ECRI Institute commends Banner Health (Chandler, AZ) for its project establishing an in-house medical physics program. Banner described the project in its submission for ECRI Institute's 13th Health Devices Achievement Award competition. The in-house arrangement allows for a more efficient use of resources, facilitates protocol standardization for CT and other imaging modalities, reduces service delivery time, and improves the overall coordination of equipment management.

The Health Devices Achievement Award recognizes outstanding initiatives undertaken by member healthcare institutions to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology. For details about the winning submission and other finalists, see The Health Devices Achievement Award: Recognizing Exceptional Health Technology Management.

ECRI Institute congratulates Priyanka Upendra, Perry Kirwan, Uday Rao, and the rest of the Banner Health team.
 

The Challenge

To transition from an outsourced medical physics program to an in-house program, with the goal of achieving imaging equipment management efficiencies and reducing expenditures, ultimately benefiting patient care.
 

The Context

For years, Banner Health used a contracted medical physics service, as is common practice. Medical physicists affiliated with the service were responsible for activities such as:

1. Radiation safety—that is, protecting patients and others from potentially harmful radiation used in the diagnosis and treatment of disease

2. Quality assurance—such as establishing radiation dosimetry protocols

3. Regulatory compliance

4. Working with internal teams on facility design and construction to ensure the safety of radiologic imaging

This arrangement provided Banner Health with a professional level of service, but it limited the extent to which the program's activities could be coordinated with the organization's core health technology management (HTM) function. Further, the relationship with the outside service was, by definition, transactional, rather than a true a partnership among stakeholders.

As a large health system, Banner Health had the requisite resources to bring the medical physics function in-house. The organization believed that such a move would:

1. Streamline medical physics operations, allowing for better coordination with existing HTM staff

2. Streamline compliance efforts with applicable federal and state regulations

3. Reduce costs through better use of internal resources
 

The Process

Banner established an in-house medical physics team consisting of four medical physicists and four quality control technologists. The change required realigning staff, defining policies and processes, and developing operating procedures to facilitate collaboration, cooperation, and coordination between HTM staff and the medical physicists.

The in-house medical physics team works closely with the HTM department's imaging service engineers, as well as with Banner's Department of Radiology. The team's functions include:

1. Performing quality checks and performance evaluations

2. Standardizing protocols for CT and other imaging modalities

3. Conducting dose monitoring

4. Monitoring radiation exposure for healthcare workers and patients

5. Troubleshooting system protocols

6. Addressing dose concerns with cardiologists
 

The Results

According to Banner, establishing an in-house medical physics program has yielded benefits in the following categories:

1. Technology management and financial benefits—The change has streamlined operations for both the HTM and radiology departments, allowing for better use of internal resources and creating opportunities for savings, either by reducing costs or by avoiding expenditures. For example:

a) With an in-house program, all staff who support medical and imaging equipment now use the same asset management software. This simplifies the documentation and reconciliation processes. As soon as a report is completed, the physicist can upload the report into the system.

b) If a problem is identified, the physicist can work with the engineer to identify, initiate, and evaluate the effectiveness of remediating steps without delay. As a result, equipment can be cleared for patient care more quickly. Banner cites the example of a mammography unit that fails its medical physics checks because of an issue with the radiation dose or image quality. In such cases, the machine cannot be used on patients until the issue has been resolved and the physicist has signed off on the device. When a contracted service was used, Banner's radiology department sometimes had to wait for the physicist to arrive on-site to evaluate the device and clear it for patient care. Such occurrences could result in patient diversion, increased service and consultant costs, and noncompliance with (or additional effort to comply with) regulatory and organizational quality metrics and documentation practices.

2. Clinician benefits—The change has enabled clinicians to spend less time coordinating equipment support services (e.g., calling vendors to schedule support visits), allowing them to spend more time caring for their patients.

3. Patient care and staff safety benefits—The change has allowed for more efficient use of medical physics resources to improve clinical care operations and radiation safety. Activities include:

a) Protocol standardization and dose monitoring on an enterprise-wide level—The team runs monthly, enterprise-wide reports that are evaluated by a group comprising physicists, radiologists, HTM staff, and the radiation safety officer.

b) The development of dosage charts and distribution plans

c) Ensuring shielding meets safety requirements during facility design and construction

d) Equipment performance-testing and commissioning

e) Hazard analysis and risk assessment
 

Key Takeaways

The team at Banner Health identified three key developments associated with its transition to an in-house program:

1. The close partnership and collaboration among clinicians, radiologists, imaging engineers, and clinical engineers has helped reduce service delivery times, prevent diversion of patients to other facilities, and minimize avoidable support costs.

2. The use of a single asset management system by all teams has allowed for seamless reconciliation of the service documentation used for the routine evaluation of quality metrics, as well as for federal and state inspections.

3. The arrangement has facilitated reconciling system reports and evaluating radiation dose on an enterprise level.

One challenge going forward, as Banner notes, will be to maintain the team and retain physicists over the long term, as medical physicists are in short supply. To address this challenge, Banner is considering establishing a clinical residency program, thereby contributing to the profession by graduating medical physicists who are qualified to perform the role.