Santa Barbara Cottage Hospital – DR Systems

Cottage Health System, formed in 1996 as the not-for-profit parent organization of Santa Barbara Cottage Hospital (including Cottage Children’s Hospital), Goleta Valley Cottage Hospital, and Santa Ynez Valley Cottage Hospital is guided by a volunteer board of directors from the greater Santa Barbara community and provides the residents of the Central and South Coast with exemplary health care, continuous improvements in medical practice, and a commitment to our communities.

Situation

Cottage Hospital installed its initial PACS in 1998. As new PACS features were subsequently added, it was expected that the Web access and voice clips features of the system would improve patient safety in several ways. Obvious benefits included:

• Faster, sounder clinical decisionmaking. The voice clip is permanently stored with the archived exam, along with a montage (key summary images of the exam). This combination enables referring MD’s to review results expeditiously, speeding care for critically ill patients. The voice clip’s near-immediate availability helps ensure that decisions will be based on the images and report together -- rather than just images alone. Written reports are also available.
  
• Efficient review of prior exams. To save time, MD’s with critically ill patients can listen to voice clips while viewing prior exams and comparing them to current exams.
  
• Universal Web access for consultations. All caregivers consulting on a case can access exams and voice clip reports simultaneously and remotely.
  
• EKG, echocardiograms, and pulmonary function tests are on the PACS via the Web. EKG availability contributes to patient safety when a patient comes into the emergency room with chest pain and the prior EKG is available for comparison.
  

Were physicians taking full advantage of these features? Was their experience consistent with the expectations of both DR Systems and the administrators at Cottage Hospital about the ways the PACS could improve patient safety at the hospital? To find out, a survey of referring physicians was conducted in two stages: a quantitative survey in 2001, followed up by a qualitative survey in 2006.

Solution

Of 119 quantitative surveys mailed in 2001, 37 physicians responded. Their answers showed that the hoped-for patient safety improvements were in fact being achieved. Among key indicators:

• 69% of respondents reported that Web access to the PACS saves “significant time” in retrieving results from the Radiology Department vs. film images and paper reports.
  
• 61% said exam access in their office via the PACS significantly expedited patient care.
  
• 94% found voice clips “valuable” or “very useful. 90% found montage images “valuable” or “very useful.” 

The qualitative survey conducted in 2006 captured nuances and detail that were beyond the scope of the quantitative survey, while underlining the PACS’ value as a patient safety tool. Comments from referring doctors emphasized such qualities as:

• Immediacy: “Image availability is there as soon as it’s done, and the voice clip is there that gives you the meat of the report, and that’s available right after the exam is cleared.”
  
• Collaboration: “I can look at the digital images a lot more clearly with a lot better resolution. It improves communication because you can talk to a referring [additional consulting] physician about a case and both of you can be looking at the same image.”
  
• Connection to Patient: “It’s also been helpful on my rounds in the hospital because I can see the patient and at the same time, right there, look at the X-ray.”
  
• Reliability: “You never lose films…which used to be a problem.”
  

Better Health & Lower Cost

PACS Business Advantages

The quantitative survey also revealed some direct business benefits of the PACS design, particularly in relation to outpatient referrals to Cottage Hospital. For example, when asked if PACS connectivity affected their outpatient referrals to Cottage Hospital, some 58% answered “yes.” Of those, 30% said their referrals were affected significantly.

Adding capacity to the radiology department at Cottage increased referrals. At the time of the survey, outpatient slots for CT and MRI were nearly always filled. Clearly, the lack of capacity was hurting business, since 70% of survey respondents answered that adding capacity would affect their referrals. Some 30% answered that additional capacity would affect their referrals significantly. Acting on this indication of unmet demand, the department later acquired an additional CT scanner and MRI unit.

Web access is no longer the competitive advantage that it was when the quantitative survey was conducted, because the two other enterprises in Santa Barbara that compete with Cottage for radiological business use the same PACS. But Web access is probably even more valuable now, because any Santa Barbara hospital that didn’t have it would today be at a competitive disadvantage.

In sum, improving patient safety with a state-of-the-art PACS ultimately is a smart business move as well -- because the same design increases physician referrals that are a vital source of hospital revenue.