Workflow success story: Process improvement initiative spurs efficiency, increases volumes

Intradepartmental process improvement efforts can significantly improve workflow and patient-centeredness in a larger academic MRI department, according to an article published in the March issue of the Journal of the American College of Radiology.

By re-engineering workflow and empowering staff, the department grew MR volumes without additional equipment or personnel, according to Michael Recht, MD, and colleagues at New York University Langone Medical Center in New York City.

“A patient-centered environment is one that provides a safe, efficient, high-quality healthcare experience every time a patient arrives for medical care,” wrote the authors. “Analyzing the steps of patients' experience as they navigate through the radiology department can be helpful in determining where areas of focused improvement can be achieved.”

Recht and colleagues identified a number of key performance indicators (KPIs) in their MRI department, including daily inpatient backlogs, on-time performance for outpatient exams, exam volumes, backlogs for pediatric anesthesia cases and scan duration relative to time allotted for an exam. In April 2011, members of the department, ranging from administrators and physicians to technologists and schedulers, tracked patient flow, analyzed data and determined where processes could improve.

Changes implemented by the department included:

  • A live calling system replaced an automated telephone message system for notifying patients of when to arrive for their MR exams. This emphasized the importance of an on-time arrival and allowed for a second screening process for implantable devices, noted the authors.
  • An “electronic greaseboard,” which displayed each step of the MR process for scheduled exams, was added so technologists could better assess the schedule. Prior to this addition, technologists would switch patients between magnets in an effort to improve workflow, but because not all exams were of the same duration, this well-intentioned maneuver often caused delays later in the day.
  • Technologist staffing was increased to 1.5 per room, compared with only a single technologist prior to process improvement, to help prepare outpatients for exams.
  • Coordination with inpatient nursing was improved so that staff were notified the evening before a scheduled exam and inpatients could be delivered as early as 7 a.m., rather than the previous earliest time slot of 8 a.m.
  • Pediatric anesthesia slots were reorganized to begin earlier and limit their duration, resulting in an additional eight outpatient pediatric slots per week.

The result of these efforts was a significant improvement in a number of KPIs, according to the authors. The mean number of backlogged inpatient MR exams not performed per day fell from 4.2 to 1.3. After process improvement, 76 percent of exams were initiated on time, compared with 68 percent prior to implementation. The number of exams performed within 30 minutes jumped from 35 percent to 44 percent. Outpatient anesthesia backlogs also were greatly reduced, with a 28.4 day mean wait time cut to 5.9 days after re-engineering workflow.

These improvements led to an overall increase in daily exam volumes from 114 and 24 on weekdays and weekends, respectively, to 136 and 36, respectively, reported Recht and colleagues.

The authors emphasized the role of teamwork in the success of the process improvement efforts. “The makeup of our process improvement team was critical to the success of our effort. It was important to include representatives from all areas of the department but also to maintain a small enough team to work efficiently.”