Consequences of outsourcing referrals for radiological examinations
Tavakol Olofsson, Parvin
2016-12-16
09.00
H2, Grön Hall, Alfred Nobels Allé 23, Karolinska Institutet, Huddinge
Inst för klinisk vetenskap, intervention och teknik / Dept of Clinical Science, Intervention and Technology
Background: Demands for ever more effective healthcare and care
accessibility for all patients continue to increase the workload in diagnostic
radiology departments. Along with rapid developments in imaging technology
which affect its day-to-day clinical use, these are three important factors for
which outsourcing might be a potential solution. Outsourcing radiological
examinations increases the need for cooperation between different healthcare
units. Outsourcing a radiological examination is accompanied by
administrative work. Examinations performed externally change the work flow
and create a multifaceted environment that can be reviewed both qualitatively
and quantitatively. The impact of outsourcing magnetic resonance (MR) and
computed tomography (CT) examinations to external units in a zero-based
budgeting healthcare system is unknown. This impact can be studied both from
the perspective of healthcare work flow as well as from that of the patient
experience.
Aims: The overall aim of this thesis was to describe the outsourcing of
radiological examinations such as MR and CT scans from a university hospital
in terms of costs, quality, time efficiency, and both the patient’s and referring
physician’s perspectives, and also to investigate the differences when CT
examinations are outsourced from a university hospital as part of a contract
compared to conditions prior to the contract between the hospital and external
radiology unit.
Material and Methods: In Study I, consecutive outsourced MR examinations
requested by the Department of Oncology during the first quarters of 2005 and
2006 were selected for investigation. Examinations performed by the
University Hospital’s Radiology Department (Group A, n = 97) were compared
to matched examinations outsourced to external private units (Group B, n =
97). In Study II, structured interviews (oral questionnaires) were held with one
group of patients (n = 160) referred for MR examinations. In Study III,
qualitative interviews were held with 10 referring physicians from orthopedic
and oncology clinics representing clinics with large volumes of radiological
referrals. In Study IV, 264 elective CT examinations were randomly selected
from four different groups of patients referred from the Departments of
Hematology and Oncology during two time periods: one time period had no
detailed plan for cooperation (OSnC) and one represented contract-based
outsourcing (OsC). Within these time periods, examinations performed inhouse (Group HI13; IN14) and outsourced (Group OSnC; OsC) were
compared.
Results: In Study Ι, the time from writing a referral to obtaining the report was
significantly longer in Group A (in-house) than in Group B (outsourced). For
referrals without a preferred timeframe, the waiting time was shorter for outsourced examinations than those not outsourced. No significant difference
in the number of examinations requiring additional imaging was observed
between the two groups. Fewer examinations in Group A needed additional
work for reinterpretation of images than in Group B (14% vs. 28%). The
average cost for an MR examination in Group A was calculated to be €616.80,
and €510.80 in Group B.
In Study II, 69% of the patients stated that they could neither choose nor
influence the location to which their examination was referred. Aspects that
influenced the patients’ choice of radiology department were: short waiting
time 79% (127/160), ease of travelling to the radiology department 68% (110
/160), and short distance to their home or work 58% (93/160). For 40%
(60/160) of the patients, a short time in the waiting room was related to a
positive response regarding returning for a further MR examination. In study
III, all the referring physicians agreed that the quality of outsourced
examinations was frequently inferior to that of examinations performed in the
University Hospital’s Radiology Department and that requests for additional
reinterpretation work led to higher costs for their clinics. In Study IV, during
2013, management time for CT examinations which needed no reinterpretation
was longer in the outsourced group than in the in-house group, with a statistical
significance of 0.002. CT examinations in Group OsC (contract-based
outsourcing) were associated with shorter overall processing time, shorter
patient waiting time and lower costs compared to group OsC (without a
detailed plan for cooperation).
Conclusion:
- Outsourcing magnetic resonance examinations is one potential
solution for reducing patient waiting time.
- Outsourced examinations more frequently need reassessment at the
University Hospital than examinations that are not outsourced.
- If patients were informed about outsourcing and could also choose
where to have their examination, the key factors contributing to
patient satisfaction could be met even when MR examinations are
outsourced.
- When considering outsourcing, the needs of the patients, of the
referring physicians and of the radiology departments must all be
considered, to optimize patient care.
- For better planning of radiological services, radiology departments
must consider the referring physicians’ needs and develop a suitable
contract for organizing the practice of outsourcing.
- Using a contract for outsourcing CT examinations may be an effective
way of reducing patient waiting time.
- Outsourcing based on a well-founded contract can be cost-effective,
compared with outsourcing without a detailed plan for cooperation.