Preprocedural checklists can improve patient satisfaction in IR departments

A simple seven-point quality improvement (QI) checklist, completed at minimum one day before a scheduled interventional radiology (IR) procedure, could improve workflow and on-time starts in the IR department while maximizing patient satisfaction, an Arkansas-based nurse practitioner reported in the Journal of Radiology Nursing this summer.

Valerie Amanda White, DNP, APRN, of the Central Arkansas Veterans Healthcare System in Little Rock, wrote that timely workflow is essential to the success of radiology departments across the country, because procedures that start late waste taxpayer dollars, hospital resources and significant time.

“Workflow efficiency in interventional radiology is exceptionally challenging because of the mixture of inpatients and outpatients being scheduled throughout the day, using the same rooms, for procedures of fluctuating lengths,” she said in the journal. “Efficiency is a crucial issue for revenue stream in for-profit organizations, and improved efficiency allows more procedures to be executed for the same cost in not-for-profit institutions.”

Delayed appointments can also lead to an uptick in cancellations and poor patient satisfaction, she said—not to mention deferred treatment.

In an effort to improve efficiency at the Veterans Healthcare System, White said her colleagues devised a checklist to be completed by an IR staffer at least one day ahead of a patient’s procedure. A team including an imaging services chief, nursing supervisor, IR radiology technologist leader, scheduler, licensed practical nurse and advanced practice registered nurse created the document from research collected from six articles about underlying issues with workplace efficiency. 

The team took into account proven interventions like checklists, facilitators, reminder emails to staff, earlier work hours and reporting arrival times to supervisors. In addition to implementing the list, which comprised of a seven yes-or-no questions to ensure reminder emails were sent, letters were mailed, phone calls were made and labs were ordered, White and her fellow researchers tracked patient satisfaction surveys.

Over the course of four months, White said, on-time starts at her institution increased from 29 percent and 24 percent in the two months before checklist implementation to 34 percent and 40 percent in the two months after. The number of satisfied patients, based on their surveys, increased from 73 percent and 83 percent before implementation to 93 percent and 100 percent after. Satisfaction was tracked by asking patients if their appointments started at the time they expected.

“The most common reasons for procedural start delay in IR before and after implementation were first-case delay causing subsequent delays, lack of physician ability and the patient not being prepared for the procedure,” White wrote. “Although on-start times only increased by 10 percent from preimplementation to postimplementation period, there was a significant increase in patient satisfaction with the use of a preprocedural checklist and physician start-time reminders.”

White said her hospital plans to continue to send physician reminder emails and use their checklist to improve care in addition to new, biweekly meetings with providers, the nurse manager and the lead technologist to “stay on top of workflow and scheduling needs.”