Clicca qui per scaricare

Dieci anni di studi nella gestione dei tempi di attesa nella diagnostica per immagine. Quali prospettive per un governo di sistema?
Titolo Rivista: MECOSAN 
Autori/Curatori: Cristiana Bettelli, Milena Vainieri, Bruna Vinci 
Anno di pubblicazione:  2016 Fascicolo: 100  Lingua: Italiano 
Numero pagine:  19 P. 7-25 Dimensione file:  23778 KB
DOI:  10.3280/MESA2016-100002
Il DOI è il codice a barre della proprietà intellettuale: per saperne di più:  clicca qui   qui 

Nell’ultimo decennio, in risposta a una domanda in notevole crescita, la diagnostica per immagini è stata oggetto di un rilevante sviluppo sia in termini di innovazione tecnologica sia di volumi erogati. Nonostante un aumento sistematico dell’offerta i tempi di attesa rappresentano ancora oggi una criticità per i sistemi sanitari. Quali azioni sono state intraprese per ridurre i tempi di attesa negli ultimi 10 anni? La maggior parte degli studi in letteratura si concentrano su azioni di saturazione della capacità produttiva, mentre ancora pochi sono quelli che riguardano il governo della domanda. L’intento finale di questo lavoro è individuare spazi di intervento per il governo più appropriato del sistema sanitario.

Keywords: Tempi di attesa, diagnostica per immagini, governo della domanda, processo diagnostico, appropriatezza prescrittiva, soluzioni organizzative.

  1. Akhtar W., Ali A., Mirza K. (2011). Impact of a voice recognition system on radiology report turnaround time: experience from a non-English-speaking South Asian country. American Journal of Roentgenology, 196: 485., DOI: 10.2214/AJR.10.5426
  2. Appleby J., Raleigh V., Frosini F., Bevan G., Gao H., Lyscom T. (2011). Variations in healthcare: the good, the bad and the inexplicable. London: The King’s Fund. --Disponibile al sito:, consultato il 09/09/2016.
  3. Bhavani N.S., Kulkarni G. (2009). Patient flow management and analysis using location tracking. --Disponibile al sito:, consultato il 13/09/2016.
  4. Bian J., Topaloglu U., Lane C. (2009). EIR: enterprise imaging repository, an alternative imaging archiving and communication system. Engineering in Medicine and Biology Society, Annual International Conference of the IEEE., DOI: 10.1109/IEMBS.2009.5332428
  5. Blakeley C., Hogg P., Heywood J. (2008). Effectiveness of UK radiographer image reading. Radiologic Technology, 79: 221-226.
  6. Blackmore C. (2007). Defining Quality in Radiology. Journal of the American College of Radiology, 4 (4): 217-223.
  7. Boland G.W.L., Halpern E.F., Gazelle G.S. (2010). Radiologist report turnaround time: impact of payfor-performance measures. American Journal of Roentgenology, 195: 707-711., DOI: 10.2214/AJR.09.4164
  8. Brealey S.D., Scuffham P.A. (2005). The effect of introducing radiographer reporting on the availability of reports for Accident and Emergency and General Pratictioner examination: a time series analysis. British Journal of Radiology, 78: 538-542.
  9. Bucci R.V., Musitano A. (2011). A Lean Six Sigma journey in radiology. Radiology Management, 33: 27-33.
  10. Chen P., Yu C., Chen G.Y.J (2015). Applying Task-Technology Fit Model to the Healthcare Sector: a Case Study of Hospitals’ Computed Tomography Patient-Referral Mechanism. Journal of Medical Systems, 39: 80.
  11. Dionne D.T. (2013). Growing the range of services in a radiology observation unit. Radiology Management, 35 (3): 34-38.
  12. Dodd G.D., Allen B., Birzniek D., Boland Giles W., Brink J. A., Dreyer K. J., Khandheria P., Kruskal J. B., Ricci P., Seibert J.A., Zane R. (2015). Reengineering the radiology enterprise: A summary of the 2014 intersociety committee summer conference. Journal of the American College of Radiology, 12 (3): 228-234.
  13. Emery D.J., Forster A.J., Shojania K.G., Magnan S., Tubman M., Feasby E.J. (2009). Management of MRI Wait Lists in Canada. Healthcare Policy, 4(3): 76-86.
  14. Gilbert J.E., Dobrow M.J., Kaan M., Dobranowski J., Srigley R., Jusko Friedman M.D., Irish MSW J.C. (2014). Creation of a diagnostic wait times measurement framework based on evidence and consensus. Journal of the Pancreas, 10 (5): e373-e379.
  15. Granja C., Almada-Lobo B., Janela F., Seabrad J., Mendes A. (2014). An optimization based on simulation approach to the patient admission scheduling problem: Diagnostic imaging department case study. Journal of Digital Imaging, 27 (1): 33-40.
  16. Hart J.L., McBride A., Blunt D., Gishen P., Strickland N. (2010). Immediate and sustained benefits of a “total” implementation of speech recognition reporting. British Journal of Radiology, 83: 424-427.
  17. Humphries R., Russell P.M., Pennington R.J., Colwell K.D. (2011). Utilizing lean management techniques to improve emergency department radiology ct turnaround times. Annals of Emergency Medicine, 1: 248. --
  18. Johnston M.J., Samaranayake P., Dadich A., Fitzgerald J.A. (2009). Modelling radiology department operation using discrete event simulation, 18th World IMACS / MODSIM Congress, Cairns (Australia). --Disponibile al sito:
  19. Johnson G., Kiernan J., Swan A. (2016). Designing patient throughput and task management innovations in orthopaedics. IEEE Systems and Information Engineering Design Symposium, SIEDS 2016, 7489284: 124-129., DOI: 10.1109/SIEDS.2016.7489284
  20. Jones S., Cournane S., Sheehy N., Hederman L. (2016). A Business Analytics Software Tool for Monitoring and Predicting Radiology Throughput Performance. Journal of Digital Imaging, 29(6): 645-653.
  21. Karstoft J., Tarp L. (2011). Is Lean Management implementable in a department of radiology?. Insights Imaging, 2: 267-273.
  22. Kelley L. (2011). Improving satisfaction performance through faster turnaround times. Radiology Managing, 33 (5): 38-41. PMID: 22043733.
  23. Kennedy S., Bhargavan M., Sunshine J.H., Forman H.P. (2009). The effect of teleradiology on time to interpretation for CT pulmonary angiographic studies. Journal of the American College of Radiology, 6: 180-189.
  24. Kim J.Y., Lee H.J., Byeon N.S., Hyun-Chul K., Kyoo-Seop H., Chin-Youb C. (2009). Development and Impact of Radio-frequency Identification-Based Workflow Management in Health Promotion Center: Using Interrupted Time-Series Analysis. Information Technology in Biomedicine, 14(4): 935-940., DOI: 10.1109/TITB.2009.2026167
  25. Koivikko M., Kauppinen T., Ahovuo J. (2008). Improvement of report workflow and productivity using speech recognition. A follow-up study. Journal of Digital Imaging, 21: 378-382.
  26. Krishnaraj A., Lee J.K., Laws S.A., Crawford T.J. (2010). Voice recognition software: effect on radiology report turnaround time at an academic medical center. American Jounal of Roentgenology, 195: 194-197., DOI: 10.2214/AJR.09.3169
  27. Il Sole 24 Ore Sanità (22 settembre 2015). Inappropriatezza prescrittiva, 48 ore ai sindacati per esprimersi sulle 208 prestazioni. --Disponibile al sito: _ presentazione.pdf?uuid=ACOh9M2, consultato il 14/01/2016.
  28. Laupacis A., Evans W. (2005). Diagnostic imaging in Canada. HealthcarePapers, 6 (1): 8-15.
  29. Li M., Tsai J.C.H., Chen W., Linc H.S. Pana H.B., Yanga T.L. (2013). Redefining the sonography workflow through the application of a departmental computerized workflow management system. International Journal of Medical Informatics, 82 (3): 168-176.
  30. Lodge A., Bamford D. (2008). New development: Using lean techniques to reduce radiology waiting times. Public Money & Management, 28 (1): 49-52.
  31. Lodge A., Bamford D. (2007). Health service improvement through diagnostic waiting list management. Leadership in Health Services, 20(4): 254-265., DOI: 10.1108/1751187071082936
  32. Lysdahl K.B., Hofmann B.M. (2009). What causes increasing and unnecessary use of radiological investigations? A survey of radiologists’ perceptions. BMC Health Services Research, 9-155., DOI: 10.1186/1472-6963-9-155
  33. MacDonald S.L., Cowan I.A., Floyd R., Mackintosh S., Graham R. (2013). Measuring and managing radiologist workload: Application of lean and constraint theories and production planning principles to planning radiology services in a major tertiary hospital. Journal of Medical Imaging and Radiation Oncology, 57(5): 527-631., DOI: 10.1111/1754-9485.12090
  34. Mackinnon A.D., Billington R.A., Adam E.J., Dundas D.D., Patel U. (2008). Picture archiving and communication systems lead to sustained improvements in reporting times and productivity: results of a 5- year audit. Clinical Radiology, 63: 796-804.
  35. Newman R.D., Nightingale J. (2011). Improving patient access to videofluoroscopy services: role of the pratictioners-led clinic. Radiography, 17: 280-283.
  36. Nickel S., Schmidt U.A. (2009). Process improvement in Hospitals: A case study in a radiology department. Quality Management in Health Care, 18 (4): 326-338.
  37. Nuti S., Vainieri M. (2012). Managing waiting times in diagnostic medical imaging, BMJ Open, 2: e001255.
  38. OECD (2011). --Disponibile al sito:, consultato il 18/12/2015.
  39. OECD (2012). --Disponibile al sito:, consultato il 18/12/2015.
  40. OECD (2015). Health at a Glance 2015. --Disponibile al sito:, consultato il 06/09/2016.
  41. Olisemeke B., Chen Y.F., Hemming K., Girling A. (2014). The effectiveness of service delivery initiatives at improving patient’s waiting times in clinical radiology departments: a systematic review. Journal of Digital Imaging, 27 (6): 751-778.
  42. Patrick J., Puterman M.L. (2006). Improving resource utilization for diagnostic services through flexible inpatient scheduling: A method for improving resource utilization, Journal of the Operational Research Society, 58: 235-245.
  43. Pianykh O.S., Rosenthal D.I. (2015). Can We Predict Patient Wait Time? Journal of the American College of Radiology, 12 (10): 1058-1066.
  44. Scoccianti S., Agresti B., Simontacchi G. (2012). From a waiting list to a priority list: a computerized model for an easy-to-manage and automatically updated priority list in the booking of patients waiting for radiotherapy. Tumori, 98 (6): 728-735., DOI: 10.1700/1217.13496
  45. SIRM – Società Italiana Radiologia Medica (2009). L’atto medico radiologico. --Disponibile al sito:, consultato il 01.12.2016.
  46. SlowMedicine (2014). --Disponibile al sito:, consultato il 24.02.2016.
  47. Song Y., Skinner J., Bynum J., Sutherland J., Wennberg J.E., Fisher E.S. (2010). Regional Variations in Diagnostic Practices. The New England Journal of Medicine, 363:45-53.
  48. Steffen M.W. (2010). Improving the efficiency of patient throughput via centralized inpatient scheduling. Radiology Management, 32: 30-36. PMID: 22279717.
  49. Tavakol P., Labruto F., Bergstrand L., Blomqvist L. (2011). Effects of outsourcing magnetic resonance examinations from a public university hospital to a private agent. Acta Radiologica, 52: 81-85.
  50. Thomsen M.S., Nørrevang O. (2009). A model for managing patient booking in a radiotherapy department with differentiated waiting times. Acta Oncologica, 48(2): 251-258., DOI: 10.1080/02841860802266680
  51. Tiwari S., De Rover W.S., Dawson S., Moran C., Sahota O. (2015). Rapid access imaging for occult fractured neck of femur. Osteoporosis International, 26: 407.
  52. Villarreal M.C., Rostad B.S., Wright R., Applegate K.E. (2015). Improving Procedure Start Times and Decreasing Delays in Interventional Radiology: A Department’s Quality Improvement Initiative. Academic Radiology, 22 (12): 1579-15786.
  53. White L., Beckingham E., Calman F., Deehan C. (2007). Extended hours working in radiotherapy in the UK. Clinical Oncology, 19 (4): 213-222.
  54. WHO (2010). Health systems financing. The path to universal coverage. The world health report. WHO Press: Geneva.

  1. Daniel Adrian Lungu, Tommaso Grillo Ruggieri, Sabina Nuti, Decision making tools for managing waiting times and treatment rates in elective surgery in BMC Health Services Research 369/2019 pp. , DOI: 10.1186/s12913-019-4199-6
  2. Daniel Adrian Lungu, Elisa Foresi, Paolo Belardi, Sabina Nuti, Andrea Giannini, Tommaso Simoncini, The Impact of New Surgical Techniques on Geographical Unwarranted Variation: The Case of Benign Hysterectomy in International Journal of Environmental Research and Public Health /2021 pp. 6722, DOI: 10.3390/ijerph18136722

Cristiana Bettelli, Milena Vainieri, Bruna Vinci, in "MECOSAN" 100/2016, pp. 7-25, DOI:10.3280/MESA2016-100002


FrancoAngeli è membro della Publishers International Linking Association associazione indipendente e no profit per facilitare l'accesso degli studiosi ai contenuti digitali nelle pubblicazioni professionali e scientifiche