A “lean” system improvement analysis conducted by interventional radiologists at the University of North Carolina (UNC) School of Medicine in Chapel Hill was able to help streamline workflow and cut technologist and nurse overtime hours by 20 percent and 57 percent, respectively.

An overview of the lean process and how it was used at UNC was published online April 4 in the Journal of the American College of Radiology.

Ari Isaacson, MD, and colleagues from UNC noted their interventional radiology division had consistently high overtime expenditures. An initial workflow analysis focused on the scheduling template, which called for four inpatient cases to start the day, followed by outpatients. “After review of the daily procedure log, it became apparent that the problem started with the inability to complete the first inpatient cases on time,” wrote Isaacson and colleagues. “Consequently, the first outpatient procedures were delayed, and a snowball effect began.”

They then turned to lean principles—first popularized to increase efficiency in the automotive industry, but have since been transferred to many other fields, including medicine—to improve department efficiency. A multidisciplinary team consisting of a scheduler, technologist, nurse, physician and systems improvement expert outlined the process workflow, and set about collecting a month’s worth of baseline data on the time it took to complete each step of the procedure process.

Following this baseline period, three specific interventions were chosen based on ease of implementation and potential impact on completing early inpatient cases on time. These interventions included allocated more staff members for 7 a.m. patient transport, coinciding the start of the nursing shift with the 7:30 a.m. start of the technologists’ shift, and attempting to schedule simpler first inpatient cases that take less time to complete.

Isaacson and colleagues noted that transport time fell by an average of 7 minutes, and the number of cases in the room by 8 a.m. increased from 30 to 34. The number of first inpatient cases completed within the allotted 45 minute procedure time goal rose from 51 to 59, and the number of patients brought out of the procedure room by 9:15 a.m. increased from 24 to 40. As a result, technologist overtime hours fell from 105.3 to 84.8, and nursing overtime hours decreased from 60 to 25.6 between the baseline and intervention periods.

The authors noted there was some initial resistance from staff, notably from the nurse manager and several attending physicians. However, once the goals of the project and potential to result in cost savings were discussed, all staff agreed to the changes.

“Although the 22 percent increase of first-case on-time finishes was less than we would have liked, the 20 percent and 57 percent decrease in technologist and nurse overtime hours, respectively, exceeded our expectations and served as motivation to pursue further system improvement within the department,” wrote Isaacson and colleagues.