Increasing Access and Efficiency of the Medical Imaging ......• Agreed MI patient flow TAT Targets...
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Project Gains to Date • Increased Nursing staff in MI holding bay both in and out of hours, increasing more effective, safe supervision and escorts for patients between MI and ED. • Reduced TAT for CT, XR and U/S – See Figures 1, 2 & 3. • Established Governance links between MI, ED and RNS Executive. • Improved understanding from ED and Executive regarding MI workflow processes, limitations, and constraints. • Agreed MI patient flow TAT Targets – reported monthly. • Reliable transparent data and workload visualisation; including agreed TAT targets, expression of rtime0of-day-changes and the directed application of increased resources. • Agreed ‘flex up’ resourcing - Step 1, 2 and 3. • 2019/2020 workforce/fiscal planning and proposals. • Additional evening Technical Assistant. • MI/ED nurse escort protocol ISBAR handover. • Increased accuracy and visibility of data through use of two systems –FSI transport booking/QlikSense. Starting Objectives: Objective 1: Reduce the median in-house reporting hours TAT for CT ED Patients, from Request to Report in 2 hours 21 minutes to 2 hours by April 2019. Objective 2: Reduce the median 24 hour TAT for X-Ray ED patients, from Request to Exam Finished from 38 minutes to 30 minutes by April 2019. Objective 3: Reduce the median in-house reporting hours TAT for Ultrasound ED patients, from Request to Report in 2 hours 42 minutes to 2 hours by April 2019. (Objective measured using Radiology Information System Statistics) Increasing Access and Efficiency of the Medical Imaging Department’s Service for Emergency Patients Kate Erdman Senior Radiographer - RNSH Calum Rogerson Radiographer - RNSH Lenae Dean Service Improvement Project Officer Acknowledgements: The COGS Team would like to thank our sponsors: Sarina Klages | Executive Director Medical Imaging NSLHD Marian Roberts | Clinical Director Medical Imaging, RNSH Nathan Emanuel | Chief Radiographer NSRHS, and the ACI Contact: Calum Rogerson – Radiographer RNS Radiology | Ph:02 99264454 |Email: [email protected] Largest reduction in TAT – latest U/S Report (from Feb’19-Mar’19) Weekday In Hours: 81% of volume. • Median TAT has reduced by 73 minutes. • Average TAT has reduced by 113 minutes. Method The Centre for Healthcare Redesign Methodology was used for this project, in collaboration with the Agency for Clinical Innovation, Medical Imaging (MI), Emergency Department (ED), and RNS Executive. Sustaining Change MI will continue on the solutions with the future implementation of 2 data systems which will aid real time visualisation and manage patient flow. Departmental targets and governance will be monitored and reported by project sponsors via 1. the ‘Best care together’, 2. ED/MI and 3. ‘Front door’ meetings, ensuring changes are sustained, workflow trends are identified and proactively managed. Goal To support the Emergency Treatment Performance (ETP) target of the hospital by reducing the time taken for ED patients to receive medical imaging and diagnostic reports, aiding clinical decisions and care pathways, while consistently maintaining high quality and safe patient care Moving Forwards The largest constraint for MI services is the accurate reporting, communication, and impact of complex patient imaging, workflow, and expression of volume/capacity. The implementation of QlikSense across NSW hospitals will enable a enhanced visualisation of the challenges facing MI demand, and assist in an efficient application of resources. This project has established a structure and governance pathway for the department that was not previously applied. It has further enhanced executive understanding of the issues facing this department and its impact on whole of hospital patient flow. Future projects can build from the base established in this redesign project allowing the MI department to sustain high levels of patient care and safety while continuing to work towards the objectives set; essentially achieving the right treatment in a timely fashion with accurate and precise diagnostic imaging for each patient. Diagnostics Qualitative and quantitative data was gathered using a variety of methods: Data Analysis: • Centricity RIS Data analysis 2014-2019 (n=Approx 900,000 examinations). • BIU Emergency Data Analysis. Process mapping: • Radiology Process mapping (n=35) Patient Tag-A-Longs (n=6) Staff Roster Reviews. Staff surveys: • MI Staff Survey (n=75) ED Staff Survey (n=40) Patient Survey (n=7). • Healthshare Survey (n=10) MI Interviews (n=15) Patient Interviews (n=10). Historical Analysis: • Previous Project Reviews (n-4) Literature review, IIMS Analysis (2014-2018). • Patient RIS/EMR Review, Financial Analysis (2014-2018). 226 issues were raised during our diagnostics phase. ED issues were passed to ED management. MI issues were stratified into 5 key areas with root causes identified. This was then brought to the Steering committee, for prioritisation and solution design. 4. Improve Orderly transfer times: Implementing extra orderly shifts 7.30am/3pm. Level 2 supervisor. Orderly Co-ordinator. • Orderly electronic booking system to make transport workflow visible/accountable. – Planned implementation June 2019. 2. Improve TAT data accuracy and utilisation: Develop QlikSense to ensure accurate, transparent data that enables senior executive decision makers to act appropriately and plan for the future of the department. Recognise and appreciate the different workflow processes that occur in Radiology during different time markers representing “end points”. Visualise real-time workload using QlikSense for more timely response to increased demand. 1. Improve Governance: Re-establish governance links to RNS and ED executive for issue escalation and improve collaborative relationship and MI advancement. Agreed performance targets, and MI capacity v resources limitations. Three step ‘flex up’ activation system based on demand/capacity to manage increased demand in MI services - Implementation with QlikSense workflow module June 2019. 3. Improve Patient flow through MI by: Developing, endorsing and implementing a new MI/ED Nurse Escort Flowchart. Defining and implementing agreed patient flow actions and responsibilities for all MI disciplines – Full implementation by Sept 2019. Planning and Implementing Opportunities 5. Match staffing to demand: Better align current resources to demand. Staffing increase briefs for FY 2019/2020 – Radiologists, Radiographers, Nurses, Technical Assistants. For ED Patients: Access block and overcrowding in the Emergency department (ED) is widely associated with poorer outcomes for emergency patients. This can lead to: • Unnecessary deaths. • Delays in ambulance off loads. • Increased length of stay in hospitals (LOS). • Delays in treatment. • Risk of cross infection. • Adverse effects on the work force. What is TAT? TAT is shorthand for Turn Around Time. It is the time from when we start the clock to the time we stop the clock. For Medical Imaging, it is the time from the Request until the Report is released. We measure this as a median value, in minutes. For MI Patients: In 2018 MI received 54,283 ED requests for imaging using either X-ray, CT, or Ultrasound. Case for Change 145 169 145 222 178 192 259 186 0 50 100 150 200 250 300 U/S TAT 37 37 36 33 36 35 43 36 0 5 10 15 20 25 30 35 40 45 50 X-Ray TAT 168 158 158 115 122 116 120 121 0 20 40 60 80 100 120 140 160 180 Time (mins) CT TAT Figure 1 – CT Target. Figure 3 – XRAY Target. Figure 2 – US Target. Objective (Mins) Target (Mins) Legend: Solution Process Measures:
Transcript of Increasing Access and Efficiency of the Medical Imaging ......• Agreed MI patient flow TAT Targets...
Project Gains to Date• Increased Nursing staff in MI holding bay both in and out of hours, increasing more
effective, safe supervision and escorts for patients between MI and ED.
• Reduced TAT for CT, XR and U/S – See Figures 1, 2 & 3.
• Established Governance links between MI, ED and RNS Executive.
• Improved understanding from ED and Executive regarding MI workflow processes, limitations, and constraints.
• Agreed MI patient flow TAT Targets – reported monthly.
• Reliable transparent data and workload visualisation; including agreed TAT targets, expression of rtime0of-day-changes and the directed application of increased resources.
• Agreed ‘flex up’ resourcing - Step 1, 2 and 3.
• 2019/2020 workforce/fiscal planning and proposals.
• Additional evening Technical Assistant.
• MI/ED nurse escort protocol ISBAR handover.
• Increased accuracy and visibility of data through use of two systems –FSI transport booking/QlikSense.
Starting Objectives:Objective 1: Reduce the median in-house reporting hours TAT for CT ED Patients, from Request to Report in 2 hours 21 minutes to 2 hours by April 2019.Objective 2: Reduce the median 24 hour TAT for X-Ray ED patients, from Request to Exam Finished from 38 minutes to 30 minutes by April 2019.Objective 3: Reduce the median in-house reporting hours TAT for Ultrasound ED patients, from Request to Report in 2 hours 42 minutes to 2 hours by April 2019.(Objective measured using Radiology Information System Statistics)
Increasing Access and Efficiency of the Medical Imaging Department’s Service for Emergency Patients Kate Erdman Senior Radiographer - RNSH Calum Rogerson Radiographer - RNSH Lenae Dean Service Improvement Project Officer
Acknowledgements:The COGS Team would like to thank our sponsors:
Sarina Klages | Executive Director Medical Imaging NSLHD
Marian Roberts | Clinical Director Medical Imaging, RNSH
Nathan Emanuel | Chief Radiographer NSRHS, and the ACI
Contact:Calum Rogerson – Radiographer RNS Radiology | Ph:02 99264454 |Email: [email protected]
Largest reduction in TAT – latest U/S Report (from Feb’19-Mar’19)
Weekday In Hours: 81% of volume. • Median TAT has reduced by 73 minutes.
• Average TAT has reduced by 113 minutes.MethodThe Centre for Healthcare Redesign Methodology was used for this project, in collaboration with the Agency for Clinical Innovation, Medical Imaging (MI), Emergency Department (ED), and RNS Executive.
Sustaining ChangeMI will continue on the solutions with the future implementation of 2 data systems which will aid real time visualisation and manage patient flow. Departmental targets and governance will be monitored and reported by project sponsors via 1. the ‘Best care together’, 2. ED/MI and 3. ‘Front door’ meetings, ensuring changes are sustained, workflow trends are identified and proactively managed.
GoalTo support the Emergency Treatment Performance (ETP) target of the hospital by reducing the time taken for ED patients to receive medical imaging and diagnostic reports, aiding clinical decisions and care pathways, while consistently maintaining high quality and safe patient care
Moving ForwardsThe largest constraint for MI services is the accurate reporting, communication, and impact of complex patient imaging, workflow, and expression of volume/capacity. The implementation of QlikSense across NSW hospitals will enable a enhanced visualisation of the challenges facing MI demand, and assist in an efficient application of resources. This project has established a structure and governance pathway for the department that was not previously applied. It has further enhanced executive understanding of the issues facing this department and its impact on whole of hospital patient flow. Future projects can build from the base established in this redesign project allowing the MI department to sustain high levels of patient care and safety while continuing to work towards the objectives set; essentially achieving the right treatment in a timely fashion with accurate and precise diagnostic imaging for each patient.
DiagnosticsQualitative and quantitative data was gathered using a variety of methods: Data Analysis: • Centricity RIS Data analysis 2014-2019 (n=Approx 900,000 examinations).• BIU Emergency Data Analysis.Process mapping:• Radiology Process mapping (n=35) Patient Tag-A-Longs (n=6) Staff Roster
Reviews.Staff surveys:• MI Staff Survey (n=75) ED Staff Survey (n=40) Patient Survey (n=7).• Healthshare Survey (n=10) MI Interviews (n=15) Patient Interviews (n=10).Historical Analysis:• Previous Project Reviews (n-4) Literature review, IIMS Analysis (2014-2018).• Patient RIS/EMR Review, Financial Analysis (2014-2018).
226 issues were raised during our diagnostics phase. ED issues were passed to ED management. MI issues were stratified into 5 key areas with root causes identified. This was then brought to the Steering committee, for prioritisation and solution design.
4. Improve Orderly transfer times: Implementing extra orderly shifts
7.30am/3pm. Level 2 supervisor. Orderly Co-ordinator.• Orderly electronic booking system
to make transport workflow visible/accountable. – Planned implementation June 2019.
2. Improve TAT data accuracy and utilisation: Develop QlikSense to ensure accurate,
transparent data that enables senior executive decision makers to act appropriately and plan for the future of the department.
Recognise and appreciate the different workflow processes that occur in Radiology during different time markers representing “end points”.
Visualise real-time workload using QlikSense for more timely response to increased demand.
1. Improve Governance: Re-establish governance links to RNS
and ED executive for issue escalation and improve collaborative relationship and MI advancement.
Agreed performance targets, and MI capacity v resources limitations.
Three step ‘flex up’ activation system based on demand/capacity to manage increased demand in MI services -Implementation with QlikSense workflow module June 2019.
3. Improve Patient flow through MI by: Developing, endorsing and
implementing a new MI/ED Nurse Escort Flowchart.
Defining and implementing agreed patient flow actions and responsibilities for all MI disciplines – Full implementation by Sept 2019.
Planning and Implementing Opportunities
5. Match staffing to demand: Better align current resources to
demand. Staffing increase briefs for FY
2019/2020 – Radiologists, Radiographers, Nurses, Technical Assistants.
For ED Patients:Access block and overcrowding in the Emergency department (ED) is widely associated with poorer outcomes for emergency patients. This can lead to: • Unnecessary deaths. • Delays in ambulance off loads.• Increased length of stay in hospitals (LOS).• Delays in treatment.• Risk of cross infection.• Adverse effects on the work force.
What is TAT?TAT is shorthand for Turn Around Time.It is the time from when we start the clock to the time we stop the clock.For Medical Imaging, it is the time from the Request until the Report is released.We measure this as a median value, in minutes.
For MI Patients:In 2018 MI received 54,283 ED requests for imaging using either X-ray, CT, or Ultrasound.
Case for Change
145169
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178192
259
186
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U/S TAT
37 37 3633
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X-Ray TAT
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Tim
e (m
ins)
CT TAT
Figure 1 – CT Target. Figure 3 – XRAY Target.Figure 2 – US Target.
Objective (Mins)Target (Mins)
Legend:
Solution Process Measures:
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