Assessing Radiology Workflow Interruptions in the Era of Electronic Communications: A Human Factors Engineering Approach.

RATIONALE AND OBJECTIVES

To identify the frequency and nature of messages, communication topics, and the contextual factors that lead to communication and potentially detrimental workflow interruptions via an electronic communication platform (ECP; WebEx) in a multi-subspecialty academic radiology practice.

MATERIALS AND METHODS

In this retrospective sequential mixed methods quality improvement study, we performed quantitative analysis of WebEx messages from July 2022 to July 2023. Message frequency was determined across three daily timeframes corresponding to radiology coverage shifts. Structural topic modeling (STM) was used to identify common communication topics in WebEx. Semi-structured interviews with technologists and residents were performed to determine the context behind these topics. The Systems Engineering Initiative for Patient Safety (SEIPS) framework was used to analyze contextual factors influencing communication.

RESULTS

A total of 39,448 WebEx messages were analyzed. Timeframes with the highest frequency of messages were 7:30 AM-4:30 PM (4.2 messages/hr [SD 3.4]) and 4:30 PM-9:00 PM (4.2 messages/hr [SD 3.5]). Protocol-related questions were the most frequent topic (13%), followed by clarifications regarding allergy and contrast (7%), and exam appropriateness. 24 contextual factors influencing communication via WebEx were identified, including organizational factors (e.g., psychological safety, perceived workload), task characteristics (e.g., protocol complexity, time pressure), person characteristics (e.g., experience of technologists and residents), and physical environment (e.g., noise).

CONCLUSION

High electronic message volumes and unnecessary interruptions via low friction ECPs and ad hoc messaging negatively impact radiology workflows and could affect patient safety. Organizational communication protocols could reduce workflow disruption for radiologists and technologists. Optimizing ECP communication protocols by time of day and message type could also improve workflow efficiency, ultimately enhancing patient safety and productivity. Future implementation of targeted interventions using these data is warranted.

SUMMARY

Human factors engineering strategies show that interruptions from high volume electronic communications that potentially have a negative impact on workflow, workload, and patient safety are contextual in nature. This study identifies targets for improved electronic communications in a busy academic radiology practice.