1. Streamlining Patient Access

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

3. 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

4. PROBLEM

5. Who Is Impacted ? Thoracic PATIENTS Melanoma Head and Neck Surgery Endocrine NIR Other Referring Services

6. NIR US Project Goal Decrease Delays Increase Access

7. 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.

8. IDENTIFYING & ASSESSING

9.  PATIENT SCHEDULING TEMPLATE  WORKFLOW  PERSONNEL CAUSE ANALYSIS

10. KEY ISSUES  SCHEDULING  LIMITATIONS  OPERATIONS  PROCESSES  WORKFLOW

11. PERFORMANCE ASSESSED

12. Capacity Backlog : Scheduling  Max 38 potential appointment slots/day  25 day delay for next available appointment

13. Process Analysis: Scheduling

14. Operations: Processes  Workflow  Personnel  Situational Processes  Practical Processes

15. Operations: Asset Utilization

16. PHASED APPROACH

17. 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

18. 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

19.  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

20. 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

21. The data reveals that measured improvements are attributed to : SCHEDULE  The new scheduling template

22. NIR Clinical Operations Report Summary Template Timeslots Available Jan.Feb.MarchAprilMayJuneJuly Scan w/biopsy timeslots 10 1416 Scan only timeslots 18 232425 Overbook timeslots 10 1214 Total Timeslots 38 435055 Available appointment slots increased from 38 to 55

23. Scheduling Template Results

24. 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

25. 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.

26. Calculation Summary / ROI Year 0Year 1Year 2 Year 3 Cost of Capital 9.20% Investments/Costs (3,906)000 Benefit/Revenue 120,919 Annual Net Benefit/Revenue(Costs) (3,906)120,919 Benefit/Revenue Including Soft Savings 120,919 Annual Net Benefit (Costs) Including soft Savings (3,906)120,919 Risk Adjusted ROI = Net Present Value of Cumulative Net Benefit / Net Present Value of Total Costs RA ROI (Margin for yrs 1-3 discounted @ Cost of Capital %)6959% Net Present Value$275,722.78 Internal Rate of Return (Expected Return)3096%

27. NEXT STEPS

28. Thank You  NIR US Process Improvement Teams  NIR US Manager Tonya Brightmon  Executive Sponsor Dr. Steele