Implementing PACS 2/2
Potential problems with PACS: A case study
Let's look at a mid-sized District general hospital, which had PACS supplied as part of a deal under a PFI contract. The new PACS system was implemented in only a few months, with a huge training programme to train all staff that would be using it, and it was done on time and on budget (!) Computer workstations were installed on every ward, in outpatient clinics and in consultants' offices before the system went live. The plan was to eliminate the need to print hard films as soon as the system went live, and using the cost saving in chemicals, running costs of the X-ray printers and archiving costs to help offset the considerable cost of the PACS system.
As soon as the system went live, the orthopaedic surgeons highlighted a key problem. There was no monitor or computer in the operating theatres.
This meant that X-ray images could not be accessed during operations; and since this is an essential part of most orthopaedic operations (for alignment, sizing and planning), the only way to carry on with both routine and emergency surgery was to print hard copies of X-rays for every patient for operation -- defeating the point of PACS in the first place. This became routine practice among the radiographers working the day shift, as they dealt with the bulk of the workload and dealt with all the patients coming for planned operations.
Late one night, a patient was admitted with a very unstable fracture. When the patient had X-rays taken, night shift staff were unaware of the protocol, so no hard films were printed. The X-rays were reviewed by a senior surgeon, and the patient prepared for immediate surgery. The team made a request for the hard copies of the X-rays which had been viewed on the PACS, only to find the printer had broken down.
As there was no way to access the images in the theatre, the operation was delayed until a service engineer could be called in to fix the machine; and as it was late at night, it took several hours. The patient risked losing a limb because of this unnecessary delay; but thankfully, the operation was successful.
Although in this case the patient outcome was not badly affected, it did highlight a major flaw in the implementation. Just think of the implications and, indeed, the headlines. if this (young) patient had lost a limb. This is despite a 'successful' implementation with adequate training. After consultation with management, radiology and the surgeons, the Trust has now installed mobile workstations with PACS access in all the operating theatres.
Some tips
So how can you ensure a smooth implementation in your Trust? Here are a few tips:
- Plan the changeover early, with consultation from all the major user groups. There needs to be an identifiable lead with whom people can raise any issues.
- Involving clinicians is essential for success, as they will be using the system from day-to-day. Find out when, where and how they access radiological images.
- Don't forget that you will need a display wherever you have a lightbox now. These could include clinics, wards, meeting rooms, operating theatres, lecture theatres.
- Make sure you get the right equipment for each area. A display that is great for watching videos of endoscopy would be worthless for viewing mammograms.
- Training is one of the key factors to success, and it needs to happen before, during and after implementation.