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23 November 2015

Re-Engineering Engagement: The Sheridan Emergency Medicine Provider Engagement Project

By Dr. David Mishkin, Director of Emergency Medicine Innovation and Amichay Porges, Kaizen Promotion Lead Clinical Facilitator

Most organizations are full of great ideas that haven't been discovered yet – and more often than not, the only thing keeping these ideas from being shared is the lack of a forum to discuss them. One of our core beliefs – both personally and at Sheridan – is that developing systems that allow these ideas to come to the surface can deliver tremendous value for a hospital or health system.

For several years at Sheridan, we've both been using Kaizen events to accomplish this. For those unfamiliar, Kaizen is one of the world's leading process improvement methodologies. Founded on the work of W. Edwards Deming and made famous by Toyota in the 1980s and '90s, Kaizen’s framework provides a collaborative forum for all staff members to identify and implement ways to improve processes and share those insights with the organization. By giving the people who best know a process a voice in its design, Kaizen reliably generates better results than other process improvement efforts which are led from the top-down.

Applying Kaizen to Engagement

The majority of Kaizen events we lead with Sheridan are focused on re-engineering clinical and transactional workflows, such as the flow of patients through an ED. But this methodology could also be applied to less concrete processes as well. Using the resources and experience we have at our disposal, we were able to apply the principles of Kaizen to one of modern Emergency Medicine's most pressing problems: Physician Engagement. Successfully doing so would significantly reduce turnover, which is critical for understaffed specialties like emergency medicine.

This led us to create the Sheridan Emergency Medicine Provider Engagement Project: a new way to use the Kaizen event, specifically designed to act as a catalyst for generating and disseminating great engagement strategies. Attendees flew in from many of our partner hospitals across Sheridan's national provider network, which allowed us to get an extremely broad view of existing engagement strategies. Each attendee was also asked to research innovative and inspirational employee engagement practices from across industries and in organizations outside of medicine so that they could present their findings to the group.

We believed this approach would encourage our team to build on a comprehensive foundation of current best practices that would inform an engagement strategy unique to Sheridan. After setting events in motion, our primary goal was to get out of the way and let our physicians start innovating. This approach was very successful – by giving our physicians time and tools, they were able to generate scores of great ideas, and incorporate them into the comprehensive new strategy for increasing ED physician engagement which was tailored to their needs. Perhaps most importantly, we can now leverage Sheridan's nationwide network of physicians to disseminate our findings as quickly as possible.

Next Steps

We believe the strategic planning phase of the Sheridan Emergency Medicine Provider Engagement Project was very successful. Now our locally based clinical leaders are poised to begin the dialogue with each of our partner hospitals. By encouraging discussions on the local level and giving our partners time to receive and respond to our findings, we hope to strengthen the cooperation between our organizations and further adapt our approach to the distinct needs of each site. Once we have feedback from our ED teams across the country, our next step will be to partner with other hospital based service lines within Sheridan to identify points of synergy and provide them with a platform to kick off their own provider engagement Kaizens. While these departments' staffing concerns may be less acute than ours, they still benefit enormously from having highly engaged physicians on their teams.

If you'd like to learn more about how Sheridan uses Kaizen to empower ED physicians, read our blog on building a more stable emergency department or download our “Evolving Emergency Department” white paper.

10 November 2015

Critical Questions for Outsourcing a Newborn Hearing Screen Program

According to the American Academy of Pediatrics, hearing loss is one of the most frequently occurring birth defects. Considering this, states have taken action to ensure children are screened and treated early for hearing loss. Now, nearly all (97%) of newborns leaving hospitals receive hearing screenings.

Because the hearing screen process is relatively routine and simple to conduct, the primary challenge for hospital management is less about process optimization and more an issue of staffing and training. To solve the problem, more hospitals are turning to outsourced service providers that can manage the program with minimal financial commitment.

Entrusting a hearing screening program to a dedicated clinical services provider ensures that the program receives appropriate staffing and attention. It also frees up time and resources that hospital staff can dedicate to higher level responsibilities.

Use the checklist below when considering a partner to manage your newborn hearing program or to evaluate your current screening program. Here are some of the key program elements to review:

1. Who’s in charge?

Strong screening programs need a dedicated – and experienced – program coordinator to ensure a screening program is running efficiently and effectively. Do you have a coordinator that recruits and trains screeners themselves? Do they monitor the upkeep of your screening equipment? Are they data-driven and focused on successful test rates?

To be confident in your hearing screens, there needs to be a specialist in charge who can be trusted to professionally oversee their department. Outsourcing relieves the hospital from being responsible for purchasing and maintaining equipment, ordering supplies, and maintaining sufficient inventory.

2. Are you ensuring quality?

Quality control is in the details. There are certain questions that new parents will ask to feel confident in their hospital’s testing program: Do you employ best practices for screening and measure against key benchmarks of quality? This technology is highly specialized and is always advancing. State mandates/guidelines also may change. Outsourcing allows professionals experienced in this specialized field to make sure changes are implemented accordingly and address questions that hospital stakeholders will ask: does the program ensure coordination, oversight, accountability and sustainability? Do we have buy-in from nursery support staff and administrators?

3. Are parents satisfied with our care?

Patient experience and satisfaction are becoming increasingly important quality metrics for hospitals. Communication to new parents, in particular, must be clear and detailed. When evaluating a program, ask who communicates with families and caregivers. Communicating with pediatricians post-discharge with hearing screen results is an integral component of the newborn hearing screening program. In an outsourced program like Sheridan, hearing screeners communicate this important information to pediatricians. How is newborn hearing screening presented to families? Is information delivered accurately and confidentially?

4. Are our processes defined?

It’s important to understand how your hospital performs its hearing tests in various circumstances. For example, how are NICU and high-risk babies determined eligible or medically stable for screening? In those hospitals which use nurses to perform screens, outsourcing may prove to be more economical. In addition, relieving nursing staff of hearing screening, and the tracking and data entry that accompanies a newborn hearing screening program, allows nurses to be more present at the bedside. Not only will this improve nursing satisfaction, but may even have on impact on HCAP scores. What screening protocols are used for well-baby screening? What is the proposed timing?

5. Is our program compliant?

There are a number of regulations with which your program will need to demonstrate compliance. Does your hearing screening comply with your state’s EDHI program? Does your program employ well-qualified staff and facilitate appropriate well trained and retraining?

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.

5 November 2015

How to Build a Stable Emergency Medicine Department

Evidence indicates that emergency medicine will be an “undersupplied” specialty in the U.S. for at least 20 more years. The number of physicians who are board-certified in emergency medicine is unlikely to meet the staffing needs of U.S. hospital emergency departments – staffing needs which, if requiring at least one physician present in the ED 24 hours a day, demand 40,000 physicians with such training. In 2005, there were only 22,000 EM board-certified physicians, meaning that only 55 percent of the need was filled. Supply is not estimated to meet demand until 2038 at the earliest.

These data highlight the dire need for hospitals to retain the board-certified physicians that they already employ and the new ones they hope to hire. Easier said than done, as emergency medicine physicians experience the highest rate of burnout among all specialties. While this is not necessarily surprising, what is surprising is that hospitals do not always dedicate the right resources to recruiting the best physicians and prioritizing their physicians’ job satisfaction and retention.

Recruiting is the first piece of the puzzle — and that often means finding people or agencies with a comprehensive knowledge of the local physician market in order to attract top tier talent. Then, a key step in quality recruiting efforts is defining the job requirements. Not only does this help an organization find the right physician to fulfill its needs, but it also helps set the expectation of the physician for what will be required of him or her in this new role.

Retaining these physicians, on the other hand, can be a bit tougher, largely due to the ambiguity surrounding “burnout” among physicians and how it can be counteracted. According to the 2015 Medscape Physician Lifestyle Report, 46 percent of physicians said they experienced feelings of burnout. This represents a significant jump up from the 39.8 percent that reported feeling burned out just two years prior. As previously mentioned, the rate of burnout is highest among emergency medicine physicians.

For healthcare providers, reducing physician burnout is crucial for several reasons. Physicians facing high levels of burnout or stress may be more likely to change jobs or quit. Additionally, a disengaged, tired physician is more likely to make mistakes and less likely to act empathetically towards patients. As one article in Hospitals & Health Networks put it, “the secret to caring for patients is caring for our caregivers.” At a time when patient quality outcomes and satisfaction scores directly impact reimbursement, hospitals have a massive added incentive to start to take better care of their doctors.

By attracting the right type of talent and instituting processes that help doctors in emergency medicine cope with the high levels of stress, hospitals can build stable emergency department units that better serve patients and staff. One of the best ways to do this is to build a culture that gives physicians a voice in their departments, allowing them to regularly give input on day-to-day processes and independently design strategies to improve them. At Sheridan, we accomplish this using Kaizen, a continuous improvement methodology pioneered by Toyota. Kaizen empowers all participants in a process by giving them regular opportunities to give constructive feedback and improve their workplace.

If you'd like to learn more about how Kaizen builds more stable departments by empowering physicians, check out our “The Role of Kaizen in Hospital Performance Improvement” video, featuring the President/CEO of Jupiter Medical Center in Jupiter, FL.

30 October 2015

Sheridan Reduces Chronic Lung Disease in NICU Patients

Chronic lung disease (CLD) is a common morbidity for infants born prematurely. CLD — also known as bronchopulmonary dysplasia — is defined as a need for supplemental oxygen or ventilator support at 36 weeks gestational age. CLD affects roughly two thirds of extremely low birth weight infants.

The rate of incidence of CLD has driven many hospitals to implement strategies to reduce its frequency in NICU patients. One popular strategy is to benchmark against Vermont Oxford Network (VON) data. The VON is a nonprofit collaboration of healthcare professionals working together to improve outcomes and increase the quality, safety and value of newborn care. The VON maintains a clinical database of information about extremely low birth weight infants and releases reports to its members with data and strategies for care improvement.

Beginning in 2008, Sheridan Healthcare undertook an improvement project aimed at reducing the incidence of CLD at its hospitals, using VON recommended practices and benchmarking data. Sheridan’s commitment to best-in-class care for premature babies and increased emphasis on teamwork have resulted in a significant drop in the rate of CLD across all NICUs in the Sheridan network.

Tackling Chronic Lung Disease in Preemies

Beginning in the second half of 2008, Sheridan began preparing for the quality improvement initiative by collecting baseline data from each of its NICUs. After a year and a half of project planning and prep work, Sheridan’s neonatology team sent out communications asking each NICU to selected one of four “potentially better practices” (PBPs) to implement (the VON prefers the term “potentially better practice” to “best practice” because it recognizes that one strategy may not work best at all hospitals). The four PBPs that Sheridan NICUs could choose from were evidence-based strategies for reducing the risk of CLD among newborns:

  • Early caffeine treatment for babies less than 1Kg (10 grams)
  • Oxygen saturation targeting at 88-95% fir babies less than 1.5Kg
  • Room air challenge testing at 32, 34 and 36 postmenstrual age
  • Antenatal steroids for babies at 23-33 weeks gestation age

NICUs implemented one PBP from Q1 of 2010 through the end of 2011 and reported their outcomes. At the start of 2012, NICUs were asked to implement all four of the PBPs. Sheridan collected data on the CLD rate and conformance rates among practices by querying their PremiEHR clinical database. The results were quantified and were then shared with each NICU in a quarterly Quality Management report. PremiEHR helped Sheridan NICUs collect the data, and the software also helped NICU nurses, doctors and therapists monitor an infant’s documented oxygen level, respiratory support and medication, and provided reminders when infants were due for challenge testing under the program.

In addition to collecting and analyzing the PremiEHR data, Sheridan’s neonatology team also conducted quality site visits. The site visits incorporated team building exercises to align the nurses, respiratory therapists and physicians. Ensuring consistent understanding of the program, goals and division of new responsibilities across the care team was critical to the success of the program. Sheridan’s team also worked with its hospitals to create an environment conducive to teamwork. For example, Sheridan encouraged hospitals to send out weekly communications to notify care teams of patients nearing CLD criteria. The increased communication ensured all care team members were informed of a patient’s status and fostered more effective distribution of care responsibilities.

The Results

Chronic Lung Disease Rate in VLBW Infants - All Hospitals

Sheridan’s neonatal improvement project was extremely successful in lowering the incidence of CLD in newborns. During the five-year-long project, Sheridan was able to drop its incidence of CLD well below VON’s mean — VON’s data shows 24 percent of extremely low birth weight infants at member NICUs are affected by CLD, while just 16 percent of Sheridan patients are affected. The baseline CLD rate for all NICUs in the Sheridan neonatal network was 37 percent in 2008, so Sheridan was able to decrease its CLD rate by nearly 57 percent.

Cumulative CLD Cases and Cost Averted - All Hospitals [Chart]

Beyond the improved care outcomes, Sheridan’s NICUs also experienced tremendous cost savings. According to the Journal of Pediatrics, the incremental cost of a CLD patient is $31,562 (as of 2013). Altogether, Sheridan NICUs were able to save 800 cases of CLD, resulting in averted costs of $25 million for Sheridan hospitals.

Sheridan’s employment of VON’s PBPs and its dedication to collaboration between NICU care team members significantly improved care for infants at risk of CLD. To learn more about Sheridan’s neonatal services, visit our neonatology page.

28 October 2015

Collaborative ED/EMS Relationships Can Improve Emergency Department Experiences

Improving the efficiency of triage and intake processes is a high priority for emergency departments, especially since 60-80 percent of inpatient admissions in many hospitals are made in the ED. With the changes made to Medicaid in 2014 and the evolution of diagnostic practices, many are now using the ED as their primary source of medical care. ED overcrowding is a challenge, especially during peak ED times when there may not be enough dedicated staff to respond to high traffic volumes in a timely manner. When this growing demand exceeds the ED’s capacity, the result is more ambulance diversion, extended door-to-provider times (AKA “wall times”) and greater patient dissatisfaction.

Identifying and implementing ED intake process improvements that streamline throughput and reduce wait times is key to creating lasting, positive changes to efficiency, outcomes and patient satisfaction. Building trusted, collaborative partnerships and improving communication between hospital ED staff and local EMS providers can help to promote more effective and efficient intake and triage. A 2013 study in the Annals of Emergency Medicine found that higher performing hospitals “demonstrated specific investment in and attention to EMS through: 1) respect for EMS as valued professionals and colleagues; 2) strong communication and coordination with EMS; and 3) active engagement of EMS in hospital AMI quality improvement efforts.” To improve in the three areas of a successful ED/EMS partnership outlined, consider these strategies:

  • Bring EMS and ED stakeholders together to collaboratively assess the problem of ambulance patient offload delays and explore strategies and tactics for reducing wall times. Facilitating times for ED personnel to interact with their EMS partners beyond ED patient handoffs strengthens relationships. It allows stakeholders from each team to establish mutual goals and a better understanding of one another’s roles and the collaboration necessary for success.
  • Collect, monitor and analyze offload delay data to inform and support this problem-solving process. Reviewing comprehensive data can help identify trends in volume and case types that come in throughout the week. Understanding the patterns can help EDs staff appropriately.
  • Consider strategies that have been deployed successfully in other hospitals. Examples include improving intake with dedicated ED/EMS liaisons and bedside registration.
  • Consider investing in technology that facilitates ED/EMS communication. Telemedicine and advancements in health information exchanges and EHR technology can streamline offloading and ensure ED staff know the pertinent information as soon as — or even before — a patient arrives.

Sheridan Healthcare proactively fosters the development of trusted relationships with its local EMS provider partners by cultivating a more inclusive and collaborative approach to communication and decision making, grounded in mutual understanding between emergency department staff and EMS field staff. Sheridan’s clinical chiefs oversee 11 EMS medical directorships and understand the challenges facing paramedics and EMTs. As part of our commitment to continuous improvement of our intake process and patient satisfaction, Sheridan tracks EMS offloading times and works to improve our practices. Between February and June of 2015, we have decreased door-to-provider times by 91 percent.

For more information about how Sheridan is working with its EMS partners to improve collaboration, communication and teamwork, contact our emergency medicine division.

14 October 2015

Three Management Strategies for an Effective Radiology Department

Radiology has been able to embrace the technological advances of the 21st century more rapidly than any other medical specialty. Thanks to innovations in telecommunications and radiology enterprise management (REM) software platforms, radiologists no longer need to be physically present within the same hospital as the patient to make an accurate an informed diagnosis. These innovations also enable physician teams to focus on other aspects of their practice including greater integration and subspecialization. This has led to a proliferation of strategies for hospitals and radiology groups managing growing departments on an increasingly tight budget.

Broadly, these strategies fall into three categories: a standards-based approach, strong enterprise-wide physician leadership and the utilization of comprehensive REM platforms. It is well understood that different hospitals have different needs, and hospital administrators must have the flexibility and necessary guidance to adopt a set of strategies that will best fit their needs. The highly fragmented and inconsistent nature of radiology in the United States today means that programs may take various forms, ranging from an entirely teleradiology-based practice to a fully-staffed enterprise-wide radiology teams (and everything in-between). By recognizing the uniqueness of radiology as a specialty and leveraging advanced technology, hospital executives can achieve their goals, while ensuring a consistent, effective model that allows for the delivery of high quality and cost-effective patient care.

Standards-Based Radiology

Currently, there is no universally adopted set of standards to define what an acceptable radiology program should look like. As a result, performance and quality may vary greatly from one facility to the next, even within the same health system. In an era of value-based, consumer driven care, this fragmented approach to radiology delivery is totally unacceptable. What is needed is a set of performance and quality standards that are hardwired for compliance, and agreed upon by all relevant healthcare stakeholders. Radiology practices possess the resources and technology to provide hospitals with 360 degrees of real-time feedback; however, this level of insight is relatively unheard of among top-level healthcare executives. Instead, such information is often buried beneath layers of cryptic data spanning several months, and lacking individual provider performance.

It is essential to the continued growth of our specialty to harness the capabilities made available through technological advances to standardize and sustain crucial measures of performance such as diagnostic accuracy and critical results communication compliance. These types of data are important not only for accountability reasons, but are required for healthcare leaders to make critical decisions impacting patient care on an informed basis. As radiology reimbursements continue to fall, providers and business leaders must accept a new reality: radiology is no longer the straight-A child hospitals once boasted of. To remain profitable, hospitals and radiology groups must break down all barriers affecting communication to achieve a model based on realistic and holistic standards.

Physician Leadership

While distributed radiology models take hold across the nation, radiology providers must continue to satisfy the need for strong, accessible physician leadership. It is important for medical staff to “know” their on-site radiology providers, as well as off-site subspecialists, in order for radiology to become a truly integrated practice. Additionally, on-site radiologists provide an invaluable service to staff physicians by interfacing with medical staff on key safety and quality initiatives, such as managing utilization of radiology resources. In addition, through frontline employee engagement, radiologists can employ proven lean workflow methodologies such as Kaizen to ensure all efforts are being made to continuously improve upon radiology department performance.

There is one aspect of radiology out of reach of telecommunications innovation: interventional radiology. Interventional radiology (IR) serves a well-defined patient population and, like other modalities, spans both inpatient as well as outpatient realms, meaning there are ample opportunities for growth internally and otherwise. These programs require strong leadership support and resources to continue growing due to interdepartmental conflict over IR’s expanding role and universal applicability.

The takeaway: There is no substitute for enterprise-wide physician leadership.

Radiology Enterprise Management Suite

To effectively make use of the aforementioned strategies, radiology practices must utilize comprehensive REM suites capable of managing all aspects of the practice including quality and performance analytics, scheduling, peer review and relevant patient information. These platforms must facilitate ease of communication while allowing hospitals and health systems to harness the collective expertise of the entire enterprise through a distributed subspecialist model.

Radiology enterprise management suites make use of the full complement of technological capabilities made available to radiology groups by hardwiring compliance and performance standards directly into the practice. This allows for improved quality and performance through automated double-blind peer review and standardized report structure – two challenges that plague radiology practices across the nation. Additionally, REM suites facilitate a cost-effective distributed model by eliminating costly management and workflow entities that would otherwise be required for the operation of a scalable subspecialist delivery model.

As value-based healthcare continues its drive toward better radiology at lower costs, radiology leaders and healthcare leaders alike must accept that fundamental change is required to remain viable among an increasingly competitive array of providers and systems. These three distinct options for radiology staffing and delivery – or any combination of the three – allow hospitals to customize a model that best fits their unique needs, and allows them to enjoy the maximum benefit of radiology’s technological transformation. If you are interested in learning more about how our radiology group helps hospital executives design and implement the right program for them, get in touch!

8 October 2015

The Value of Medical Society Membership for Large Group-Employed Physicians

In an era of rapid consolidation in healthcare, industry organizations are having a harder time sustaining their membership — particularly when it comes to physicians working within large groups like healthcare systems or outsourced physician services providers like Sheridan Healthcare. Large group members are, in many ways, protected and supported by their employer, leading them to believe that they have less need for support from a medical society.

However, healthcare providers should remain committed to their individual development beyond the enrichment opportunities furnished by their employers. Medicine is not a static field, so it’s critical to stay engaged in the conversations and transformations happening around clinical techniques, safety measures and healthcare policy. Sheridan provides leadership and ongoing education programming for its physicians, but encourages them to join industry organizations as well; Sheridan anesthesiologists, for example, are encouraged to become members of the American Society of Anesthesiologists (ASA) and other industry groups.

There is also value in the ability to unite as a specialty, with peers beyond a physician’s immediate network, to address the larger challenges of the field. Though there’s a sense of “strength in numbers” in a large group practice, the ability to unite as an industry is crucial to effect change in the policy and advocacy work that trade groups often do.

Additionally, large group employers benefit when their providers stay up to date on the advocacy, clinical and managerial guidelines and advisories issued by medical societies. An organization is made stronger if all of its constituents optimize their industry knowledge. Resources related to practice standards, education and MOCA, quality and advocacy can be of great value to a large practice.

Some large groups encourage association membership by covering the annual dues. Though supportive, this has the potential to result in registration without real participation. To encourage active engagement, industry organizations must ensure their membership is relevant and valuable to large group physicians. Sheridan’s National Education Director for the anesthesiology division, Dr. Adam Blomberg, serves on the ASA’s Committee on Large Group Practice and works to develop offerings that are tailored to large group physicians and are complementary to the resources large groups like Sheridan already offer their employees. To stay relevant, medical societies’ offerings will need to evolve as the industry’s structure evolves.

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.