Learning From Experience: "Minimizing Patient Delays in Radiology: Optimizing On-Time Starts for CT Procedures"

To identify and analyze factors resulting in consistently delayed start times of the first outpatient procedure scheduled at 8:30 AM and to establish a standardized process to increase on time starts from 11% to greater than 50% within 20 weeks.

Team of key stakeholders were assembled and goals for quality improvement project were established. Current state analysis performed via retrospective data warehouse collection and prospective monitoring of patient arrival and throughput. On time starts defined as patient arrival into computed tomography suite within 15 minutes of scheduled time. Root cause analysis and tests of change were generated during team meetings to address factors contributing to delays. Implementation phase of new processes and tests of change occurred over 20 weeks and continuous feedback was obtained. Number of on time starts and turnaround time (TAT) was monitored and collected throughout implementation phase and post implementation (control phase) for an additional 8 weeks.

Current state process map demonstrated a baseline cycle time of 62-133 minutes from patient check in to start time. Root cause analysis identified multiple factors including environment, people, processes and materials issues. 14 tests of change were developed, including standardization of process map with specific time allotments and role assignments for the procedural team. Mean TAT decreased from 71.5 to 21 minutes during implementation phase. Mean TAT further decreased to 15.9 minutes during control phase. Exams starting within 15 minutes of appointment time improved from 11% to 60% with significant outliers being due to patient late arrival and difficult IV access. Excluding these causes, on time starts improved to 82%.

Significant strides in improving workflow efficiency and patient waits and delays in the procedural space of radiology departments can be achieved by selecting a well-defined specific goal and utilizing a team approach to quality improvement.