Making the change to structured reporting in the cath lab is not easy, simple, fast or fun. But it can be done, according to interventional cardiologists who have taken the challenge and succeeded.
There are no ready-to-use software programs, training is only one small step in the process and getting doctors to check boxes when they have spent their careers dictating prose doesn’t just happen overnight.
A “fundamental change in the dynamics of the workflow in the cath lab” is what’s needed to successfully transition to structured cath lab reporting, according to H. Vernon Anderson, MD, co-author of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions 2014 Health Policy Statement on Structured Reporting for the Cardiac Catheterization Laboratory (J Am Coll Cardiol 2014;63:2591-2623).
“You are asking people to redesign workflow processes that have been in place for decades. That requires fundamental organizational change that is difficult to achieve,” says Anderson, a professor of cardiovascular medicine at The University of Texas Health Science Center at Houston.
Even though the process requires substantial commitment of time and resources, several strategies have proven successful for cath labs that have made the shift.
Find your motivation
Identifying a motivator that physicians, staff and hospital administrators understand and support is a first step, says Timothy C. Ball, MD, PhD, medical director of the cath lab at Carilion Roanoke Memorial Hospital in Virginia.
Ball and his team got motivated to adopt structured reporting in part because they wanted to be known as a cath lab of excellence. To earn that distinction, they set the goal of full accreditation from Accreditation for Cardiovascular Excellence (ACE).
“Having that motivational driver was key because [ACE] gave us a template to follow. It was very helpful as we moved forward,” says Ball, whose lab received accreditation in 2013.
Other cath lab teams have gotten motivated by the increasing
demand for data on compliance with practice guidelines and for quality metrics reporting.
“Achieving structured reporting will ultimately bring down costs, will save resources, and will produce a better working environment. Your systems will run more smoothly … and you can argue that a smoother running hospital will be better,” he says.
Choose your workflow model
No workflow model works for every cath lab, which is why Anderson advises hospital administrators and cath lab managers to start by studying the system diagrams in the Health Policy Statement and talking about workflow changes that make sense for their institution. “The hospital has to sit down and decide what applies to them,” Anderson says.
“It takes some of the documentation burden off the physician if they can create the right workflow, and [the change] can engage other members of the cath lab team in that process,” says Bonnie H. Weiner, MD, MSEC, MBA, chief medical officer at ACE and an author of the Health Policy Statement.
For example, Weiner says many physicians prefer to dictate patient and procedure information in prose format. So, for some facilities, workflow change might mean hiring medical scribes who enter data for physicians.
At Duke University School of Medicine, the cath lab transitioned to structured reporting by expanding staff roles so that they now contribute to procedure reports that had traditionally been the domain of physicians. Trained staff enter details on computers as physicians work and talk throughout procedures.
Duke physicians now spend less time generating and correcting reports and more time with patients, according to James Tcheng, MD, vice-chair of the Health Policy Statement, professor of community and family medicine (informatics) at Duke and director of both Performance Improvement for the Duke Heart Center and of the Duke Cardiovascular Data Bank.
“Transcription errors that physicians would make or just wouldn’t remember when they did the reports a few days later and when they were dictating a note have all been removed,” Tcheng says.
Take small steps to build consensus
Making change in small, incremental steps helps build consensus. Staff at Carilion were encouraged to get involved in the process, understand the goals, attend training and give input so that the changes were not “something thrown on them,” Ball says. “If they wanted to have input they could have all the input they wanted.”