Arnon Makori MD, Presenter: Medical Advisory Board, Carestream Health, Inc

Roman Tsirkin BA, Abstract Co-Author: Nothing to Disclose

Ilan Shelef MD, Abstract Co-Author: Nothing to Disclose

Escalating medical costs and ever-increasing imaging workloads require the modern day radiology department to implement a Pre-Approval Process (PAP). The principal goal of PAP is to prevent unnecessary requests for imaging studies, a process in which the radiologist plays an important role as 'gate keeper'. The major advantages of PAP are the efficient use of imaging resources, reducing workload, curtailing expenses and improving patient care. Our medical center is a1,100 beds academic tertiary care hospital. Our radiology department performs more than 300,000 studies a year. PAP was implemented in our radiology department in 2013. To understand its full impact we evaluated its overall performance metrics, and how they affect the departmental workflow.

Our PAP workflow is fully integrated into our state-of-the-art RIS. Radiology Orders (RO) are computerized and are sent using an ordered entry module. Our departmental policy mandates PAP for RO requesting predefined studies: US, CT and MR. RO are manually added to a special PAP worklist, reviewed by our radiologist and are either Approved, Denied or Suspended pending further information.  Our evaluation is Institutional Review Board exempt. Using our RIS database we collected and analyzed the RO that required Pre-Approval during 2013 for inpatients and the Emergency Department (ED). The ratio of Pre-Approved Radiology Orders (PARO) was calculated as the number of PARO divided by the number studies. Similarly, Denied Radiology Orders ratio (DRO) was calculated.           

During 2013 the total number of Pre-Approved Radiology Orders (PARO) was 21,409. The total number of studies (US, CT and MR for inpatients and ED) was 40,622. Overall PARO ratio was 56%. Overall Denied ratio was 2%.  MR was the modality with the highest PARO ratio of 116% and a Denied ratio of 10%.  US had a PARO of 91% and a Denied ratio of 4%.  CT had the lowest PARO and Denied ratios of 43% and 2% respectively.   

The Pre-Approval Process is successfully integrated into our departmental workflow and plays an important role in the efficient management of our imaging resources.

Pre-Approval Process (PAP) will become a key task and an integral part of the modern radiology department. Radiology and Healthcare policy makers should be aware of the advantages of PAP and understand its potential for improving the efficiency of the departmental workflow. 

Makori, A, Tsirkin, R, Shelef, I, Pre-Approval Process for Radiology Services in a Tertiary Medical Center.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045607.html