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Applying Systems Engineering Reduces Radiology Transport Cycle Times in the Emergency Department

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Emergency department (ED) crowding is widespread, and can result in care delays, medical errors, increased costs, and decreased patient satisfaction. Simultaneously, while capacity constraints on EDs are worsening, contributing factors such as patient volume and inpatient bed capacity are often outside the influence of ED administrators. Therefore, systems engineering approaches that improve throughput and reduce waste may hold the most readily available gains. Decreasing radiology turnaround times improves ED patient throughput and decreases patient waiting time. We sought to investigate the impact of systems engineering science targeting ED radiology transport delays and determine the most effective techniques.

Methods: This prospective, before-and-after analysis of radiology process flow improvements in an academic hospital ED was exempt from institutional review board review as a quality improvement initiative. We hypothesized that reorganization of radiology transport would improve radiology cycle time and reduce waste. The intervention included systems engineering science-based reorganization of ED radiology transport processes, largely using Lean methodologies, and adding no resources. The primary outcome was average transport time between study order and complete time. All patients presenting between 8/2013–3/2016 and requiring plain film imaging were included. We analyzed electronic medical record data using Microsoft Excel and SAS version 9.4, and we used a two-sample t-test to compare data from the pre- and post-intervention periods.

Results: Following the intervention, average transport time decreased significantly and sustainably. Average radiology transport time was 28.7 ± 4.2 minutes during the three months pre-intervention. It was reduced by 15% in the first three months (4.4 minutes [95% confidence interval [CI] 1.5–7.3]; to 24.3 ± 3.3 min, P=0.021), 19% in the following six months (5.4 minutes, 95% CI [2.7–8.2]; to 23.3 ± 3.5 min, P=0.003), and 26% one year following the intervention (7.4 minutes, 95% CI [4.8–9.9]; to 21.3 ± 3.1 min, P=0.0001). This result was achieved without any additional resources, and demonstrated a continual trend towards improvement. This innovation demonstrates the value of systems engineering science to increase efficiency in ED radiology processes.

Conclusion: In this study, reorganization of the ED radiology transport process using systems engineering science significantly increased process efficiency without additional resource use.

No MeSH data available.


Pre-intervention radiology process flow. Lean value-stream map demonstrating multiple process steps required to achieve plain film radiology testing in the emergency department.
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f1-wjem-18-410: Pre-intervention radiology process flow. Lean value-stream map demonstrating multiple process steps required to achieve plain film radiology testing in the emergency department.

Mentions: The intervention consisted of a series of process improvement steps based on Lean methodologies, and aimed at reorganizing radiology process flow. The overall aim was to eliminate non-value added waste when possible, with the goal of reducing transport delay. We used a granular, value stream mapping approach to analyze the current state (Figure 1) and identify opportunities to reduce process steps and increase value added activity (Figure 2). In our ED, as in most, a patient is registered, triaged, and then evaluated by a provider. This provider orders diagnostic testing, including plain film imaging when indicated. The order is then scheduled by the radiology scheduling receptionist and populates a queue for the radiology technologists. The patient is then transported to radiology through a number of steps (Figure 1) and then the study is performed. Each of the steps involved in performing plain film radiology following placement of an order were included in the initial process map. In addition, we used supply chain management science, queuing theory, and demand capacity matching to identify other opportunities.


Applying Systems Engineering Reduces Radiology Transport Cycle Times in the Emergency Department
Pre-intervention radiology process flow. Lean value-stream map demonstrating multiple process steps required to achieve plain film radiology testing in the emergency department.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5391891&req=5

f1-wjem-18-410: Pre-intervention radiology process flow. Lean value-stream map demonstrating multiple process steps required to achieve plain film radiology testing in the emergency department.
Mentions: The intervention consisted of a series of process improvement steps based on Lean methodologies, and aimed at reorganizing radiology process flow. The overall aim was to eliminate non-value added waste when possible, with the goal of reducing transport delay. We used a granular, value stream mapping approach to analyze the current state (Figure 1) and identify opportunities to reduce process steps and increase value added activity (Figure 2). In our ED, as in most, a patient is registered, triaged, and then evaluated by a provider. This provider orders diagnostic testing, including plain film imaging when indicated. The order is then scheduled by the radiology scheduling receptionist and populates a queue for the radiology technologists. The patient is then transported to radiology through a number of steps (Figure 1) and then the study is performed. Each of the steps involved in performing plain film radiology following placement of an order were included in the initial process map. In addition, we used supply chain management science, queuing theory, and demand capacity matching to identify other opportunities.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Emergency department (ED) crowding is widespread, and can result in care delays, medical errors, increased costs, and decreased patient satisfaction. Simultaneously, while capacity constraints on EDs are worsening, contributing factors such as patient volume and inpatient bed capacity are often outside the influence of ED administrators. Therefore, systems engineering approaches that improve throughput and reduce waste may hold the most readily available gains. Decreasing radiology turnaround times improves ED patient throughput and decreases patient waiting time. We sought to investigate the impact of systems engineering science targeting ED radiology transport delays and determine the most effective techniques.

Methods: This prospective, before-and-after analysis of radiology process flow improvements in an academic hospital ED was exempt from institutional review board review as a quality improvement initiative. We hypothesized that reorganization of radiology transport would improve radiology cycle time and reduce waste. The intervention included systems engineering science-based reorganization of ED radiology transport processes, largely using Lean methodologies, and adding no resources. The primary outcome was average transport time between study order and complete time. All patients presenting between 8/2013–3/2016 and requiring plain film imaging were included. We analyzed electronic medical record data using Microsoft Excel and SAS version 9.4, and we used a two-sample t-test to compare data from the pre- and post-intervention periods.

Results: Following the intervention, average transport time decreased significantly and sustainably. Average radiology transport time was 28.7 ± 4.2 minutes during the three months pre-intervention. It was reduced by 15% in the first three months (4.4 minutes [95% confidence interval [CI] 1.5–7.3]; to 24.3 ± 3.3 min, P=0.021), 19% in the following six months (5.4 minutes, 95% CI [2.7–8.2]; to 23.3 ± 3.5 min, P=0.003), and 26% one year following the intervention (7.4 minutes, 95% CI [4.8–9.9]; to 21.3 ± 3.1 min, P=0.0001). This result was achieved without any additional resources, and demonstrated a continual trend towards improvement. This innovation demonstrates the value of systems engineering science to increase efficiency in ED radiology processes.

Conclusion: In this study, reorganization of the ED radiology transport process using systems engineering science significantly increased process efficiency without additional resource use.

No MeSH data available.