title: Augmenting the impact of technology adoption with financial incentive to improve radiology report signature times.
abstract: OBJECTIVE
  Radiology report signature time (ST) can be a substantial component of total report turnaround time. Poor turnaround time resulting from lengthy ST can adversely affect patient care. The combination of technology adoption with financial incentive was evaluated to determine if ST improvement can be augmented and sustained.
  
  
  METHODS
  This prospective study was performed at a 751-bed, urban, tertiary care adult teaching hospital. Test-site imaging volume approximated 48,000 examinations per month. The radiology department has 100 trainees and 124 attending radiologists serving multiple institutions. Over a study period of 4 years and 4 months, three interventions focused on radiologist signature performance were implemented: 1) a notification paging application that alerted radiologists when reports were ready for signature, 2) a picture archiving and communications systems (PACS)-integrated speech recognition report generation system, and 3) a departmental financial incentive to reward radiologists semiannually for ST performance. Signature time was compared before and after the interventions. Wilcoxon and linear regression statistical analyses were used to assess the significance of trends.
  
  
  RESULTS
  Technology adoption (paging plus speech recognition) reduced median ST from >5 to <1 hour (P < .001) and 80th-percentile ST from >24 to 15 to 18 hours (P < .001). Subsequent addition of a financial incentive further improved 80th-percentile ST to 4 to 8 hours (P < .001). The gains in median and 80th-percentile ST were sustained over the final 31 months of the study period.
  
  
  CONCLUSIONS
  Technology interventions coupled with financial incentive can result in synergistic and sustainable improvement in radiologist report-signing behavior. The addition of a financial incentive leads to better performance than that achievable through technology alone.
authors.affiliation: Center for Evidence-Based Imaging, Brookline, Massachusetts 02445, USA. kandriole@partners.org
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Andriole
authors.forename: Luciano M
authors.initials: LM
authors.lastname: Prevedello
authors.forename: Allen
authors.initials: A
authors.lastname: Dufault
authors.forename: Parham
authors.initials: P
authors.lastname: Pezeshk
authors.forename: Robert
authors.initials: R
authors.lastname: Bransfield
authors.forename: Richard
authors.initials: R
authors.lastname: Hanson
authors.forename: Peter M
authors.initials: PM
authors.lastname: Doubilet
authors.forename: Steven E
authors.initials: SE
authors.lastname: Seltzer
authors.forename: Ramin
authors.initials: R
authors.lastname: Khorasani
mesh_terms: D001900:Boston; D003952:Diagnostic Imaging; D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D006784:Hospitals, Teaching; D006801:Humans; D009042:Motivation; D011446:Prospective Studies; D011872:Radiology Department, Hospital / Q000458:organization & administration*; D011873:Radiology Information Systems; D049250:Speech Recognition Software; D018709:Statistics, Nonparametric; D013996:Time and Motion Studies; D014040:Token Economy