The current sonographer shortage has been well documented. One of its primary impacts has been the fast-track of new ultrasound graduates into clinical roles. Due to variations in the scope of training programs and evolving educational requirements, the preparedness and experience levels of these graduates can vary significantly. Some ultrasound technologists are gaining more practical experience on the job than in the classroom.
RadNet, the largest provider of outpatient diagnostic imaging services in the United States, is meeting this reality head-on. Over the past year it has adopted virtual collaboration, utilizing tele-ultrasound, as a core component of ultrasound workflow in its western region, which is home to approximately 400 technologists.
Tele-ultrasound works on an ultrasound system to transmit a secure, live feed of images as they are being captured during an exam. Two-way video or text chat with a lead sonographer or radiologists allows new ultrasound techs to be telementored during cases, regardless of the point of care, to ensure exam quality and a high-caliber patient experience, no matter the experience level of the tech who is capturing images.
The rollout and adoption of telementored ultrasound at RadNet was led by Ashley Repp, Director of Ultrasound for Western Operations. “Once virtual collaboration was brought to the table, I knew it was going to be a gamechanger,” she said.
What does remote telementored ultrasound entail at RadNet? Picture this: select ultrasound machines in its imaging centers are now fitted with tablets that turn them into dynamic collaboration hubs. A few taps and swipes allow a technologist to see which peers and radiologists are online and available. They can quickly send chat messages, initiate real-time video consults, and even securely share the live feed of an exam. Colleagues can monitor exams and provide real-time guidance on probe placement, image quality and completeness, and make live annotations to illustrate best practices. The system is available for technologists to use at their discretion1; this could be every exam, or simply when they have a question or want additional support.
Prior to the implementation of its current virtual collaboration platform RadNet relied on common communication channels such as FaceTime and Facebook Messenger video calls to provide ultrasound techs with real-time guidance. Though easy to use, this required all collaborators to have access to the same apps on their personal devices. RadNet explored other ultrasound-specific solutions but found them to be cumbersome, or lacking essential features.
Core telementored ultrasound workflows at RadNet
1.) Reducing infant hip dysplasia exam time
Screening for developmental dysplasia of the hip (DDH) is an inherently complex and time-consuming exam that relies heavily on the expertise of ultrasound technologists. To obtain the necessary images for assessing hip joint structure and detecting abnormalities, technologists must carefully position and stabilize infants while angling the probe correctly to avoid false positives or negatives for dysplasia. RadNet had to allot at least 45 minutes for these exams. This included families waiting as long as 20 minutes for a radiologist to approve exam quality or request a rescan due to patient movement during the initial exam.
According to Ashley, RadNet reduced its average DDH exam time from around 40 minutes to about 20 minutes with fewer repeat scans through two key workflow updates.2 First, it now assigns two technologists to these exams: one to position and stabilize the child, and another to capture images. Second, technologists are encouraged to remotely engage a lead sonographer or radiologist in real-time via virtual collaboration so an expert can observe how the patient is positioned, where the probe is on the baby, and what images are being captured. This collaborative approach reduces wait times for families and assures parents that a team of experts is involved in their baby’s care. Teamwork is improving the quality and efficiency of individual DDH exams while also providing technologists with valuable practical training.
2.) Reducing patient wait time through real-time OB consultations
RadNet utilizes its virtual collaboration platform to involve its fetal imaging radiologists during second and third trimester ultrasounds. Technologists can invite a radiologist to provide guidance on capturing accurate live cine loops and improving heart views. In some instances, the radiologist will directly communicate with the patient through the collaboration screen to explain what they are discussing with the ultrasound technologist. “Patients love being able to connect with the radiologist,” Ashley explained. “This interaction gives them a feeling of comfort. They know there is a team caring for their little one.”
RadNet requires that these images be checked for completeness by a lead sonographer or radiologists before they can be sent to the PACS. Before it implemented virtual collaboration, this workflow step could take 25 minutes – nearly one-third of the allotted exam time. This created a significant and potentially nerve-wracking waiting period for expectant mothers. With remote telemonitored ultrasound, RadNet has been able to cut this wait time and reduce the need to reimage because a radiologist observes image acquisition during the exam.
What do RadNet’s radiologists think about this added workflow step? “There was no convincing needed… they want to try anything that is going to make our techs better, or feel more comfortable and confident,” explained Ashley.
3.) Added support when navigating the intricacies of hernia exams
Remote ultrasound collaboration has been a resource to technologists assessing potentially herniated tissue and its contents. Performing a hernia ultrasound requires expertise in musculoskeletal and abdominal ultrasound—it takes proficiency and adaptability to accurately distinguish between hernia contents and other structures. Due to the high potential for patient recalls in this exam type, RadNet mandates that only approved technologists sign off on these images. Before gaining this privilege, technologists benefit from real-time guidance by experienced sonographers or radiologists. Their expert oversight helps them execute precise maneuvers and optimize probe positioning.
4.) Collaborating on rare and complex cases
Remote digital collaboration can enable a team of RadNet experts to discuss a rare or complex case. Up to five RadNet users can virtually huddle on the same image in real-time. The platform allows each collaborator to make annotations that are visible to the team. This functionality was recently used to develop a plan for a patient who had several failed lower extremity arterial grafts and stents—the patient did not know their full surgical history, so the platform helped the team collaboratively map out prior interventions.
5.) Empowering technologists in appendicitis assessments
In suspected cases of appendicitis, it is common for newer technologists to reach out to a colleague via the collaboration platform. This allows a more seasoned peer to observe the exam and make sure the technologist captures the necessary images. This is another example of improving the quality of an individual exam while simultaneously helping a less experienced tech gain confidence.
Tips for collaboration rollout
According to Ashley, strategic placement of collaboration tools is important. When RadNet was first implementing the collaboration tools, she carefully selected locations with a mix of brand-new sonographers and those with only one staff sonographer. Now she adjusts placement as needed to align with changes in technologist experience and confidence levels due to hiring and attrition. She also suggests monitoring collaboration analytics and reaching out to technologists when there are utilization changes.
RadNet’s ultrasound technologists have enthusiastically embraced virtual collaboration. They appreciate the ability to seek input from colleagues for a 'second set of eyes' whenever needed. This feature is particularly valuable considering research indicating that new or less-experienced technologists often feel isolated in their work, and that nearly 80% of sonographers think real-time virtual support from peers or physicians would enhance their job performance.3 RadNet has positioned digital collaboration as a means for technologists to get a boost of confidence.
The impact of remote ultrasound collaboration
At RadNet, virtual collaboration can reduce exam time across a variety of ultrasound types, which allows for more efficient resource utilization. Sonographers—even those who are newly trained operators— are empowered to capture high quality images from the outset which streamlines radiologists’ workflow and prevents patients from being inconvenienced by unnecessary callbacks. It also provides the intangible benefit of inspiring clinical confidence throughout its sonography staff.
Virtual collaboration during ultrasound exams also allows RadNet to demonstrate to patients that they are under the care of a subspecialized team of experts. This emphasis on expertise can influence patient satisfaction and distinguish RadNet's services from those offered by other providers.
“We are able to make sure that we are giving our highest quality and our highest standards to our patients,” said Ashley.
About Digital Expert Connect
RadNet’s telementored ultrasound workflows are powered by Digital Expert Connect. It connects ultrasound console operators and remote experts within a health system for live training, consulting and guidance. Learn more about enabling your ultrasound staff to virtually collaborate anytime, anywhere. from anywhere.
REFERENCES:
1. Digital Expert Connect is not for diagnostic use
2. Optimizing the Radiology Workflow: https://www.youtube.com/watch?v=F602_gG7UyA
3. Based on GEHC Survey with 150 U.S. Sonographers: https://gehealthcare.showpad.com/share/OjWhTIHX4YYi4nGK7voP4
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