Viewpoint: The Joining of Two Worlds

Education closes the gap between radiology's clinical and clerical staffs

Learn from someone who has worked on both the clerical and clinical sides of radiology how better patient care and efficient workflow can be attained through increasing the administrative staff’s knowledge and awareness of radiology techniques, procedures, and terms.

As a student on the verge of finishing a radiology program and as a person who has worked on the clerical side of the radiology department for more than 10 years, I would like to think that I have a different perspective on this profession. Over the years, I have seen the installation of a RIS that took us into a paperless filing system, the change from film to computed radiography, and the implementation of a PACS.

Although these changes were a scary transition for our department, nothing has caused me more concern than the probability that the wrong exam could be performed due to a mis-scheduled or mis-ordered exam. I feel that radiology’s reception and scheduling personnel training is an area that needs to be more focused on because of the importance of obtaining and giving the right information and instruction to the patient so that the proper exam can be done.

Because of its complexities, CT would be a modality in particular I feel is more susceptible to such an occurrence. Modalities such as ultrasound, fluoroscopy, Dexa, and others are also a concern, but do not have the same complexities.

Frontline Soldiers

The clerical staff of the radiology department are the frontline soldiers of the department and affect how our patients interpret the way we function. They are the first people who come in contact with the patient – whether on the phone or in person – and play a huge role in patient care and aiding us in retrieving all the information needed to perform the exam. The radiology department cannot function without its hardworking frontline supporting staff. But unfortunately, problems in this department do arise, even with such hardworking and dedicated staff.

In many radiology departments, the scheduling staff lacks an understanding of medical terminology and knowledge of why an examination is performed. More than half of the CT exams scheduled are changed by the technologist on the morning those cases are scheduled to be done.

Although alarming, these don’t become a problem because the technologist screens the schedule with the radiologist before the patient even arrives. Proper preparation and IV contrast indication also pose a problem when a scheduler does not understand why these preparations are given and why the contraindication questions are asked for a particular exam.

Scheduling was one of the first things I tried to tackle when I took on the clerical supervisor job for a radiology department. I inherited a department that had only basic preparation information in the scheduling preparation binder. There was no way of differentiating a CT exam with a diagnosis for renal stone that required no diet restriction, no IV contrast, and no oral contrast, from an exam for gallbladder stones that required all three.

This lack of information did not only affect scheduling but radiology reception, as well. Patients given oral contrast for exams that did not require it is an example of a consequence of these mistakes. Although performing the wrong exam was not the outcome of these mistakes, it proves to be a mistake that leads to the exam being rescheduled and an inconvenience to the patient.

What makes CT different from other modalities is it’s a modality that can be used to image so many different pathologies. The scanning protocol for so many pathologies require different
variations in contrast use, and at times an experienced CT technologist needs the aid of a radiologist to figure it out. In addition, the contraindication of contrast media is another complexity that the laymen clerical personnel find hard to understand.

Looking for a Solution

Most of the clerical staff hired have a high school education, some of them with previous medical office work, but for the most part, they possess no prior experience in diagnostic imaging. Most pick up the method of entering orders through referencing the protocol book, and the same can be said for scheduling examinations. The front desk ordering duties are learned by repetition and memorization of the protocol given by the technologist – for example, the department protocol that a
trauma knee requires four views and a non-trauma knee requires only two views.

Scheduling was handled in the same manner, but with scheduling binders that provide protocols for different pathologies, such as how to enter them, whether contrast is to be used, what type of contrast, and the contraindications. The changes I made in the binders covered everything I could think of and had an immediate impact on all modalities other than CT. I didn’t have to reschedule any patients for allergies, contrast, and other contraindications because the guidelines given worked great, but the exams were still entered wrong.

I came to a realization that the problem could not be solved with a protocol book change and that the staff was fully capable of understanding if they could have more than a protocol to go by, and thereby understand the reasons why the protocol is set up that way.

The hospital started a program that offered classes for workers that wanted advancement in their education and knowledge of their field. I encouraged the staff to participate in two classes that related to our practice – medical terminology and anatomy. The newfound knowledge has led to the staff wanting to understand the reasons why we choose certain perpetration for our exams. As their knowledge grew, so did the efficiency and accuracy of the orders entered and exams scheduled. Although it wasn’t the perfect solution because it required a lot of time and effort by the technologist to answer these questions, sometimes repeatedly, the improvement was worth it.

I can’t say that this approach will work with every radiology department and every hospital. It depends on the institution’s resources, but educating the clerical staff seems to be an approach that can lead to a more efficient department workflow as a whole. Radiology departments are much more than just the technologists and radiologists; the clerical staff is a huge part of the department, and they should not be ignored.

There are a lot of programs that continually educate technologists and staff about patient care, HIPAA, JCAHO requirements, and other hospital requirements. These competency requirements are taught through a hospital online teaching tool. I believe that the use of these online education services can be used in radiology to educate the clerical staff. These programs need to only give a general education about radiology and teach the staff in segments about different procedures and modalities used to diagnose pathologies in radiology.

The teaching program can work like any other hospital competency program but be specific to radiology. The key is to find a means of educating the clerical staff so they are a part of what we do and not just another administration position.

Education will not only lead to a reduction in the mistakes made but will also improve the quality of work for the staff involved. The entire staff will work better together and find pride in what they do when the department can work as a whole by uniting the clinical and clerical. By involving the clerical staff and educating them about the profession, we can reach our potential and provide the very best patient care and experience.

— Arturo Hiyagon works for the California Pacific Medical Center in San Francisco and is pursuing a career in radiologic technology. Direct questions and comments to editorial@rt-image.com.