By Matt Skoufalos
At the end of every fiscal year, imaging centers and health systems start making difficult choices about capital planning and budgeting for the future. Those resources are always judiciously meted out, and yet it seems like there’s never enough to go around for all the institutional needs that exist. So we asked radiology managers and directors at a handful of sites across the country to tell us what their wishlists consist of — from staffing to technology and everything in between. Here’s what they told us…
For Connie Hatcher, CT Supervisor at the Lourdes Health System in Burlington, New Jersey, a small, community hospital, the technological wishlist is short. Hatcher just wants another CT scanner. She’s working on a 16-slice unit from 2011, and “it can only do so much.” At most, Hatcher said, her department can scan 20 to 40 patients per day. But those with complicated conditions may need to be transported elsewhere, like to the Lourdes sister facility in Camden City 15 miles away.
“If you get a patient from the hospital who really needs a perfusion, I have to send them in an ambulance to Michele down in Camden,” Hatcher said. “It’s not a great thing to do the imaging at two facilities, because time is brain.”
Michele is Michele Ross, the CT and 3D Imaging Supervisor for the Camden and Burlington campuses of Lourdes Health System. At Lourdes Camden, Ross oversees two CT scanners, a 256-slice unit in the emergency department for critical care patients, and a 64-slice device in the main imaging department, for biopsies. The biopsy scanner is 15 years old, which means every physician wants their studies performed on the other one.
“With everything being all about turnaround time now, it becomes an issue,” Ross said. “We are a heart hospital. We do a ton of cardiac studies, and then we get Burlington’s too, whatever they can’t do there. We’re not going to be able to keep up with our work schedule if we don’t get another scanner.”
Hatcher has almost the same problem in reverse. With only one scanner at her site, the limited capacity of her department also affects the nature of studies it can provide in a given day.
“We do a fair amount of interventional, but we try to keep it to a minimum because you don’t want to tie up the machine because you only have one,” she said. “You have to use other modalities, or just do it under fluoro because the scanner’s not available. It impacts how you have to arrange your schedule.”
Both Lourdes hospital sites are in the process of being sold to nearby Virtua Health of Marlton, New Jersey. Hatcher and Ross are optimistic that the merger could mean more, or newer, equipment might be made available to them soon, and not just scanners. Ross wants to streamline some of its IT processes, and migrate from a PACS-driven system to a RIS-driven system. Patient histories, requisitions, even dose-tracking functions are all managed manually, “and it’s labor-intensive,” she said.
“We do a lot of things manually,” Ross said. “None of our systems work together. It’s very old-school. It takes more time, and if you forget something, it’s gone.”
Oddly, that doesn’t square with some of the most frustrating presumptions both Hatcher and Ross say they encounter within their broader hospital community: that their teams are composed of low-skilled “button-pushers” who are there only to follow the orders of more knowledgeable medical staff. That’s why their wishlists would also include some way of improving inter-departmental communication and understanding of the roles and responsibilities of the imaging department as relates to caregiving and patient satisfaction.
“In my 38 years, it’s gotten much better,” Ross said. “I have a great relationship with my ER department, and it wasn’t always like that. In my domain, I know what’s going on. A lot of nurses will come down and query my techs on different things. There’s still room for improvement on some of the physician’s part.
“You’re always going to be educating your nurses because you’re in contact with them every day,” she said. “The doctors, you teach a bunch, and then a new bunch come in. It’s an ongoing thing. And the older techs know how to handle it, and the younger techs don’t. I’ve seen techs get steamrolled by ER physicians.”
“It’s a matter of getting the message out that what we do is important,” Ross said. “They can’t do their jobs without us, and we can’t do ours without them.”
Hatcher said that communication with physicians can be a challenge overall, not only for those reasons, but sometimes for more practical ones—like their physical whereabouts. Those delays can contribute to longer patient wait times, which ultimately increase the length of studies conducted, affecting patient satisfaction scores, and reimbursement rates. She would like help explaining the complexity of the job of the imaging department not only to physicians but to patients as well.
“Trying to reach the ordering physician to pick their brain and educate them and clarify an order can be time-consuming, and you’re waiting,” Hatcher said. “It can be laborious, and everything is patient satisfaction today.
“Everybody thinks that the scan is so fast, but everything you need to do before and after for that patient; the time does not change,” she said. “I don’t think the public realizes it’s about safety of the patient. All these things take time. It takes time to speak to the patient. You’re starting IVs, you’re calling floors, you’re calling radiologists. All these factors on both sides, it’s important.
“Probably the radiologists need to get more involved with the care of patients, but they’re not used to that either,” Ross said. “It’s hard to get our radiologists here to go out and educate physicians on what they should order and how they should order. People don’t understand all the pieces it takes to make the right study with the right experience.”
For Nicole Walton-Trujillo, Manager for Desert Radiology of Las Vegas, Nevada, her biggest needs center on staffing. Walton-Trujillo is responsible for overseeing 88 employees at nine Desert Radiology sites, including a floating pool of full-time employees who are scheduled at any of them on a given day. In just a month, her primary site alone sees more patients (380) than do most critical access hospitals.
Even for someone who describes herself as “the queen of multitasking,” the personnel oversight duties of her position are intensely demanding.
“I get time-off requests every day,” she said. “I do eight things at a time, my phone goes off 24-7. I have supervisors at two of my sites, and they do an incredible job of keeping the house going when I’m not in it. I need the ability to have way more floats.”
Walton-Trujillo describes Las Vegas as “a very well-populated small town,” and in addition to its general population, Desert Radiology provides imaging services for the NHL’s Golden Knights and student-athletes at the University of Nevada Las Vegas. To that end, the institution must obtain and maintain the latest equipment, and although it does just that, there’s significant wear and tear on a machine that performs a study every 15 minutes.
“That’s a lot of rotation in that tube,” Walton-Trujillo said. “That tube never slows down.”
She credits her service provider with being “the key that keeps us running,” by performing service and preventive maintenance after-hours so as not to interrupt patient flow. Just as important to her operations is cross-departmental communication, and if Walton-Trujillo had a wishlist, it would include development of staffers’ soft skills to better align with organizational goals.
“How you communicate across departments and to your people is important,” she said. “It’s how you align the strategic roadmap of the company to the actual work that’s being done. It doesn’t matter who the employee is; the goal, the role they align back to is that five-year strategic plan.”
Along those lines, Walton-Trujillo, like Ross and Hatcher, believes that more could be done to advance patient safety and priorities with patient-physician advocacy programs. She’d like to see more patient navigators sourced from an imaging background so they can understand physician orders and the studies to which they correlate.
Of course, with all the emphasis on patient safety and comfort, Desert Radiology has invested in improving the patient experience, from mobile device docking stations in its waiting rooms to more comfortable furniture. Of course, in her dream of dreams, Walton-Trujillo would love to add a Starbucks “between the parking lot and my office.”
“I firmly believe that a chai tea latte has saved more patients’ lives than anything else,” she said. “That caffeine keeps me moving.”
For Danny Gonzales, radiology manager at Lincoln County Medical Center in Ruidoso, New Mexico there’s not a whole lot of technology needs. The 25-bed, critical access center is in the process of constructing an entirely new facility. Primarily a rural radiology center, Lincoln County Medical Center is updating all its equipment and moving to a completely digital radiography system, bringing its MRI in-house and beginning to offer nuclear medicine services in 2019.
“Even though we are nonprofit, we have to spend money to put in high-quality equipment,” Gonzales said. “In 2019, our equipment’s going to be top-notch.”
That new hardware will play a vital role in the financial well-being of the new facility by helping avoid reimbursement rate cuts as it goes 100-percent digital, he said.
“I’ve been very fortunate to get what I want to upgrade our department,” Gonzales said. “We have a 64-slice CT scanner, we’ve upgraded our ultrasound to the top they have out there, and we’re going to move to totally digital in our trauma rooms.”
“Everything’s tied to reimbursement,” he said. “Once you start telling people they’re going to lose money on imaging [without transitioning to DR], they wake up. We’re going to do a lot more angiography for stroke protocols, and we’ve upgraded our ultrasound, which will help with reimbursement in vascular.”
Yet despite the advantages of all-new equipment on the horizon, Gonzales’ biggest challenge is always going to be hiring. The site is located in the tall pines of New Mexico, in a resort community of about 12,000 people that can boom to 35,000 in season. Although it’s a ski lodge in the winter and a horse farm in the summer, trying to find technologists for whom those interests are a match is a case-by-case candidate search.
The closest urban centers are Roswell or Alamagordo, and although Lincoln County draws patients from there for its top-flight imaging services, they’re still some 70 miles away. Even for Gonzales, who commutes from Carlsbad to work every week, the shift in altitude from 3,200 feet to 7,000 is a commitment.
“I could recruit for radiographers all day long, and I have people actually waiting to come up here,” he said. “Our hardest-hit areas are ultrasound and nuc med. We have several sonographers, but it’s going to be a process to get that first nuc med hire.”
“We were fortunate to recruit an echo-technologist to start in January,” Gonzales said. “A lot of it is meeting their salary and benefit expectations, helping them find housing, and making sure that our technology is up to date.”
Gonzales also knows that he’s in an enviable position as compared with other rural radiology managers. For facilities that don’t have the resources or wherewithal to upgrade their equipment as his has done, he emphasizes clear lines of communication with management, clinical staff, and everyone under his direct supervision.
“I have meetings with ER staff, and tell them, ‘This is what we can do for you,’ We’re fortunate that we have ER physicians who aren’t prima donnas, who will listen to you and will work with you, and who have an understanding of what we can and can’t do,” He said. “It’s a communication gap that we’ve been able to fill. I don’t bark orders; I believe in constructive criticism. Work with me, I’ll work with you.”