Contemporary nuclear medicine is a rapidly evolving healthcare discipline. It is a highly specialized division of radiology that utilizes functional imaging to characterize and track cellular changes of abnormal lesions. Understanding these structures at the molecular level enables more informed diagnoses and effective tracking of disease progression over time.
In a webinar hosted by GE Healthcare, Philippe Declerck, MD, Head of the Department of Nuclear Medicine at Clinique Saint-Jean in Brussels, Belgium, shares his perspective on how he has elevated his own nuclear medicine department into an efficient first-line service within a hospital system and offers suggestions on how others can do the same.
“The commitments of our department,” said Declerck, “are to provide fast and accurate responses to the diagnostic questions, to fully integrate molecular imaging in the clinical proceedings, to achieve multidisciplinary collaboration, and ultimately, to offer the best care to our patients.”
According to Declerck, there are four key areas that need attention to capitalize on molecular imaging’s unique capabilities and elevate a nuclear medicine department to a highly visible and integrated part of the patients’ care team. The four key areas consist of: 1) staff and patient focus, 2) hospital and nuclear medicine department infrastructure, 3) human factors, and 4) workflow management.
Starting with the patient, people are the most important part of the nuclear medicine department
First and foremost, Declerck says patients come first. “The most important people in my department are my patients. They have rights and expectations, and they deserve to get the best in patient-centered care. It’s important to meet with patients and explain what you are going to do and what you’re expecting to see from imaging tests. Our powerful modalities give us the opportunity to scan the whole body and see the entirety of our patient and not only the sick organ.”
This holistic approach gives the nuclear medicine physician the opportunity to provide diagnostic answers to the prescribing physician. Collaboration among medical teams has proven to be effective in impacting patient outcomes[1]. Coordinated communication and image quality are extremely important in establishing confidence in a nuclear medicine department, according to Declerck.
Patient care in the nuclear medicine department is undertaken by technologists and physicists, who are responsible for image acquisition and post-processing. They need to be patient oriented with a sense of responsibility for quality control and working within the guidelines of the complex procedures and radioactive material required for molecular imaging. Support from administrative staff in Declerck’s department does not go unnoticed. They are recognized for their organization of the many detailed tasks associated with the department’s daily work including the agenda, workflow management, patient administration and billing.
People outside of the department, namely the hospital administration, also play an important role, explains Declerck. “They must have confidence in nuclear medicine and the additional value it brings to the hospital. It’s important for this part of the medical community to know and to trust us because they are responsible for the hospital’s infrastructure and its investments. They can promote nuclear medicine within and outside of the hospital and they help enable the integration of our department within the hospital by encouraging multidisciplinary collaboration. They also oversee our activities via SAP systems, applications and other IT support services.”
Building a lasting nuclear medicine department infrastructure
Designing a workplace infrastructure to support the complex operational requirements and technology needs for an efficient nuclear medicine department is key, says Declerck. As his facility expanded its investment in molecular imaging with a new positron emission tomography/computed tomography (PET/CT) scanner and digital single-photon emission computerized tomography/computed tomography (SPECT/CT) scanner, Declerck took the opportunity to optimize the layout of the department.
“In 2016, our hospital invested 2.5 million euros into our department. We not only installed new SPECT/CT and PET/CT systems, but we also took the opportunity to rethink the whole layout of the department,” said Declerck.
Declerck and his team created efficient spaces designed for patient flow, staff flow, meeting rooms for collaboration, as well as dedicated spaces for the hot lab and cold resources needed for nuclear medicine imaging exams. Bringing in new technology and designing new spaces, however, was not the only part of the investment. Assuring the ongoing quality of newly installed systems along with older units by committing to long-term maintenance planning is equally important, Declerck says.
“Although it can be expensive, it’s worth investing in new technologies and the maintenance and upkeep that will keep them running into the future to support our efforts in providing great patient care.”
A solid financial analysis, including the department’s status and outlook, prior to any investment are important parts of supporting the department infrastructure. When Declerck’s facility invested in the new SPECT/CT and PET/CT systems, that investment also brought with it a certain expectation in terms of potential projected return on investment (ROI). Estimating increasing patient volumes over time helped to determine that number.
At the time of the investment, Declerck’s financial team suggested using a three percent annual increase in patient volume to determine ROI in a best-case scenario. Declerck did not agree, and insisted on using only half of that number, accounting for maintenance contract expenses, personnel, radiopharmaceuticals, and even administering free scans for those patients who could not afford their scan.
“Luckily, we did initially experience an increase in patient volume of three percent, however, the coronavirus hit us hard in early 2020, with a 60 percent decrease in activity throughout the department. Our clinicians were needed to assist with COVID patients, and any examinations that were not urgent were postponed. But because we ran the ROI simulation with the lower number, our investment plan still holds. So, it is really important to understand your financials in scenarios where something happens like this.”
Optimizing human factors and workflow with collaboration in nuclear medicine
In contemporary nuclear medicine, the use of more complex and equally individualized molecular imaging can be critical in optimizing care. Putting tracers into daily clinical practice requires knowledge from specialists who are up to date on the latest techniques. It is also imperative to implement an efficient, standardized workflow to support them, which allows the department to maintain quality control measures and accreditation.
Declerck explains that considering human factors in the workflow is critical to its success. By considering the human factors within a workflow, it allows the design to address the multiple connections between people, the technology or imaging system they use, and their environment. According to Declerck, the nuclear medicine workplace needs to be efficient, but also harmonious.
Often, addressing time, energy and cost savings can be challenging when designing the workflow to manage the interrelated factors. For example, if additional patients are added to the schedule, Declerck’s support staff needs to push those changes to the master schedule and on Declerck’s schedule, as he works at two hospitals. The staff also needs to inform the hot lab preparing the doses and the technologist. This can be time consuming and can cause errors, Declerck says, but through skilled coordination the department can be cost-efficient and reliable, while also being a satisfying place for employees to work so they can continue to offer the best patient care.
Additionally, the nuclear medicine department needs to interact and collaborate with clinicians outside the department. Collaborating with other specialists for a multidisciplinary approach is critical teamwork that benefits the patient.
“I need additional information to make my diagnosis,” Declerck says. “So, we have to make time to collaborate with other specialties for a multidisciplinary approach to diseases. It’s very time demanding, and it is not paid, but at the end of the day, I am helping my patient. And I am generating confidence in the way I work and treat my patients.”
Overall, a well-designed nuclear medicine department should be optimized not only with the state-of-the-art equipment and specialty resources needed for imaging procedures, but also fortified with an efficient workflow, human factors considerations, as well as long-term maintenance planning to optimize the life of the equipment. When the department is operating at peak efficiency, the nuclear medicine department clinicians can spend more time consulting with patients and other members of the clinical care team who are working towards the best outcomes for their patients.
[1] Rosen MA, DiazGranados D, Dietz AS, et al. Teamwork in healthcare: Key discoveries enabling safer, high-quality care. Am Psychol. 2018;73(4):433-450. doi:10.1037/amp0000298
