title: Expediting the turnaround of radiology reports: use of total quality management to facilitate radiologists' report signing.
abstract: OBJECTIVE
  The purpose of this study was to determine whether total quality management techniques could be used to speed radiologists' performance on the task of signing reports.
  
  
  METHODS
  Total quality management represents a group of tools that can be used to improve the functioning of complex processes in the workplace. The steps involved in our total quality management project were as follows: (1) commit to improving radiologists' performance, (2) commission an interdisciplinary study team, (3) propose hypotheses for the causes of signing delays, (4) identify the key issues constraining performance (Pareto analysis), (5) intervene to correct systematic problems in a test system, (6) evaluate the results of intervention on radiologists' report signing performance, and (7) hold the gains achieved by the intervention. An interdisciplinary study team identified five key obstacles to prompt signing of reports: (1) radiologists' absence from the department when reports were available for signing (e.g., nights and weekends), (2) dysfunctional hand-off between transcriptionist and radiologist, (3) requirement that a fellow or resident sign before a staff radiologist, (4) lack of a system for signing by proxy (if primary radiologist is away), (5) perceived lack of impact of signed report on clinical decision making.
  
  
  RESULTS
  Interventions included (1) providing home computer terminals, (2) implementing a buddy system for proxy signing, (3) eliminating the requirement for a signature from a fellow or resident, (4) teaming groups of radiologists with specific transcriptionists, and (5) streamlining transcription service. When these enhancements were used in a test system, the mean time required to sign reports decreased 59% from 26.0 +/- 8.4 hr (mean +/- standard error) in the baseline period to 10.6 +/- 2.9 hr (in the enhanced period, p = .05).
  
  
  CONCLUSIONS
  We conclude that total quality management methods can accelerate radiologists' signing of reports.
authors.affiliation: Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115.
authors.forename: S E
authors.initials: SE
authors.lastname: Seltzer
authors.forename: P
authors.initials: P
authors.lastname: Kelly
authors.forename: D F
authors.initials: DF
authors.lastname: Adams
authors.forename: B F
authors.initials: BF
authors.lastname: Chiango
authors.forename: M A
authors.initials: MA
authors.lastname: Viera
authors.forename: E
authors.initials: E
authors.lastname: Fener
authors.forename: R
authors.initials: R
authors.lastname: Rondeau
authors.forename: N
authors.initials: N
authors.lastname: Kazanjian
authors.forename: G
authors.initials: G
authors.lastname: Laffel
authors.forename: K
authors.initials: K
authors.lastname: Shaffer
mesh_terms: D001319:Authorship; D001900:Boston; D004282:Documentation / Q000592:standards; D005568:Forms and Records Control / Q000458:organization & administration; D006801:Humans; D008499:Medical Records / Q000592:standards; D011871:Radiology / Q000706:statistics & numerical data; D011872:Radiology Department, Hospital / Q000458:organization & administration / Q000592:standards*; D011873:Radiology Information Systems / Q000458:organization & administration*; D013996:Time and Motion Studies; D017749:Total Quality Management