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5 October 2015

Aligning the Radiology Department with the Emergency Department

In emergency departments, high quality and timely care are the top priorities. To improve these metrics, radiologists can work collaboratively with emergency physicians by offering recommendations on imaging modalities and utilization. Since the emergency department is typically the heaviest user of radiology within a hospital - ordering, on average, 45 percent of all CT scans - improving radiologist-EM physician alignment and communication can have dramatic impact.


Working to better align the radiology department with the ED has payoffs for all involved: physicians, patients and hospital leadership. When the two departments understand one another’s objectives, they can work together to build a workflow that meets each other’s needs.

A streamlined workflow cuts down on time spent locating pertinent clinical information and ensures the best imaging modality has been chosen to address the questions of the referring physician. This time saved, in turn, cuts down on the patient’s wait time — improving his or her experience in the ED — and improves the turnaround time of studies allowing EM physicians to act quickly with the results of the imaging test.

Improving communication between radiologists and EM physicians can cut down on costly emergent imaging that may be unnecessary during the ED visit. Roughly eight percent of patients who receive high-tech imaging in the ED are sent home before their test results are even returned to the ordering physician, and as many as 16 percent of MRIs are ordered unnecessarily.

Fortunately, better radiology-ED integration is possible to achieve with relatively simple process improvements.


First, radiologist should be supplied with access to patient EMRs, empowering them to review detailed provider notes & supplying them with clear indication for examination. Valuable radiology reports are not only accurate (getting the answer right), but also address the clinical question asked by the ordering physician (answering the right question). Access to real time patient records allows the radiologist access to a comprehensive recap of how the patient was injured, the location of pain, the physician’s specific concerns and other pertinent information, which enable radiologists to produce a useful report. Ambiguous or incomplete medical records may not allow the radiologist to appropriately address the reason for the exam or provide a definitive interpretation that is valuable to the ordering clinician. Providing an indication of a wet read can be helpful for both teams as well. Keeping an open exchange of communication and real time dialogue between the EM physician and radiologist regarding each of their study interpretations can ensure the most accurate final results are reported.

Second, establish a process to communicate critical findings. Certain imaging results require immediate attention from the EM physician. Critical life threating findings, such as brain hemorrhages, must be communicated as quickly and effectively as possible. A Kaizen event can be a breakthrough tool that helps leadership and front line workers from both departments to establish efficient, high performing communication processes. Critical results — those that require urgent action or are a major finding, like cancer — necessitate direct physician to physician voice communication from the radiologist to the emergency physician. Even when studies have a short turnaround time, critical results should be directly communicated via phone, video conferencing or in person to ensure appropriate delivery and response.

Lastly, use technology to make records accessible. Now that EHRs are ubiquitous, it is important to make sure they are configured in a way that makes it easy for radiologists to access relevant information. Radiologists should be able to see the patient’s current symptoms and his or her medical and surgical history. Radiology workflow technology can also facilitate the sharing of patient documents and information. To ensure the speediest care, referring physicians should still include all relevant notes in their indication for examination.


Until recently, hospital departments worked in silos, but there is a growing push to break down the barriers that insulate physicians into their own departments and specialties. Increasingly, clinicians are finding that working collaboratively, acting in a consultative capacity for their peers and sharing knowledge improve patient care and hospital efficiency. Encouraging dialogue between radiologists and emergency medicine clinicians helps build rapport and establish trust. When EM doctors view radiologists as teammates and advisors, radiologists have an opportunity to provide guidance during diagnosis and treatment planning, and also during test ordering, saving both time and money. Clear, effective communication can move radiologists from order takers to true consultants and collaborators.

30 September 2015

What Are the Radiology Challenges for Hospitals?

The significant growth in radiology, as we’ve discussed, represents an extraordinary opportunity for hospitals to improve their key metrics while also increasing profitability. These are goals that modern hospitals need to aspire to – but to accomplish them, there are significant challenges that need to be overcome.

Despite the importance of patient care to hospital economics, radiology remains fragmented in its service delivery in terms of efficiency, quality standards, effectiveness of service and even the scalability of its basic delivery model. The American College of Radiology publishes a set of guidelines and appropriateness criteria governing the specialty. The complexity of the specialty guidelines makes it difficult for hospitals to implement and measure.

In addition to patient and quality control, staffing and specialization are also significant challenges. Addressing all subspecialty needs is very difficult, particularly for smaller hospitals and health systems: The Journal of the American College of Radiology estimates that at least 10 radiology subspecialties are required to cover all the fields of the practice.

Most hospitals do not have the capacity or range to employ this number of radiologists, which means they send most imaging studies to unspecialized radiologists. Some specialty reads are subcontracted to other practices, but the fragmentation of the provider landscape prevents that from solving the scaling problem; there are more than 25,000 radiologists in private practice in the United States, and more than 3,000 radiology groups. Incredibly, only 15 of these 3,000 practices have more than 65 radiologists.

This fragmentation problem is one of the key challenges hospitals must overcome in order to take advantage of the opportunities presented by the modern radiology department. But the good news is that the problem is far from unsolvable. To learn more about how hospitals are overcoming the challenges of the modern radiology department, stay tuned to our series of radiology-focused blog posts rolling out over the next few weeks, or click the link below to read our white paper:

28 September 2015

The Evolution of Neonatal Care

In the last few decades, neonatology has evolved dramatically in its ability to care for premature infants. Whereas before doctors provided active care to babies at 30 weeks, neonatologists are now equipped to provide care for newborns at just 22 or 23 weeks. Years ago, babies under 1000 grams were not resuscitated; today, infants at under half that weight are provided care. In fact, a report published in JAMA this month found that among extremely preterm infants born at US academic centers over the last 20 years, reductions in several morbidities were observed. Survival increased most significantly for infants born at 23 and 24 weeks gestation.

Research has produced technological and innovative new treatments which have broadened the scope of patients that NICUs can care for. There have been marked changes in the philosophy and approach to NICU care. Treatments now trend towards being gentler and less intrusive. This is especially true regarding the manner in which infants receive breathing support. Nasal prongs delivering enriched air may be all that a premature infant needs. In the past, most babies born at two pounds and less always received mechanical ventilation necessitating breathing tubes in their windpipes. Skin-to-skin contact between mother and child is also prioritized when feasible, since research has proven its numerous health benefits.

Earlier this summer, Dr. Richard Auerbach, Senior Vice President of Children’s Services for Sheridan, was quoted in a Huffington Post article about the evolution of neonatal care. Check it out here to learn how preemie care has evolved over the decades, from Dr. Martin Couney’s experimental incubator treatment (which was paid for with Coney Island sideshow fares) all the way to its modern incarnation.

22 September 2015

The Opportunity of a Strengthened Radiology Program for Hospitals

Radiology represents nearly 10 percent of annual commercial healthcare spending in the United States, and that percentage is increasing rapidly. The Advisory Board Company expects that total radiology spend will increase by nine percent year-over-year through 2018. This matters because imaging is the largest source of outpatient profit for many hospitals, contributing as much as 35 percent to the bottom line – nearly three times the next most profitable service line for hospitals. Any growth in radiology is therefore a significant potential growth in profit.

In addition to potential for profit, radiology is also especially important because it affects patient satisfaction in nearly all fields of medicine. Because radiology is used in most patient and disease categories hospitals manage, its accuracy and efficiency have a direct effect on patient safety, referral patterns, emergency department throughput, length of stay and the overall patient experience. When considered in this broad scope, it’s clear that the influence of radiology on the cost and quality of care across the entire health system is greater than even profit margins suggest.

Radiology is an important step in a patient’s diagnosis and, as such, plays a key role in a patient’s care plan and potential admittance to an inpatient department. Getting accurate imaging results in a timely manner is critical for both patient outcomes and the hospital’s profitability. According to the Institute for Health Care Improvement, “overutilization of imaging and downstream impact of misdiagnoses contributes to more than $50 billion in excess health care costs each year.” This demonstrates the need for specialized radiologists who can provide accurate reads the first time around.

By performing appropriate studies at the beginning of a patient’s stay - and having them read by radiologists specialized in that field of imaging - health systems can reduce cost, increase patient satisfaction and reduce overall length of stay. In turn, this allows them to increase intake of new patients, which is critical as the population of the United States continues to age and demand for healthcare rises.

In order for hospitals to improve across a variety of quality metrics and increase profitability, radiology cannot be ignored. To learn more about improving your radiology department, follow our series of radiology-focused blog posts rolling out over the next few weeks, or click the link below to read our white paper:

17 September 2015

Enhancing Anesthesiologists’ Value to Hospitals

Leadership roles within and beyond the perioperative domain

Over the past few years, the concept of the Perioperative Surgical Home (PSH) — a healthcare delivery model in which an anesthesiologist coordinates care from the initial decision to have surgery through 30 days post-discharge — has gained momentum in the anesthesiology community. In fact, a recent study (abstract S-150) from the University of California, Irvine - one of the pioneering institutions of the PSH model - found nationwide agreement that anesthesiologists’ coordination of care using the PSH model will help reduce healthcare costs by improving processes and patient outcomes.

The study, which went out to 6,000 randomly-selected members of the American Society of Anesthesiologists and garnered 883 responses, found that more than half of respondents believed anesthesiologists should coordinate patient care from scheduling to hospital discharge (60%), and that coordination of preoperative (81%) and postoperative (64%) care should become standard. Because anesthesiologists have always been involved in the planning stages, operation and post-operative care, serving as the coordinator, or “air traffic controller,” of the perioperative experience is a natural extension of their role and an important leadership opportunity for anesthesiology providers.

Anesthesiologists’ coordination of perioperative care improves a number of critical hospital quality metrics. Respondents to the UC Irvine study agreed that anesthesiologist coordination of care would improve outcomes (89%) while reducing costs (82%), hospital length of stay (81%) and readmission rate (73%). Anesthesiologists have the training and knowledge required for pre-operative planning, surgical experience and post-operative pain management and care expertise — this broad and holistic perspective leads to better patient outcomes. It also helps to reduce waste in the form of unnecessary testing. More pre-op tests lead to more information, but not necessarily meaningful or useful information. More testing can also lead to false positives which may cause same-day surgery cancellations and become a burden on a patient as it may require even more unnecessary testing.

Day-of surgery cancellations can cost a facility almost $3,000 per patient. With 90 percent of surgery cancellations taking place just before a patient enters the OR, hospitals stand to benefit from implementing strategies that reduce cancellation rates. Same-day cancellations are also one of the biggest patient and surgeon dissatisfiers, so limiting their instances can help improve patient and staff satisfaction. Having the anesthesiologist serve as a consistent point person throughout the surgical continuum improves the patient experience as well.

Beyond the patient’s care and experience, the PSH, a physician-lead team-based model, can improve staff satisfaction. Assigning the surgical coordination role to anesthesiologists helps to clearly define responsibilities among the various departments involved in an operation. The anesthesiologist serves as an interdepartmental point person, improving communication and teamwork.

As hospitals explore new care delivery and payment models, administrators envision and expect broader involvement from anesthesiologists. Healthcare reform has created a need for the optimization of resources. In addition to the larger role provided by the PSH model, anesthesiologists can take part in broader hospital initiatives like staffing & process improvements, interdepartmental pain management and nausea & vomiting initiatives, and more. Hospital administration and anesthesiology leadership should work collaboratively to identify areas where clinical and managerial operations could be strengthened by anesthesiologists’ expertise. Review our one-pager on enhancing anesthesiologists’ value to hospitals for ideas.

18 August 2015

Improving Newborn Hearing Screening Programs

Thanks to a combination of policy and technology, newborn infant hearing screening programs have made tremendous progress over the past two decades. Policy changes — spearheaded by position statements from the NIH (1993) and Joint Commission for Infant Hearing (JCIH, 1994) and later supported by the American Academy of Pediatrics — drove meaningful discussion about the importance of early detection of hearing deficiencies, while advances in Automated Auditory Brainstem Response (A-ABR) technology made it possible to efficiently screen all newborns within 12 hours of birth. As a result, more than 97 percent of all U.S. newborns now receive a hearing screen before discharge from the hospital.

Because hearing loss is the most common congenital condition in the United States, this change has had a major positive impact on public health. The system is not yet perfect, though. Just as with any new process, these changes have introduced complexity to neonatal programs, and this complexity must be managed properly to extract the maximum benefit.

Because the hearing screen process is relatively routine and low-skill, the primary challenge for hospital management is less about process optimization than it is about staffing and training. Most staff issues can be traced to two related problems:

Poor Knowledge of Local EHDI Program

As part of the push to improve early hearing screening policy, the CDC set aside grants to support the development of Early Hearing Detection and Intervention (EHDI) programs at the state-level. While this provided states with additional flexibility to meet the national EHDI goals, it also led to the development of dozens of parallel processes for achieving the same result. Each state has its own ways of implementing EHDI programs and mandating continuing education for medical employees, and the quality of these implementations can vary widely.

This makes dealing with staffing issues and policy changes more challenging, for obvious reasons. Without a national standard (or high quality state-level one), hospitals can struggle to recruit staff that have the necessary skills to immediately contribute to the productivity of the screening program. This puts a significant burden on the hospital's human resources team.

Improper Training on Hospital SOPs

Staff that lack proper state-level EHDI training will naturally struggle with hospital-level standard operating procedures (SOPs). This case is surprisingly common: at some hospitals, many staff are unaware that their state even offers an EHDI program. When training is absent and these SOPs are poorly implemented, it creates “loss to follow-up,” “loss to documentation” and “loss to treatment” cases. These are essentially scenarios where process errors allow newborns who failed their screening to slip through the cracks and not receive appropriate follow-up care. According to the American Academy of Pediatrics, almost half the children who do not pass their screening ultimately fall through the cracks and do not receive a documented diagnosis.


There are many strategies for addressing these issues, but at their core they all share three things: a comprehensive knowledge of EHDI programs, a solid recruitment pipeline and a well-documented training and SOP library. While it is certainly an option for a hospital to develop these resources in-house, the majority find that partnering with a physician services organization is a more cost-effective solution. Unlike individual hospitals, physician services groups can apply scale to hearing screening programs, which means that staff pipelines are more robust and best practices can be implemented quickly across an entire network. In addition to these management practices, the scale offered by external groups allows them to easily implement best-in-class technologies, including pre-existing billing systems that simplify payment. In most cases, this leads to improved department performance at a lower cost when compared to an in-house solution.

If you're interested in learning more about how Sheridan can help make your hospital's hearing screen program as successful as possible, we encourage you to visit our Healthy Hearing website or contact us directly.

24 July 2015

21st Century Medicine – Leveraging the Benefits of Distributed Radiology Solutions

When it comes to technological advances changing the way healthcare is delivered, no specialty has undergone more drastic changes than radiology. The advent of distributed radiology — driven by the ability to reliably transmit radiologic studies via Radiology Enterprise Management (REM) systems— has led to significant improvements in patient care, increased physician satisfaction and generated cost savings for hospitals. Gone are the days when a radiologist needed to be physically on site to read and interpret an image in order to make a diagnosis; REM systems have given both radiologists and radiology departments increased flexibility in how they deliver their services. As a result, the distributed radiology market is large and growing; valued at $920 million in 2012, it is expected to grow to $3.78 billion by 2019.

Distributed radiology benefits the healthcare industry in numerous ways: first, it benefits the patient by providing doctors and hospitals with a more comprehensive set of tools to come to a complete, precise diagnosis at any time of day; second, it benefits radiologists by making their employment conditions, working arrangements and hours more flexible; and finally, it benefits hospitals by giving them flexibility in their staffing models so that they may adapt to shifting demands in their local market.

Let's begin with patients. Advances in technology now allow hospitals to provide comprehensive and quality service to their patients 24/7. Even after hours, emergency room doctors can send studies to the overnight radiologist in his or her home office and get a diagnosis back in near real-time. Before distributed radiology, after-hours reads may not have been possible, thus limiting the quality of care that a provider could achieve. Furthermore, enterprise radiology systems can provide remote access to subspecialists, whose additional expertise lends itself to greater diagnostic accuracy (when compared to generalists).

Radiologists also benefit from this arrangement, enjoying increased flexibility with their schedules and work environments. Radiologists can choose to work from their home offices or take night shifts in order to have time during the day to spend with their family or address other personal needs. Allowing flexibility in their schedules is an important factor in physician satisfaction and retention rates. Additionally, highly specialized radiologists can now apply their expertise to cases outside of their local area, which improves both their career and the outcomes of the patients they serve.

Distributed radiology also allows remote radiologists to access all of the information they need – including prior studies – in real-time, which significantly improves diagnostic accuracy in cases where a radiologist needs more information than simply the most recent image of a patient. This has obvious impacts on quality of care and is especially useful in geriatric and/or high-acuity cases.

Finally, distributed radiology solutions also provide hospitals with cost-saving opportunities by giving their staffing model more flexibility. By connecting in-house radiologists with specialists anywhere in the country at any time of day, distributed radiology gives hospitals the flexibility to hire radiologists on a per-case basis and rapidly respond to variations in patient volume.

If you're interested in learning more about how Sheridan helps implement distributed radiology solutions for radiology departments across the country, we encourage you to contact Sheridan’s radiology experts today.

16 July 2015

Sheridan Physicians Help Memorial Regional Hospital Win Prestigious STS Ranking

When Sheridan partners with a hospital, we don't just staff a department — we partner with management to build a culture of innovation and continuous improvement, striving to make that department the best it can possibly be. Our clinical leaders embody that ideal, and three of our physicians recently demonstrated a fantastic example of just that: Dr. Joseph Loskove, our regional medical director, Sheridan anesthesiologist Dr. Robert Brooker, and Dr. Adam Blomberg, the national education director for the anesthesiology division of Sheridan.

Dr. Loskove serves as the chief of anesthesia for the Memorial Healthcare System in South Florida; Dr. Brooker is the chief of cardiac anesthesia at the healthcare system’s flagship hospital, Memorial Regional Hospital in Hollywood, Fla.; and Dr. Blomberg is the chief of anesthesia at Memorial Regional. The three physician leaders made it possible for the hospital's cardiac surgery program to achieve an across-the-board 3-star rating from the Society for Thoracic Surgeons (STS).

A complete 3-star rating from the STS is very difficult to achieve — only 1.2 percent of the 1,005 surgical sites surveyed this year were able to win the distinction. To be recognized, facilities must demonstrate excellence in three procedures: coronary artery bypass surgery (CABG), aortic valve replacement (AVR) and combined CABG/AVR. As leaders of the anesthesia group at Memorial, Dr. Loskove, Dr. Brooker and Dr. Blomberg played key roles in making this achievement possible.

Dr. Richard Perryman, the medical director of Memorial Regional's Cardiac and Vascular Institute, highlighted the importance of his collaboration with the cardiac anesthesiologists in an announcement to hospital staff. Specifically, Dr. Perry recognized the “tremendous contribution of the cardiac anesthesia group to these outstanding results,” and said that “their continuing skills, dedication and enthusiasm” played a critical role in developing the “most comprehensive and high-quality service line for all patients needing cardiac care in South Florida.”

Building “the most comprehensive and high-quality service line” in South Florida — that's a mission that Sheridan is proud to be a part of. Congratulations to Dr. Loskove, Dr. Brooker, Dr. Blomberg and their team — we look forward to more fantastic results from MRH!

8 July 2015

Gulf Coast Regional Medical Center Introduces Neonatal Cooling Therapy

Sheridan would like to announce that the NICU team at Gulf Coast Medical Center in Panama City, Florida has begun neonatal cooling therapy, thanks to the efforts of neonatologist Melissa Tyree, MD, FAAP. Dr. Tyree and this new therapy were highlighted on local channel 13 WMBB-TV: “This therapeutic option is being provided to term and near-term infants who experience birth-related oxygen deprivation and show signs of brain injury. The therapy has been shown to reduce the risk of death and disabilities such as cerebral palsy, mental retardation, and learning disorders.”  There are several problems that occur during pregnancy and delivery that can lead to this condition, also known as Hypoxic Ischemic Encephalopathy (HIE). Therapeutic cooling is a clinical treatment that involves reducing a patient’s body temperature to 92 degrees Fahrenheit for three days. In the past there was no brain-specific therapy for HIE. While cooling therapy is safe and effective, it must be initiated within 6 hours from birth. Cooling therapy also requires close monitoring and management of potential side effects and therefore can only be performed in selective, experienced level 3 neonatal intensive care units.

Click here to view the full video

Shortly after the development of the level 3 neonatal intensive care unit at Gulf Coast Regional Medical Center, the neonatologists and neonatal care team worked diligently to develop a Neonatal Therapeutic Hypothermia (Cooling) Program.  On March 1, 2015 the program was officially opened. On April 1, 2015 the first patient requiring therapy was born and experienced a full recovery with a normal exam and normal MRI after completing the 72 hour therapy. Her parents' gratitude was beyond words; not only for her recovery, but also for the ability to remain at her side throughout her entire hospital course now that this new therapy is available at Gulf Coast Regional Medical Center.

This is an exciting program that will permit timely therapy for infants born at GCRMC.  It will also provide a closer transport alternative than Pensacola or Tallahassee for babies born at other hospitals in the Florida panhandle.

1 June 2015

Strengthening Emergency Department Intake Processes

There are many measures of hospital quality, but two primary dimensions that stand out are patient health outcomes and operational efficiency. Though sometimes they seem to be at odds, the best hospital process improvements tackle these dimensions simultaneously.

Emergency department personnel are uniquely positioned to understand the relationship between patient care and efficiency — they treat both high acuity and high volume patient segments, and they’re largely measured by door-to-provider time and throughput. In the emergency department, improvements to intake and triage systems can have positive impacts on both patient outcomes and the operational efficiency of the department.

Example: Parallel Care Model of Patient Assessment

Slow door-to-provider times are a strong indicator of inefficiency in the ER — and a patient safety risk. Employing Kaizen lean process techniques, Dr. Ken Colaric of Sheridan partner hospital Saint Mary’s Medical Center in Missouri worked with his team to identify areas of inefficiency in their existing triage system. The Kaizen analysis and conversations with all stakeholders resulted in an entirely new “parallel care” model of patient assessment.

The parallel care model encourages emergency department personnel to attend to a patient as soon as they are available, rather than having providers wait for their proper turn in the traditional sequence of emergency care. The department also instituted immediate bedding, so that the patient is ready for a nurse, physician or tech to begin their work as soon as they are available to do so. Registration happens bedside, dramatically cutting down waiting room time.

Saint Mary’s new parallel care model and bedside registration have improved nearly every metric of success for the department. Patients’ average length of stay has been reduced by 30 percent. The “left before being seen” rate dropped a dramatic 88 percent. Door-to-bed and door-to-doctor times have seen significant decreases as well.

In many hospitals, 60-80 percent of inpatient admissions are made in the ER. With the majority of a hospital’s patients experiencing emergency care — and with CMS reimbursement now tied to patient satisfaction — the ER experience has never been more important. Identifying emergency department process improvements that benefit patients’ health outcomes, throughput and, by extension, patient satisfaction, is how hospital leaders can best drive lasting change in their ER.

To learn more about the ways Sheridan Healthcare can help strengthen your emergency department’s processes, read our leadership brief: “The Evolving Emergency Department: Strategies for Staying Ahead of the Curve.”