Impact of PACS deployment strategy on dictation turnaround time of chest radiographs.
OBJECTIVE
The aim of the study is to measure the impact of a picture archive and communication system (PACS) on dictation turnaround time of chest radiographs in a multisite hospital and relate variations across sites to local factors and implementation strategy.


METHODS
The multisite hospital is composed of three sites. Dictation turnaround time was calculated by using data obtained from the radiology information system for examinations performed during three 90-day periods (immediately before PACS implementation, immediately after PACS implementation, and 1 year after implementation). Productivity, expressed as number of examinations dictated per full-time-equivalent radiologist, also was calculated. For each 3-month period, average interval delay was calculated. Values for average interval delay obtained during the different pre- and post-PACS periods were compared by using analysis of variance. This was done for each hospital.


RESULTS
In the immediate post-PACS period at site 1, dictation turnaround time decreased 5% (P < .05), whereas productivity decreased 16.5%. The implementation strategy was revised for the next two sites, and dictation turnaround time decreased 21% (P < .001) in both sites in the immediate post-PACS period. Productivity increased 2% and 3% in these sites. One year after implementation, decreases in turnaround ranged from 28% to 55% (P < .001) in the three sites.


CONCLUSIONS
Our experience suggests that PACSs cannot be isolated from their contexts; therefore, implementation strategy matters in the realization of projected benefits. In addition, regardless of differences in film-based environments before PACS, all three sites benefited from conversion to filmless operation, with the greatest benefits seen in the site that was least efficient before implementation.
Department of Radiology, Centre Hospitalier de l'Université de Montréal, 1058 St-Denis Street, Montréal, Québec, Canada H2X 3J4. luigi.lepanto@umontreal.ca
Luigi
L
Lepanto
Guy
G
Paré
Alain
A
Gauvin
D002170:Canada; D003628:Database Management Systems / Q000458:organization & administration; D004282:Documentation / Q000706:statistics & numerical data; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D016247:Information Storage and Retrieval / Q000706:statistics & numerical data*; D008487:Medical History Taking / Q000706:statistics & numerical data*; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D011873:Radiology Information Systems / Q000458:organization & administration*; D013997:Time Factors; D013996:Time and Motion Studies; D014584:User-Computer Interface; D016526:Workload / Q000706:statistics & numerical data*