1 Clinical Safety & Effectiveness Session # 14 CT Mays Delay Project DATE

2 Background Mays CT began with 175 patients per day. The clinic operates from 6:30am to 11:00pm.Monday through Friday. Due to institutional objectives to increase patient volumes we have increased the schedule to 210 patients per day. (Thankfully not all of them show up) The existing scheduling template does not allow for any hic- ups in the schedule without backing up patient care. This is a daily challenge.

Background Several previous attempts at reducing the patient delays have identified barriers but most of which could not be achieved. – Adding staffing – Adding more interview rooms – Reduce the interview time per patient – Reducing the number of patients 3

Our Aim Statement “To improve operational effectiveness and efficiency in the CT Mays Section by reducing average delay time (patient procedure start time –appointment time) from ~48 minutes to 20 minutes by June 30,2011.”

5 Baseline Data Baseline Extensive baseline data was extracted from the Radiology Information System (RIS) by the division’s information analyst to determine baseline: Average patient delays Average appointments per day CT Mays scheduling template Room utilization Data collection timeline – Baseline data June-Dec 2010 – Midway evaluation Jan-March 2011 – Final data extraction-April-June 24 th 2011

Fishbone

Project Plan Standardization of processes for all staff in CT – Operational definitions Improve teamwork – Team Huddles for each shift to discuss workload, previous shift concerns and impact on operations as well as staff expectations – Work with OPI to leverage small wins and further team development and employee empowerment Improve functionality of Online protocols – Flow chart and fishbone diagram were shared with the EMR development team to tackle numerous bottlenecks

Project Plan Cont’d Getting the patient ready for the interview process sooner – Utilize all nursing staff, regardless of assignment to interview the first patients. – Utilizing all available rooms to interview first patients including prep rooms if open – Streamline PR1 – Adjust staffing schedule to accommodate early patients Template reorganization – Adding time specifically for completing assessment tool – Loading no-oral contrast procedures from 6:10-8:40 appointments 11

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Original Scheduling Template 13 7:00 AM7:20 AM7:40 AM8:00 AM8:20 AM8:40 AM9:00 AM9:20 AM9:40 AM 10:00 AM10:20 AM10:40 AM11:00 AM11:20 AM11:40 AM 12:00 PM12:20 PM12:40 PM 1:00 PM1:20 PM 1:40 PM 2:00 PM2:20 PM2:40 PM3:00 PM3:20 PM3:40 PM4:00 PM4:20 PM4:40 PM5:00 PM5:20 PM5:40 PM6:00 PM6:20 PM6:40 PM7:00 PM7:20 PM7:40 PM8:00 PM8:20 PM8:40 PM S1 S2 S3 S4 S5 Can be any patient type All slots are based on scan time appointments, prep is populated automatically Day end on Friday Can only be non- drinking patient Some patients such as Lymphoma require a 40 minute block Byy manager's discretion only If a time is manually entered such as 2:10, it takes up both the 2:00 and 2:20 slots

Revised Scheduling Template ACB CT Scheduling Template 7:00 AM7:20 AM7:40 AM8:00 AM8:20 AM8:40 AM9:00 AM9:20 AM9:40 AM 10:00 AM10:20 AM10:40 AM11:00 AM11:20 AM11:40 AM 12:00 PM12:20 PM12:40 PM 1:00 PM1:20 PM1:40 PM2:00 PM2:20 PM2:40 PM3:00 PM3:20 PM3:40 PM4:00 PM4:20 PM4:40 PM5:00 PM5:20 PM5:40 PM6:00 PM6:20 PM6:40 PM7:00 PM7:20 PM7:40 PM8:00 PM8:20 PM8:40 PM Schedule 1 Schedule 2 Schedule 3 Schedule 4 Schedule 5 Can be any patient type All slots are based on scan time appointments, prep is populated automatically Day end on Friday Can only be non- drinking patient Some patients such as Lymphoma require a 40 minute block By Manager’s Discretion Only If a time is manually entered such as 2:10, it takes up both the 2:00 and 2:20 slots

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ROI 16 Qualified Benefits ~19 minute improvement in getting patients’ scans started on schedule. Improved Morale / Staff Satisfaction Improved work relations about everyone, especially between shifts Improved Communication $19,479 Morning patients will be asked to come in earlier temporarily

17 Actions Based on Results Continue to evaluate the scheduling template – to maximize the effective use of the resources available – and minimize patient delays. Continue to foster teambuilding with the assistance of OPI/ team development program. – Continue team huddles to keep all team members appraised of operational issues and keep lines of communication open – Roll out all CS&E changes from Mays CT to the other CT areas in Main and the ROC. Continue to collaborate with Dr. McEnery and the EMR team – to eliminate the bottlenecks associated with the CT online protocol – to roll out an electronic version of the Patient Record 1 (PR1) assessment tool. Incorporate findings from the flow chart and fishbone into the Future CT Mays area redesign project – to accommodate actual growth and workflow..

Ongoing / Future Plans Team Building Ongoing Simplified PR1s August 2011 Data follow-up Quarterly through FY12 Template follow-up------Quarterly through FY12 Redesign of Mays CT-----In planning phase Online PR1s

Key Learning Variation should be considered when determining workload capabilities Employees WANT details and communication Don’t underestimate team “storming” Without standardized definitions, everyone had their own version Synergy in huddles 19

20 Special Thanks Team Members – CS&E Participant –Jerry Montalvo (Team Lead) CT supervisor – CS&E Participant –Martha Riley CQI Coordinator – Team Member-Alice Benson-ANM – Team Member-Maria Mallari-RN – Team Member –Paulose Mathai-CT Coordinator – Team Member-Dan Morrissey-CT supervisor – Team Member-Ashley Raglin-PSC – Team Member-Leonora Sumodobila-ANM – Team Member-Elsy Thomas-RN – Team Member-Dea Tulio-ANM – Team Member-Cynthia Williams-PSC supervisor – Team Member-Wendy Benedict-Sr. Information Analyst – Facilitator-John Terrell-Sr. Industrial Engineer – Carlos Sponsor – Joseph Steele M.D., Associate Professor, Diagnostic Imaging, Deputy Division Head of Operations

21 Thank you!