JACR: Process improvements, same-day MRI saves $330K

By implementing processes to streamline workflow and identify problem areas contributing to inefficient care, it is possible to provide more than 90 percent of patients access to MRI within 24 hours, according to a study published in the September issue of the Journal of the American College of Radiology.

Li Zhang, PhD, and colleagues from the department of diagnostic radiology at Philipps University and University Hospital Giessen and Marburg, both in Marburg, Germany, aimed to provide better patient access to MRI within 24 hours by focusing on improving healthcare processes.

“Many healthcare organizations do not measure key parameters such as demand, capacity, patient access, process efficiency and productivity,” wrote the authors. “They are run like cottage industries of nonintegrated and dedicated artisans. Among the consequences are underutilization of very expensive resources and long patient delays.”

The researchers applied methodologies most commonly used to improve processes in manufacturing and service industries, and applied them to the radiology setting, using questionnaires to measure patient satisfaction and analyzing throughput time and increases in revenue.

Two of these methodologies, Six Sigma and Lean, were combined to form the Lean Six Sigma (LSS) framework, which uses rigorous statistical analysis to identify defects in a process and minimize variability.

A total of 33 failure modes leading to process waste were identified, along with 113 potential failure causes. Of these, 14 failure modes were prioritized, including:

• Redundant examination;

• Wrong specification of body region by referring physician;
• Superfluous documentation in the RIS; and
• Scan protocol has to be decided by technologist.

After the failure modes were identified, solutions were implemented for each. For example, rather than have technologists decide scan protocols, they are specified in the appropriateness check. Efforts were made to streamline documentation and improve checks to avoid redundancies and errors.

The study was carried out at a large academic hospital with 1,200 beds. The facility used two 1.5T MRI scanners and, on average, performed 17 examinations daily. Prior to implementing process improvements, the proportion of patient access within 24 hours was estimated to be 53 percent.

Once the LSS approach was systematically applied, patient access within 24 hours increased to more than 90 percent. Mean cycle time was reduced from 52 to 39 minutes and the monthly throughput increased by 38 percent.

As for the bottom line, revenue and savings were estimated to be about €247,000 ($335,525) in the first year after subtracting costs.

The authors acknowledged that providing timely patient access to exams is one of the fundamental challenges in diagnostic radiology, but by implementing process improvements like the LSS approach, this challenge can be overcome. The researchers concluded by pointing out the process improvements used did not increase workload, and that all costs of the study were reconciled by process improvement.