Ultrasound News: Smooth Flow
By Dave Yeager
Radiology Today
Vol. 19 No. 5 P. 9

Ultrasound workflow requires agility and flexibility.

Ultrasound is one of the most versatile imaging modalities, which makes it one of the most requested modalities as well. To meet this demand, a hospital's imaging department must be flexible. But flexibility requires efficient workflow, and workflow can be hindered if the department's equipment doesn't match its needs.

Murray-Calloway County Hospital (MCCH) in Murray, Kentucky, is a rural community hospital that serves patients in the southwestern corner of Kentucky and the northwestern edge of neighboring Tennessee. Heidi Hordyk, RT, CNMT, MBA, MCCH's director of radiology, says the hospital's two full-time sonographers typically perform 250 to 350 ultrasound exams each month. She adds that, until recently, older ultrasound equipment was slowing workflow and making patient care more difficult.

Unlike CT or MRI machines, ultrasound machines can be moved. Portability and shorter exam times are part of ultrasound's utility, but bulky, difficult-to-move machines can make it anything but convenient. In-room ultrasound may improve patient care, but, in some cases, it can be tough on sonographers' joints and muscles. At the least, heavy machines can slow them down.

"The problem that we had with our previous machines was that they were so big and bulky, they didn't drive very well. They were hard to push, and they didn't steer well. It was difficult for the techs to transport them and do portable exams," Hordyk says. "Then, when they would get to the patient rooms, because of the size, they were literally having to move furniture, the chairs, everything out of the room, in order to have the room they needed to perform the procedure on the patient."

Properly cleaning the machines can slow sonographers down, too. Hospital-acquired infections are a serious matter so cleaning after each patient is a must, but Hordyk says cleaning older equipment is time consuming and difficult.

"Cleaning is probably even more of a concern with ultrasound than other modalities because you have the machine right at the patient's bedside," Hordyk says. "The legacy types of machines have all of the different buttons and a track ball. The sonographer is touching the patient then touching the machine, so you have all of those buttons, and it's very difficult to truly clean it easily in between patients. You can surface clean, but it's hard to get down in the cracks and clean all of the buttons."

Out With the Old
Replacing the old equipment required a thorough process and buy-in from several stakeholders. Hordyk says the workflow needs of her staff were a key consideration. She and her department looked at several factors before making a recommendation to MCCH's administrators. She says image quality, infection control, and portability were high on the list.

"My sonographers were heavily involved because they are the ones who have to use the equipment and be comfortable with it, and it needed to fit their workflow. The radiologists also needed to be satisfied that we were getting the best diagnostic images that we could," Hordyk says. "Once we took care of the clinical side with the radiologists and the sonographers, then we moved to the money side of it because that's always important as well. We narrowed it down to the top three vendors, and then from there I took all the proposals with the pros and cons for each to my administrator and chief financial officer, and we made a decision."

Ultimately, three Carestream Touch Prime XE systems were purchased. Hordyk says two are in the radiology department and one is in the OB/GYN department, which is in a separate tower from the main hospital. The units have flat screens with sealed consoles, no buttons, and no track balls, which Hordyk says makes them easier to clean. They also have control panels that adjust up and down to accommodate the sonographers and are easier to maneuver.

Hordyk doesn't expect the demand for ultrasound to decrease, but she says improved workflow allows her sonographers to perform the exams in less time with less stress. Those are important considerations for any health care-related job, but the nature of ultrasound makes workflow an especially vital concern.

"Ultrasound is one of those modalities that is going to have a lot of add-on patients. They're shorter exams, and doctors' offices are always calling; they may need a STAT exam, or an inpatient in the emergency department may need a scan," Hordyk says. "So the biggest concern is to be efficient; your sonographers need to have a comfortable workflow."

— Dave Yeager is the editor of Radiology Today.