CT process mapping cuts outpatient wait times to 1/3 of earlier average

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 - Think-Plan-Act

The radiology department at an urban academic medical center has cut its average outpatient CT wait times to a little over an hour, and that includes the scan. Prior to starting the project that took aim at streamlining CT processes, the department was averaging more than three hours in arrival-through-completion times.

In a study published online Sept. 1 in the Journal of the American College of Radiology, Farouk Dako, MD, MPH, and colleagues at Temple University Hospital in Philadelphia further report a 19 percent jump in average daily CT scan volumes, from 37 to 44 procedures per day.

The department took up the process-improvement project after noting widespread acknowledgement of its “cumbersome and inefficient” CT throughput, which had been precipitating errors and redundancies, according to the study report.

Dako and colleagues gathered a multidisciplinary team with representation from not only radiologists, technologists and radiology administrators but also scheduling, IT, film library, financial services and outside consultants.

The team spent two days running through “value stream mapping” (VSM) exercises adapted from techniques pioneered by Toyota Motor Corp. as part of its lean manufacturing methodology.

The authors note that VSM offers a way to cut out waste and optimize efficiency by changing individual behaviors and corporate culture.

The exercises yielded a high-level process map that separated CT-related tasks that either added or enabled value from tasks that added no value, they report.

Next, group analysis of the map produced a “prioritization matrix,” which stratified actionable items according to their ease of implementation as well as their likely impact on process improvement.

The proverbial low-hanging fruits fresh for the picking were missing lab work, form redundancy, poor communication, departmental ergonomics and order inaccuracies that had to be addressed upon patient arrival.

Equipped with these insights, the VSM team established weekly-meeting working groups to come up with solutions and spur change, the authors report. Meanwhile, a steering committee met monthly to provide oversight as well as guide decisions and mitigate risks.

“Implemented solutions included technologist review of pending cases three days before arrival, daily summary of order defects for manager review, schedule and scanner optimization, consolidation of registration forms and departmental renovations,” the authors write.

Dako and colleagues show the VSM project to have reduced average patient wait times from 3.1 hours (tallied as patient arrival through exam completion) to just 1.1 hours.

The gains included cutting true process time (order through scan completion) from 87 to 32 minutes and raising first-pass yield (the percentage of correct process completion on first attempt) from below 20 percent to higher than 88 percent.

“Patients’ perceptions of quality and satisfaction in a diagnostic radiology department, unlike in most other departments in the hospital, are usually based solely on nonclinical indicators,” Dako et al. write. “Analysis of the ordering, scheduling, payment and registering processes for diagnostic examinations and the patient flow within a department can reveal inefficiencies and areas of improvement at any point along this continuum.”