Starting an imaging procedure on time with a quick turnaround is an ongoing challenge for radiology departments. But one Atlanta provider has dramatically reduced such hiccups in a short matter of time.
Emory Healthcare did so by forming a team of experts, performing a root cause analysis, and devising and testing more than a dozen fixes. After a quick 20-week implementation, the academic health system has dropped turnaround times for CT-guided procedures by almost 78%, experts detailed in an analysis published Friday.
Decreasing wait times for patients and providers is a key goal of the Institute of Medicine, and Emory imaging experts urged their peers to take this issue to heart in their own practices.
“With rising radiology procedural volumes and expansion of healthcare systems it is imperative that radiology departments continue to develop and encourage both small- and large-scale quality improvement projects in this arena,” Sadhna Nandwana, MD, and colleagues wrote July 24 in Current Problems in Diagnostic Radiology. “Significant strides in improving procedural workflow efficiency and patient waits and delays can be achieved by selecting a well-defined specific goal and utilizing a team approach to quality improvement.”
Emory providers perform more than 800 computed tomography-guided outpatient procedures at a single site, a process that requires “careful coordination and optimization of workflow.” The institution, however, had struggled with this endeavor, with frequent “significant” delays starting the first CT interventional procedure each day at 8:30 a.m. This began to have a snowball effect on the department, leading to subsequent setbacks throughout the day and underutilization of imaging equipment.
To begin remedying this issue, Nandwana et al. analyzed 43 consecutive first-of-the-day procedures over a three-month period. They determined that only about 11% of 8:30 a.m. cases actually started on time and set the goal of getting that number up to 50% within 20 weeks.
Emory then formed a team consisting of proceduralists, technologists, nurses and administrators to begin solving the issue. An admin with Six Sigma training led the team, instilling the effort with Lean-improvement principles. Mapping out the entire process, Nandwana and colleagues determined patients complete six steps from arrival to their CT procedure, with the process ranging from 62-133 minutes. Nursing’s prep of the patient, and their coordination of care with CT technologists, were pinpointed as the two steps with the most variation.
After conducting a root-cause analysis, Emory determined that a lack of standardized processes and set time standards were fueling delays. For instance, the institution had no protocol for nurses to identify that the CT suite was ready for a patient, nor was there a set time to obtain consent.
All told, Emory implemented 14 different “tests of change” to begin fixing the issue, but three garnered the most positive feedback:
1. Instituting daily morning huddles at 8:10 a.m., with representatives from each staff role.
2. Eliminating phone calls between nurses and CT techs, used to assess readiness for the patient.
3. Bumping up the arrival time from an hour to 90 minutes prior to that first 8:30 a.m. appointment.
With the changes, Emory Healthcare was able to drop mean turnaround time from 71.5 minutes all the way to 15.9 after implementation, a gain of almost 78%. And exams starting on time (within 15 minutes of the appointment) went from just 11% to 82% when excluding outliers such as late patient arrivals.
Nandwana—an assistant professor and director of abdominal imaging at Emory University Hospital Midtown—cited several factors to their success. Those included assembling a team of key stakeholders, gathering prospective data of baseline cycle time, and standardizing the workflow with defined roles and responsibilities.
“In addition, one of the most important lessons learned was the benefit of being flexible and adaptable throughout the quality improvement process,” the team added. “If a test of change was not working as originally intended, we did not hesitate to modify and develop new tests of changes as needed based on feedback received.”
Read more of the analysis from Current Problems in Diagnostic Radiology here.