Upon examining various performance metrics on their MRI patient throughput, members of the radiology department at Harvard-affiliated Beth Israel Deaconess Medical Center found they were losing close to one-third of their time to delays, bottlenecks or other avoidable inefficiencies.

The team is now working to reduce or eliminate specific time-wasters identified during the study period, according to their study report, which the American Journal of Roentgenology has published online.

Kevin Beker, MD, and colleagues prospectively collected workflow data on 305 outpatient scans (body, neurologic, musculoskeletal and breast) performed over a two-week period.

Measuring two time cycles—the MRI procedure time and the patient’s total length of visit in the department—they used lean methodology to classify time increments as either value-added, business-value-added or non-value added.

They also assessed the impact and frequency of delays.

Beker and colleagues found the delay with the highest frequency (5.57 percent) was IV or port placement, which had a mean delay of 22.82 minutes.

The delay with the greatest impact on time was MRI arthrography for which joint injection of contrast medium was necessary but was not accounted for in the schedule (mean delay, 42.2 minutes; frequency, 1.64 percent).

They further found the MRI process cycle lasted a mean of 50.97 ± 24.4 (SD) minutes per examination, and the mean non-value-added time was 13.21 ± 18.77 minutes (25.87 percent of the total process cycle time).

Additionally, the mean length-of-stay cycle was 83.51 ± 33.63 minutes, while the mean non-value-added time was 24.33 ± 24.84 minutes (29.14 percent of the total patient stay).

Meanwhile, a not-insubstantial portion of the delays owed to the patients, as 11.15 percent (34 of 305) arrived late.

In their discussion, Beker et al. describe a multi-pronged initiative of process improvement their department has undertaken. The plan’s key parts shed more light on specific problem areas that came to light during the study period:

• Along with providing continuous education to relevant staff on scheduling and booking processes, the department is reviewing upcoming scans three days in advance in order to, for example, ensure correct scanner selection and prepare for concerns like patient claustrophobia.
• The department has invested in a new MRI safety resource to safely and efficiently scan patients with implants.
• The MRI scanning manager is working alongside interpreters to map the exact arrival time and required interaction time with patients for interpreters across all protocols.

“This study provides evidence of how systematic implementation of process analysis can significantly aid in streamlining patient throughput and imaging volume,” the authors conclude. “Our findings suggest that almost one-third of the total patient stay length and MRI utilization is composed of non-value-added time that can be shortened by identifying the source of inefficiency and implementing change.”

If applied systematically, they add, ongoing continuous improvement “can potentially cut costs and increase efficiency and patient satisfaction.”