RSNA: Operations management can improve emergency radiology workflow

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CHICAGO—A technologist-driven quality improvement initiative led to better patient throughput, making emergency department radiology workflow more efficient through the use of operations management tools, according to a scientific poster presented Nov. 27 at the 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).

Boston Medical Center and Boston University (BU) School of Medicine in Boston are seeking to build a culture of safety and improvement among all staff within the radiologist department. As part of this initiative, they collaborated with the department of operations management at the BU School of Management to educate their physicians, technologists and nurses on the principles of operations management and to engage them in leading operations management projects

Jennifer C. Broder, MD, and colleagues at the departments of radiology at Boston Medical Center and Boston University School of Medicine, focused this analysis specifically on the diagnostic x-ray technologists at these institutions. 

The BU School of Management provided sessions focused on how the variation in radiologic practice is a barrier to quality and safety and how operations management tools could potentially decrease variation.

After the sessions, the team conducted a KJ exercise to elicit and prioritize ideas regarding needed improvements. The KJ method, named for its Japanese inventor and anthropologist Jiro Kawakita, can allow a group to reach a consensus on priorities based on subjective, qualitative data. It is a low-tech method that requires pens, sticky notes and a wall. The method also is called an “affinity diagram.” 

According to the researchers, the KJ exercise allowed an opportunity for front-line staff, including the technologists, to voice opinions, to prioritize their own opinions, to understand that department leaders are attentive to their feedback and to take ownership of possible solutions for problems they had prioritized.

After the exercise, Broder et al used these data to determine which areas to address, and then approached the technologists to help address the problems they had prioritized. The chief technologist and supervisors were in charge of their project, with guidance from physician champions (an attending and a resident) to help with project design, strategy and leveraging interdepartmental relationships.

The chosen problem was to address inefficiencies in emergency department radiology workflow. Specifically, the technologists identified patients arriving dressed in street clothes rather than gowns as a major source of inefficiency.

As part of their evaluation, the team discovered that 11 percent of patients coming from the emergency department for x-rays had clothes (including bras) or other potential sources of artifacts on. Seventy percent of these patients were recommended for a chest x-ray. Importantly, the chest x-rays for patients arriving in street clothes took 70 percent longer to acquire than on patients who arrived in a gown.

Thus, the emergency department nurse manager worked with the emergency department staff to educate them about the importance of changing patients into a gown.

Previously, 17 percent of the emergency department patients arriving specifically for a chest x-ray arrived in street clothes, and after the process, only 5 percent of patients sent for a chest x-ray from the emergency department were in street clothes. 

In continuing the project, the team will collect data on a quarterly basis. Also, the team will continue to communicate results to the emergency department nurse manager, and intervene when necessary.