Radiation Oncology Report (Turn-Around Time)

Committee Members:

Najeeb Mohideen, MD

Autis Speights, Manager Radiation Oncology

Preston Bricker, Sr. Systems Analyst

Patricia Lenkart, Transcriptionist

Opportunity Statement and Desired Outcome

Report turnaround time for reports was approximately 4 weeks,causing a problem with reports not being available when patients returned for follow-up visits in Radiation Oncology.

Our goal is to ensure that all dictated medical documents are transcribed and distributed in a timely manner inter-departmentally as well as externally.

Most Likely Causes for Current Opportunity

Transcription staff and faculty were located at different facilities.(Dictation tapes were transported via courier)

Computer System: Antiquated (No ability to share information electronically)

Workflow based on delivery date of tapes (Not date of service)

Staffing level not sufficient: (Ratio of transcription to physicians was 1 to 9)

Solutions Implemented

Initial backlog of dictation was outsourced while team was working on a more streamlined process.

Transcription relocated closer to physician offices. Tape submission/courier pick-up deadlines were

reengineered to accommodate physician routine. Reduced number of drop off locations for

physicians. Physician work room and transcription mail box.

Increased number of courier pick-ups @ Loyola Clinic.

• Work flow based on date of service. Monitored date of service and delivery time.

• ROIS system was purchased and installed. Radiation Oncology Information System (IMPAC)

• Staffing level was adjusted Decreased transcription to physician ratio, 1 to 4

Progress to Date

Original Process Process Improvement Step #1: Physician dictates initial consult Physician dictates initial consult (Loyola Clinic) Loyola Clinic/Cancer CenterStep #2: Places dictated tape in courier location Physician deliver tapes to

transcription (Loyola Clinic) McGuire Bldg

Step #3: Transport to Hines V.A. clinic Hines dictation transported from Hines One a.m. / One p.m. pick-up and drop off clinic to transcription room @ Loyola.

Step #4: Transcription pick-up tapes Dictation tapes transcribed by service date

Multiple locations

Step #5: Transcribed by delivery date Documents available in IMPAC

First in First out

Step #6: Documents transported back to Loyola Electronic physician approval Physician correction and approval

Result: 4 or more weeks to final approval Result: More efficient process and patient chart

Results and Analysis

0

5

10

15

20

25

30

35

Before After

Before and After Intervention

Report Availability and Distribution (following ROIS implementation)

Delivery Transcription Approval

Conclusions

Change to date of service workflow reduced overall TAT. 24-32 days to 10 days

• Streamlining key points in processes helped to further reduce TAT. 10 days to average of 5-7 days

• Implementation of ROIS system (IMPAC) allowed us to reach our goal of complete transcribed documents within 24 hours of the date of service and filed in patient record within 5-7 days. On-line viewing/edits of documents Electronic approval and signature On line access to completed documents by

clerical staff

Next Steps Make Radiation Oncology documents

available to other physician groups through utilization of electronic medical record.

• Refine existing processes so that electronic and paperless environment can be fully implemented.

• Continue to improve TAT at Hines V.A. clinic.