The development of a radiology service system to reduce repeated imaging in referred patients from community hospitals in Yasothon Province

Abstract

Purposes : This study aimed to investigate the current situational problems, and to develop, implement, and evaluate a radiological service system designed to reduce repeat radiography in patients referred from community hospitals to Yasothon Hospital.

Study design: A Research and Development (R&D) design was employed.

Materials and Methods: The study involved two primary groups: 1) 25 healthcare providers, including physicians (OPD/ER/IPD), radiological technologists, nurses, and community hospital radiological staff; and 2) a recipient group consisting of 50 patients and referred cases. Data were collected through questionnaires, semi-structured interviews, and repeat radiography record forms. Quantitative data were analyzed using frequency, percentage, mean, and standard deviation, while qualitative data underwent content analysis.

Main finding: 1)The initial assessment revealed that repeat radiography was primarily caused by systemic failures, specifically the lack of seamless digital communication channels, inadequate computer infrastructure, and inconsistent radiological quality standards across the network. 2) The developed "5C Model" for radiological services consists of: Collection of Data (C1) for systematic situational analysis; Connectivity (C2) to integrate digital information systems; Communication (C3) through a 5-point strategic protocol; Clinical Governance (C4) to monitor physician ordering behavior (particularly interns) via medical organizations; and Continuous Evaluation (C5) for ongoing process improvement and the establishment of Standard Operating Procedures (SOPs), and 3) The implementation success demonstrated: (1) Quality and Efficiency: The repeat radiography rate significantly decreased from 90% to 20%. Concurrently, radiological image quality increased from 84% to 93%, enabling immediate clinical interpretation. (2) Capacity Building: Personnel skill competency reached 100%, leading to a reduction in patient waiting times from 40 to 10 minutes (a 3-fold improvement). Incident complaints decreased from 6 to 1, while staff satisfaction remained high at 85%. (3) Economic Value and Patient Safety: The annual average unit cost drastically declined from 2,611,455 THB to 580,335 THB. Furthermore, the system effectively minimized patients' unnecessary radiation exposure and reduced the overall national healthcare budgetary burden.

Conclusion and recommendations: These research outcomes contributed to a significant diminution in re-exposure rates and an augmentation of radiographic quality. Accordingly, stakeholders should integrate these findings into their quality development protocols.