Untangling Workflow

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Workflow affects everything. In the race to squeeze every last bit of efficiency from a radiology department, administrators often stand before the Gordian knot of their workflow process wondering which dangling thread to pull first. For some, gains come from the introduction of a new technology, while others find success with an intervention focused on staff processes.

More tools than ever are available to help administrators with workflow projects. Vendors offer workflow consultations when a new technology is implemented and auditing or analytics tools tapping into RIS data can flag pain points. Each workflow project comes with its own revelations, benefits and challenges.

Consulting the experts

In 2006, University of Kentucky HealthCare (UK) in Lexington wanted to increase capacity and procedures with a new CT system, and the organization tapped its CT vendor for a workflow consultation to assess the current state of operations. The analysis identified multiple opportunities for improvement, including a shift to a two-technologist workflow model.

CT scanners have reduced scan time to mere seconds, so additional workflow optimization may be mined from the processes leading up to a procedure, rather than during the procedure itself. Having two technologists per scanner, where one is focused on preparing the patient while the other manages the scanner, significantly helped workflow at UK.

“Having a dedicated technologist or a nurse prepare the patient for the scan is critically important,” says Anil K. Attili, MD, chief of the division of cardiothoracic radiology at UK.

The provider had three target metrics with the project:

  • 10 percent reduction in process steps;
  • 25 percent increase in procedures per CT technologist; and
  • 10 percent increase in procedure volume.

All goals were met or exceeded, and the department is currently running at 100 percent capacity. Wait times are key for patient satisfaction, says Attili. UK strives to schedule patients in three days and many are scheduled within 24 hours; inpatients are scheduled within an hour or two.

Another facility that got a major assist from an outside consultant is the Cleveland Clinic Breast Center. When Cleveland Clinicwas implementing a new PACS in 2009, it tapped its vendor for PACS training and workflow analysis.

At first, the consultants just watched, says Alice S. Rim, MD, head of breast imaging in the diagnostic radiology department at Cleveland Clinic. Every once in a while, the consultants would ask a staff member to explain a particular action, but they initially remained non-intrusive.

Rim had her doubts until the vendor visually laid out the department workflow by sticking notes on a whiteboard in a meeting with administrators. “They put the Post-its up there and showed ‘Alice’s normal day’ and it looked ridiculous,” she says, describing the workflow map as more of a maze suitable for lab rats. “They knew our workflow better than we did.”

The workflow plan was tailored to the PACS implementation, and clinical, technical and administrative staff was trained extensively, says Rim. To maximize the effectiveness of training, the team at Cleveland Clinic worked with the vendor to schedule training sessions two weeks prior to the go-live date and have them led by the same team that conducted the original workflow analysis. Training was conducted away from the reading environment to limit distractions, and all organizational levels were included.

“The key was making sure everybody from the radiologists to the technologists to the front desk staff to the imaging library staff was trained,” she says.

The idea that everybody should be trained to use a new system might seem obvious, but if staff is not completely comfortable with a technology, serious workflow obstructions can develop.

It’s important to have vendors train in-house staff who are then capable of training users in the department, says Katherine P. Andriole, PhD, director of imaging informatics in the department of radiology at Brigham and Women’s Hospital in Boston. A “train the trainer” model works well for new implementations, says Andriole.

The training program at Cleveland Clinic eventually paid off, because when the PACS went live, the transition was seamless, says Rim. Prior to implementation, turnaround times for screening mammography could stretch to three weeks, but after implementation, results were available within 24 hours or less. In fact, Rim says the department received some