title: Workflow Dynamics and the Imaging Value Chain: Quantifying the Effect of Designating a Nonimage-Interpretive Task Workflow.
abstract: OBJECTIVE
  To assess the impact of separate non-image interpretive task and image-interpretive task workflows in an academic neuroradiology practice.
  
  
  METHODS
  A prospective, randomized, observational investigation of a centralized academic neuroradiology reading room was performed. The primary reading room fellow was observed over a one-month period using a time-and-motion methodology, recording frequency and duration of tasks performed. Tasks were categorized into separate image interpretive and non-image interpretive workflows. Post-intervention observation of the primary fellow was repeated following the implementation of a consult assistant responsible for non-image interpretive tasks. Pre- and post-intervention data were compared.
  
  
  RESULTS
  Following separation of image-interpretive and non-image interpretive workflows, time spent on image-interpretive tasks by the primary fellow increased from 53.8% to 73.2% while non-image interpretive tasks decreased from 20.4% to 4.4%. Mean time duration of image interpretation nearly doubled, from 05:44 to 11:01 (p = 0.002). Decreases in specific non-image interpretive tasks, including phone calls/paging (2.86/hr versus 0.80/hr), in-room consultations (1.36/hr versus 0.80/hr), and protocoling (0.99/hr versus 0.10/hr), were observed. The consult assistant experienced 29.4 task switching events per hour. Rates of specific non-image interpretive tasks for the CA were 6.41/hr for phone calls/paging, 3.60/hr for in-room consultations, and 3.83/hr for protocoling.
  
  
  CONCLUSIONS
  Separating responsibilities into NIT and IIT workflows substantially increased image interpretation time and decreased TSEs for the primary fellow. Consolidation of NITs into a separate workflow may allow for more efficient task completion.
authors.affiliation: Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schemmel
authors.affiliation: Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: B Dustin
authors.initials: BD
authors.lastname: Pooler
authors.affiliation: Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin, Madison, WI.
authors.forename: Taylor
authors.initials: T
authors.lastname: Hanley
authors.affiliation: Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Tabassum A
authors.initials: TA
authors.lastname: Kennedy
authors.affiliation: Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Biomedical Engineering, College of Engineering, University of Wisconsin, Madison, WI.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Field
authors.affiliation: Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin, Madison, WI.
authors.forename: Douglas
authors.initials: D
authors.lastname: Wiegmann
authors.affiliation: Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Biomedical Engineering, College of Engineering, University of Wisconsin, Madison, WI; Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI. Electronic address: jpyu@uwhealth.org.
authors.forename: John-Paul J
authors.initials: JJ
authors.lastname: Yu
mesh_terms: D000328:Adult; D006801:Humans; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D017598:Efficiency, Organizational; D059906:Neuroimaging; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D058996:Quality Improvement; D013647:Task Performance and Analysis; D013996:Time and Motion Studies; D057188:Workflow