Like any new medical practice, interventional radiology (IR) has had some growing pains. The specialty has drastically expanded its scope of operations in the past few decades, and its growing importance was rewarded when the American Board of Medical Specialties elevated IR to the specialty level in 2012.
However, the lack of an industry-wide consensus on how best to integrate IR departments into the hospital and high demand for IR procedures can result in bottlenecks, extending hospital stays and delaying treatment. One particular area of concern is the long lead time for scheduling patients; according to a study conducted at The Ohio State University (OSU), that lead time can range from two days to two weeks.
To combat this, a group from OSU’s Wexner Medical Center used a Lean Six Sigma improvement initiative to streamline the IR scheduling process, reducing the time it takes to get patients under the knife—or under the catheter, rather. They published their methods in the Journal of the American College of Radiology (JACR), noting their template could be easily expanded to other departments’ scheduling processes.
“In any IR division, including ours, at a large tertiary medical center, there are continuous requests by referring physicians for IR interventions,” wrote lead author and Assistant Professor of Interventional Radiology at Wexner Medical Center Joshua D. Dowell, MD, PhD, et al.
Dowell and his collaborating researchers used Lean Six Sigmas’ DMAIC tool, an acronym for Define, Measure, Analyze, Improve, and Control.
“Initially designed to improve efficiency in industry, Lean Six Sigma methodology implores collecting and evaluating baseline data, as well as integrating personnel communication to identify waste and reduce variation,” wrote Dowell et al. “The study team included interventional radiologists, a radiology fellow and resident, scheduling staff, quality improvement specialists, and graduate students.”
Stakeholders were identified and tasks performed by schedulers or physicians were classified as value-added or non-value-added toward the target measure: reducing the time from when an order is received to when it is officially scheduled.
“A Value Stream Map (VSM) tool was used to identify scheduling flow constraints and areas for potential interventions,” wrote Dowell and colleagues. “After completion of the VSM, a group discussion to include all stakeholders was organized to discuss the VSM, as well as the strengths and weaknesses of the process.”
After brainstorming possible interventions, a shortlist of 10 solutions was created and evaluated for cost effectiveness, impact on the process, scheduling time, and ease of completion. The two most promising solutions minimized waste and variation in process, according to Dowell et al.
“The Solution Priority Calculator identified an IR-specific electronic checklist as most beneficial to have the greatest impact upon several identified areas for improvements, as well as an influence upon other identified possible solutions,” the authors wrote. “The checklist was created to standardize work for scheduling nurses and also to integrate procedural nurses to improve communication.”
Previous studies using Six Sigma techniques have led to similar improvements in IR departments, including a German study published in JACR documenting a 13 percent reduction in wait time.
“In conclusion, ease of scheduling, timely scheduling of procedures after referral, and improving patient/referrer satisfaction are all vital to the growth of an IR practice,” wrote Dowell et al. “By using Lean Six Sigma principles, areas for improvement in each of these areas can be identified, and changes can be implemented to further streamline clinic or scheduling processes.”
Study co-authors include third-year OSU resident Mina Makary, MD, OSU interventional radiology fellow Matthew Brocone, MD, Ohio-based lawyers James G. Sarbinoff and Ivan G. Vargas, SSBB, and Mrinalini Gadkari, senior lecturer at OSU’s Fisher College of Business.