NEURO-INTERVENTIONAL ULTRASOUND

IBI OPUIYO,RDMS EXECUTIVE SPONSOR - JOSEPH STEELE,MD

Streamlining Patient Access

The project was a collaboration with ICCE, OPI, NIR Ultrasound technologists, nurses and faculty

Neuro-Interventional Ultrasound

Provide ultrasounds of the thyroid and neck regions

Referrals from various clinics throughout the institution including Endocrine, Melanoma, Head and Neck Surgery, and Lymphoma services

Number of completed patient exams in NIR US has grown in 5 year period

from just over 4,000 in FY06 to 10,000 exams and biopsies in FY11

PROBLEM

Who Is Impacted ?

Thoracic

PATIENTS

Melanoma

Head and Neck

SurgeryEndocrine

NIR

Other Referring Services

NIR US Project Goal

Decrease Delays

Increase Access

AIM

NIR will decrease the

number of days for referring

clinics to obtain diagnostic

scans for patients from 25 or

more working days to less

than 5 days by June 2011.

CAUSE ANALYSISIDENTIFYING & ASSESSING

Scheduling Environment Procedures

Limited slots for clinics

Patients

Floor Plan Issue: Waiting area, holding area, and US rooms are

far apart

Certain US rooms are only used for scanning

CLINIC HOURS OF OPERATION 8-4PM

Dictation between patients

Conferences and meetings

Adding patients without verifying current schedule

Check in early and want to be seen early

.

Lost in the hospital

Limited Patient Access to NIR

Diagnostic Scans and

Procedures

Nursing documentation take time

Wait for BX result and DIA to set up

Double duties

Allotted exam times:SCANS: 1HOURBX: 2 HOURS

No show

Multiple BXs @ once

Wait for requesting MD to reply

Arrive late (weather, traffic and other appts

Anxiety induce HTN

6 SCAN ROOMS,TECHSCongestion of appts.

PATIENT SCHEDULING TEMPLATE

WORKFLOW

PERSONNEL

CAUSE ANALYSIS

KEY ISSUES SCHEDULING

LIMITATIONS

OPERATIONS

PROCESSES

WORKFLOW

BASELINE DATAPERFORMANCE ASSESSED

Capacity Backlog : Scheduling

Max 38 potential appointment slots/day

25 day delay for next available appointment

Process Analysis: Scheduling

Issue: limited appointment slots

available

Operations: Processes

Workflow

Personnel

Situational Processes

Practical Processes

Operations: Asset Utilization

HIGH VOLUME

DATES NUMBER OF PROCEDURES

1/21/20111/24/20111/27/20111/31/2011

2/7/20112/9/2011

2/11/20112/15/20112/25/20112/28/2011

3/2/20113/4/20113/8/20113/9/2011

3/16/20113/23/20113/28/20113/29/20113/30/2011

4/1/20114/5/2011

57.6775.3765.7166.58

68.7266.643.760.9271.43

PRE TEMPLATE ROOM UTILIZATION

BEGIN TO LEAVE DEPT.

75.4155.37

4944

74.9649.0264.8157.4956.1745.864662.5958.9152.69

445244

4648

504647484949454754

47.57 61.19

5349

AVERAGE TIME IN MINUTES

4445 55.11

01020304050607080

40

56

4

40

56

7

40

57

0

40

57

4

40

58

1

40

58

3

40

58

5

40

58

9

40

59

9

40

60

2

40

60

4

40

60

6

40

61

0

40

61

1

40

61

8

40

62

5

40

63

0

40

63

1

40

63

2

40

63

4

40

63

8Av

era

ge

tim

e i

n R

oo

ms

High Volume Dates

Pre Template Room utilization

INTERVENTIONSPHASED APPROACH

SCHEDULE

Management team began complete restructuring of scheduling template

Opening of initial set of additional scheduling slots for servicing clinics. This addressed immediate bottleneck issues.

OPERATIONS

Personnel changes to accommodate expanded schedule.

1. New technologist schedule

2. New temporary Imaging Assistant

• Phase I• Feb 1, 2011 to March 10, 2011

SCHEDULE

Process changed for ordering diagnostic scans/biopsies

Communications and education of referring service Clinical Coordinators on forthcoming schedule template usage

OPERATIONS

Departmental operational hours expanded

• Phase II• March 11, 2011 to April 14, 2011

Go Live: opening of restructured scheduling template

Data gathered for 90 day assessment of combined changes

• Phase III• April 15,2011 to July 15, 2011

The success of the project was measured using two metrics

The number of available daily slots for procedures or scans.

The time to next appointment for a diagnostic ultrasound and biopsy

Results

The data reveals that measured improvements are attributed to :

SCHEDULE

The new scheduling template

NIR Clinical Operations Report Summary

Template Timeslots Available Jan. Feb. March April May June July

Scan w/biopsy timeslots 10 10 10 14 16 16 16

Scan only timeslots 18 18 23 24 25 25 25

Overbook timeslots 10 10 10 12 14 14 14

Total Timeslots 38 38 43 50 55 55 55

Available appointment slots increased from 38 to 55

Scheduling Template

Results

1/13

/201

1

1/18

/201

1

1/21

/201

1

1/25

/201

1

1/27

/201

1

2/4/

2011

2/18

/201

1

3/4/

2011

3/18

/201

1

4/1/

2011

4/15

/201

1

4/29

/201

1

5/13

/201

1

5/27

/201

1

6/10

/201

1

6/24

/201

1

7/8/

2011

0

10

20

30

40

50

60

70

80

NUMBER OF WORKDAYS FOR NEXT AVAILABLE APPOINTMENT

Scan/Biopsy Overbook

Scan/Biopsy Template

Scan Only Overbook

Scan Only Template

WORK WEEK

# W

OR

KD

AY

S

The data reveals that measured improvements are attributed to :

OPERATIONS

Pre assessments

Extended department hours of operation

Change in personnel (tech/MD) schedules

Additional Imaging Assistant (personnel changes)

New lead technologist role

AVERAGE TIME IN MINUTES:

Pre Template Post Template

61.19 minutes 54.63 minutes

 

Room utilization improved. The time to perform one complete procedure (time from patient entering the room to exiting the room) decreased 6.6 minutes.

0

10

20

30

40

50

60

70

80

90 Day NIR Room Utilization Times

Pre Template Room Uti-lization Times Jan 2011- Apr 2011Post Template Room Uti-lization Times Apr 2011- July 2011

90 Day Period

Ro

om

Usa

ge

Per

Pat

ien

t S

een

in

Min

ute

s

Calculation Summary / ROI

Year 0 Year 1 Year 2 Year 3

Cost of Capital 9.20%

Investments/Costs (3,906) 0 0 0

Benefit/Revenue 120,919 120,919 120,919

Annual Net Benefit/Revenue(Costs) (3,906) 120,919 120,919 120,919

 Benefit/Revenue Including Soft Savings 120,919 120,919 120,919Annual Net Benefit (Costs) Including soft Savings (3,906) 120,919 120,919 120,919

Risk Adjusted ROI = Net Present Value of Cumulative Net Benefit / Net Present Value of Total CostsRA ROI(Margin for yrs 1-3 discounted @ Cost of Capital %) 6959%Net Present Value $275,722.78Internal Rate of Return (Expected Return) 3096%

NEXT STEPS

Thank You

NIR US Process Improvement Teams NIR US Manager Tonya Brightmon Executive Sponsor Dr. Steele