WinScribe improves report turnaround time at Royal United Hospital

The Royal United Hospital Bath NHS Trust provides acute treatment and care for a catchment population of around 500,000 people in Bath, and the surrounding towns and villages in North East Somerset and Western Wiltshire. The Trust occupies a 52-acre site about 1½ miles from Bath city centre and became a National Health Service Trust in 1992.

The Challenge
Both the Histopathology and Radiology departments work under intense pressure on a day-to-day basis, running to tight deadlines in stressful situations. Due to the nature of the work, it is crucial that all reporting is undertaken as efficiently and accurately as possible; cancer reports for example, need to be turned around in 24 hours. Medical staff dictate their findings and this information is then transcribed by a team of secretaries.

In early 2003, with increasing concerns about tape loss and risks of broken confidentiality, an investment into digital dictation software was considered. This would not only improve the process of transferring dictated information to written format, but also eliminate the high analogue equipment and maintenance costs.

The hospital also needed to be operating 24/7 to increase discharge efficiency and reduce bed blocking at weekends and a digital dictation system would allow for such flexible working practices.

The Solution
After considerable research, WinScribe became the chosen supplier. Lucinda Payne Johns, Laboratory Manager commented. “The WinScribe Software seemed simple to use and certainly looked as if it would save the department a considerable amount of time and money. Our main concern is providing the best possible service to our patients whether directly or indirectly. Being able to transcribe quickly and efficiently means that we can provide our results in a significantly reduced time frame.”

In April 2003, WinScribe was rolled out to the Histopathology and Radiology departments. “We were surprised at how easy the installation process proved to be. A technical team visited the hospital and installed the software onto our system in a matter of hours,” said Lucinda.

Staff dictate using any touch tone telephone or microphones with barcode scanners attached and dictations are simply uploaded into WinScribe and routed to typists.

Results
Three years later, in 2006, the hospital was reapproached to provide feedback about the results of the Winscribe installation.

Improved document turnaround time, increased staff productivity
With an increase in the volume of work from 200,000 reports to 220,000 per annum and substantial backlog reductions, it is estimated that WinScribe has contributed to a 10% increase in productivity. There has been an estimated 10-15% increase in reporting efficiency and 5–10% increase in secretarial efficiency due to clarity of dictation and fewer interruptions. Turnaround targets are being met as well as essential 24/7 working requirements.

No more tapes, increased efficiency
With WinScribe, work is no longer lost and jobs are no longer accidentally being deleted. The problem of secretaries being unable to recognise voices and identify jobs has also been eliminated with WinScribe’s job ID feature and the recording quality is consistently high. “WinScribe is saving us so much time.With the old system we wasted time re-recording reports because of lost tapes etc. That meant a day’s extra work!” commented Craig Forster, Radiology Department.

From a safety point of view, the department also needed a hands free dictation system. Analogue tapes had to be transported from the ‘cut up’ area with some health risks by handling request cards from the dissection area.

There is now a facility to scan the I.D. number, which is a major benefit as there is now a constant ‘drip-feed’ of dictation in near real time and importantly, no risk of infection.

Individual specimen/identity numbers could also be incorrectly transcribed as a result of incorrect transposition by author or incorrect transcription of patient data. WinScribe eliminates this risk by providing automatic audit and the barcode scanner system ensures that transposition and transcription will be consistent and correct.

By using the barcode scanners, consultant time is also saved as entering information is no longer manual. More importantly, the system ensures that the right patient details are entered linking the dictation to the right patient. Integrations with the hospital’s other systems such as PACS, EPR and RIS means that the system can automatically pull up the correct patient details for inclusion in the report.

Improved control, reduced stress
Since installing WinScribe, working relations have also improved between authors and secretaries. The difficulty of identifying and accessing priority reports as well as backlogs, lost tapes and incorrectly transcribed reports caused friction, frustrated phone calls and tears. Not only this, but the slowed down productivity, resulted in overtime payments. Secretaries felt that they were constantly firefighting outstanding work with tapes stacked high as a constant reminder.

With visibility of the jobs on the WinScribe server, there is also now no need for secretarial supervision to manage workload; secretaries are ‘Managers of their own work.’

Radiologists and pathologists can also check progress of their reports without interrupting the secretary and the Laboratory Manager can identify exactly ‘where each job is’, ‘when it was dictated’, ‘when transcription started’, ‘when transcription was or should be completed.’

“The benefits of using WinScribe’s software have been significant. The software is very easy to use, none of our staff have had any issues and they have all noticed how much time they have saved on a day-to-day basis. From a management perspective, the software enables senior staff to trouble shoot any problems themselves, rather than needing to get technical assistance from WinScribe,” explains Lucinda Payne-Johns. “In the past year, we have probably had to contact them only a couple of times, as generally either myself or a colleague can access the ‘management system’ to rectify any problem quickly and efficiently. For us, this is a huge benefit, as we rely so heavily on the software and cannot afford to wait for engineers to visit the hospital.”

Improved service levels
With increasing numbers of biopsies in urgent cancer waits such as prostate biopsies, larger amounts of ‘urgents’ are coped with and 24 hour targets are met. The NHS also has a 2 week cancer patient target (time from G.P. referral to diagnosis). With WinScribe the report is available faster and on screen at outpatient consultation resulting in immediate diagnosis being given person to person. With the rapid turnaround of biopsies the patients can be booked in for outpatient slots earlier enabling the 2 week cancer diagnosis to be met.

Furthermore, with a contributing factor of faster report turnaround, the National Institute of Clinical Excellence’s (NICE) target of 48 hours from initial diagnosis to enacting treatment (stroke using CT Scans) is now being met. The level of reporting against number of examinations conducted has risen from 40% to 50%.

Cost savings
An immediate return on investment can be attributed to simply replacing the old analogue system with digital technology. Aside from this, despite an increased workload, there has been no need to employ more full/part time secretaries or work and pay for overtime.

Future plans
Next steps will include further integrations with information systems such as the pathology department’s information system ULTRA.

In summary, the benefits to the Radiology and Histopathology departments have been so significant that it is now anticipated that the solution will be rolled-out as an enterprise-wide solution to the rest of the hospital.

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