ED-CT Exam Turnaround Time - Loyola...
Transcript of ED-CT Exam Turnaround Time - Loyola...
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ED-CT Exam
Turnaround Time
Lean Six Sigma Green Belt Project
CT Staff ED Staff
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Problem Statement:
From Jan – Jun 2012, the average turnaround time for Head CT exams
(without contrast) performed in the ED was 68 minutes. The average turnaround
time for Abdomen/Pelvis CT exams (with contrast) was 201 minutes.
Primary Measure: Turnaround time = order to preliminary report
Business Case:
By reducing turnaround time, we will improve patient throughput in ED,
increase patient engagement, and provide a better patient experience.
Scope:
Project Charter
D M A I C
In Out
CT exams performed in the ED:
• Head CT exams without contrast
• Abdomen / Pelvis (Abd/Pel) CT
exams with contrast
• All other CT exams
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Project Timeline (start dates):
Project Charter
D M A I C
Define Aug 15
Measure Aug 30
Analyze Sep 18
Resources:
• Champion: Dawn Csipo Assnt. Mng of ED, Kim Lenner Admin. Dir of Radiology
• Team Leader: Cliff Sissel Mgt of CT Rad
• Team: Radiology CT Techs, ED Nursing
• OpEx Practitioners: Sandy Chakonas and Jordan Erickson
Improve Sep 28
Control Nov 15
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High-Level Map (SIPOC)
D M A I C
Supplier Input Process Output Customer
ED MDs
ED RNs
CT Techs
Lab
Patient
Order
1. MD orders CT
2. Lab draws, prep
given
3. CT Tech transports
pt to exam room
4. CT scan completed
5. Pt returned to ED
room
6. Exam is reported to
MD
Images
Reports
Patient
ED MDs
Other
clinical
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Process Map
D M A I C
Process map highlighted:
• Big gap in communication between ED RNs and CT Techs
• Patients not informed
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360300240180120600
180
160
140
120
100
80
60
40
20
0
Turnaround Time (minutes)
Fre
qu
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cy
CT Exams: Head(January - June 2012)
Mean
Baseline Data
D M A I C
N (exams) 995 25th Percentile 36
Mean 68 Median 59
StdDev 44 75th Percentile 91
Data source: RIS; Jan – Jun 2012;
removed TAT > 400 minutes (0.5% of exams)
Head: Turnaround time is skewed to the right
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360300240180120600
30
25
20
15
10
5
0
Turnaround Time (minutes)
Fre
qu
en
cy
CT Exams: Abdomen/Pelvis(January - June 2012)
Mean
Baseline Data
D M A I C
N (exams) 251
Mean 201
StdDev 61
Abd/Pel: Turnaround time is much longer and more “bell-shaped”
25th Percentile 163
Median 200
75th Percentile 237
Data source: RIS; Jan – Jun 2012;
removed TAT > 400 minutes (0.5% of exams)
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Baseline Data
D M A I C
Turnaround times for Head and Abd/Pel are stable week-to-week
JunMayAprMarFebJan
Wk23Wk19Wk14Wk10Wk06Wk01
100
90
80
70
60
50
40
Me
an
Tu
rna
rou
nd
Tim
e (
min
ute
s)
CT Exams: Head(January - June 2012)
JunMayMayAprMarMarFebJanJan
Wk25Wk22Wk19Wk16Wk13Wk10Wk07Wk04Wk01
300
250
200
150
100
Me
an
Tu
rna
rou
nd
Tim
e (
min
ute
s)
CT Exams: Abdomen/Pelvis (January - June 2012)
# of CT exams Min Median Max
Head 152 163 192
Abd/Pel 34 42 57
Monthly volume:
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Baseline Data
D M A I C
We divided each exam’s turnaround time into three segments:
1. Order to begin exam
2. Begin exam to complete exam
3. Complete exam to preliminary report
Then we calculated each segment’s percentage of the total turnaround time
for all Head and Abd/Pel CT exams:
Order Prelim Begin Complete
Turnaround Time
Order Prelim Begin Complete
40% 16% 44%
Head CT Exams
Order Prelim Begin Complete
70% 8% 22%
Abd/Pel CT Exams
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We brainstormed 27 potential causes to delays in turnaround time. We
affinitized these potential causes into 5 general categories:
1) Orders / Contrast (wrong order, MD examining pt
after placing order, PO contrast)
2) Protocoling (Rad Resident busy, conference)
3) Patients
(non-compliance, language)
4) Nursing / Ancillary (waiting for lab results, RN busy)
5) Other (Holding Trauma room, lack of communication)
Identify Potential Causes
D M A I C
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We voted on what we believed to be the 3 most influential root causes:
1) CT room held for traumas
2) Delay in PO contrast
3) Delay in lab tests
Table these for another project:
• Delay in protocoling
• ED busy
Determine Root Causes
D M A I C
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Suspected Root Causes Verification
1) CT room held for traumas 53% of traumas did not need CT
exam (56 out of 105 exams)
2) Delay in PO contrast Time from order to begin exam
consumes 70% of turnaround time
3) Delay in lab tests NOT a root cause
Verify Root Causes
D M A I C
120600
480
420
360
300
240
180
120
60
0
CT Order to Lab Result (minutes)
Tu
rna
rou
nd
Tim
e (
min
ute
s)
Turnaround Time vs Creatinine Lab Results
(Removed 4 extreme values: turnaround > 500 minutes)
(CT Exams: Abdomen/Pelvis, N = 106)
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We brainstormed possible solutions for each root cause. We voted on and
selected 3 solutions to implement:
Root Causes Solutions
1) CT room held Determine CT room hold time
for traumas ED notify Techs when trauma in-house
2) Delay in PO contrast Tech assumes active role in
CT preparations
Possible Solutions
D M A I C
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Determine CT room hold time
ED notify Techs when
trauma in-house
We met with Dr. Esposito (Dir of Trauma
to discuss data and agreed to
continue CT workflow without
holding the room through comm.
between Tech and trauma Chief
regarding pending exams
Future State
D M A I C
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Tech assumes active role in CT preparations
Future State
D M A I C
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We created a Gantt chart of the tasks that needed completion in order to
implement the solutions; the “go live” date was Nov 1
Pilot Plans
D M A I C
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Head CT exams are faster and more predictable (Before: Jun, After: Nov)
Results
D M A I C
*P-value = 0.04, two-sample t test **P-value = 0.03, Mann-Whitney test †P-value = 0.03, Levene’s test
Avg exams per month: 163
Hours saved per month: 30
40
30
20
10
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30
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Before
Turnaround Time (minutes)
# o
f C
T H
ead
Exa
ms
After
CT Exams: Head(Before: Jun; After: Nov)
Median
Median
(minutes) N Mean StdDev Median IQR
Before 152 66 41 58 52
After 124 58 36 47 36
* 8 **
5 † 11
16
18
8
6
4
2
0
360300240180120600
8
6
4
2
0
Before
Turnaround Time (minutes)
# o
f C
T A
bd
/Pel
Exa
ms
After
CT Exams: Abd/Pel(Before: Jun; After: Nov)
Median
Median
Abd/Pel CT exams are faster (Before: Jun, After: Nov)
Results
D M A I C
*P-value = 003, two-sample t test **P-value = 0.02, Mann-Whitney test †P-value = 0.52, Levene’s test
Avg exams per month: 42
Hours saved per month: 29
(minutes) N Mean StdDev Median IQR
Before 44 203 65 204 96
After 47 174 58 163 88
* 29 **
7 † 41
8
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Control Plan
D M A I C
What Who When
• Handed out education material to ED staff;
posted material in ED
Cliff 11/1/12
• Monitor turnaround times;
present results in ED and CT staff meetings
Cliff Ongoing
Educational Material
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• ED RN: It’s nice to see we are working hard as a team to make the
patient experience better by speeding up the processes.
• ED RN: “Went to check on a patient, they were drinking contrast, I
hadn’t realized a CT was ordered, saved about an hour and
a half of time on their length of stay in the ED”
• CT Tech: “The nurse’s seem to really like that we are involved it frees
them up to focus on other patients and not feel they are
ignoring the patient that we prep.”
• ER RN: When it is busy we will still prep the patient especially if we
know the tech is busy.
• CT Tech: I realized prepping my patient was the right thing when she
told me my explanation put her as ease and that she looked
forward to seeing me in a hour for the test.
Lessons Learned
D M A I C