
7.2 METHOD OF COLLECTION OF DATA(INCLUDING SAMPLING
PROCEDURE, IF ANY):-
1)  Inclusion Criteria:-
Ø  More than 100 beds hospital
Ø  Hospital with radiology department
ii) Exclusion Criteria:-
Ø  Super specialty hospital
Ø  Hospital with less than 100 beds.
Ø  Hospital without radiology department
iii) Study Design:- Descriptive study
iv) Duration of the study:-
One Year.
v) Sampling Design:-
Random Sampling Design.
vi) Sample Size and Population:-
Sample size is 20 [ Patients : 10 , Doctors : 5 , Department staffs: 5 ]
vii) Data Collection Method:-
Methodology:-
The data will be collected mainly through interview with the help of structured questionnaire from the administrator, doctors and patients.
viii) Data analysis and interpretation(statistical test if any):-
Data is interpreted with the help of various literature experts in the field and from reports. The data is analyzed by using suitable statistical test like z-test, t-test, chi-square test etc. and other non parametric tests to find the statistical significance to the related data.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER
HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.
Not applicable.
7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR
INSTITUTION IN CASE OF 7.3.
Not applicable.
8 / LIST OF REFERENCES:-
1)  Bluth E, Havrilla M, Blakeman C. Quality improvement techniques: Value to improve the timeliness of preoperative chest radiographic reports, AJR 1993;160:995-998.
2)  Seltzer S. Kelly P. Adams D. Chiango B, Viero M, Fener E, Rondeau R, Kazanjian N, Laffel G, Shaffer K, Williamson D, Aliabadi P, Gillis A, Holman L, Expediting the turnaround of radiology reports: Use of total quality management to facilitate radiologists' report signing, AJR 1994;162:775-781.
3)  Sobel J, Pearson M, Gross K, Desmond K, Harrison E, Rubenstein L, Rogers W, Kahn K. Information content and clarity Of radiologists' reports for chest radiography. Acad Radiol 1990;3:709-717.
4)  Gagliardi R. The evolution of the X-ray report. AJR 1995;164;501-502.
5)  Greenes R, OBUS: A microcomputer system for measurement, Calculation, reporting, and retrieval of obstetric ultrasound examinations. Radiology 1992;144:979-833.
9 / SIGNATURE OF CANDIDATE:-
10 / REMARKS OF THE GUIDE:-
11 / NAME AND DESIGNATION OF :
11.1 GUIDE:- Mr. PRASHANTH MALLAR
ASSISTANT PROFESSOR.
11.2 SIGNATURE:-
11.3 CO-GUIDE (IF ANY):- DR(COL)S.C.MOHANTY
PRINCIPAL OF ACHARYA INSTITUTE OF
HOSPITAL ADMINISTRATION
11.4 SIGNATURE:-
11.5 HEAD OF DEPARTMENT:- DR(COL)S.C.MOHANTY
PRINCIPAL OF ACHARYA INSTITUTE OF
HOSPITAL ADMINISTRATION
11.6 SIGNATURE:-
12 / 12.1 REMARKS OF THE PRINCIPAL:-
12.2 SIGNATURE:-