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Lean study finds about a third of available MR schedule lost to poor processes

by John W. Mitchell , Senior Correspondent
There is a lot of room for operational improvement in the average MR department. That's the conclusion of a study conducted by the imaging department of Beth Israel Deaconess Medical Center (BIDMC) and published online in the American Journal of Roentgenology.

"One of the biggest burdens affecting health care-based service industries, especially radiology, is patient throughput," Dr. Kevin Beker, lead author and research fellow, Division of Abdominal Imaging, Department of Radiology at BIDMC told HCB News. "Determining how to avoid long wait times is crucial in managing an effective workflow."

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The study relied on the Lean Manufacturing method. Lean consists of principles and tools pioneered in the Japanese automotive industry in the 1980's.

The concept has been widely adopted in health care, and is characterized by training frontline workers to map work flow. They then propose and implement solutions to change bad processes to overcome inefficiencies that frustrate patients and staff.

"MRs tend to experience longer scanning times, arduous delays and increased patient wait times compared with other imaging modalities," co-author Dr. Koenraad Mortele, chief of Abdominal Imaging and director of the clinical MR division at BIDMC, told HCB News. "Therefore, our team decided to embark on a Lean process analysis in our outpatient MR scanning department where patient throughput could experience the maximum amount of improvement."

According to Beker, in a two-week review, the team identified a couple of process breakdowns responsible for the highest frequency of delay. These inefficiencies accounted for a loss of approximately 30 percent of "non-value added time" - or waste.

The delays included waiting on a specialized nurse to arrive to place IV port placements. The second source of delay was attributed to MR arthrograms when a joint injection of contrast and confirmation with fluoroscopy was necessary, but not accounted for in the schedule.

"We proposed specific solutions targeting the underlying source of the delay, prioritizing the delays when overall impact and frequency were higher," said Beker.

Their actions included teaching port placement skills to all the department technologists and ensuring at least one such skilled technologist was scheduled on each shift.

The team began continuous education for the staff on scheduling and booking processes. They also initiated a thorough review of all fluoroscopy and MR scans for the identification and resolution of potential conflicts, and instituted patient scheduling review three days in advance to identify potential issues. Such issues included proper protocol, incorrect scanner booking, identification of claustrophobic patients, and addressing other patient needs.

"Our study provides evidence on how systematic implementation of process analysis can significantly aid in streamlining patient throughput and imaging volume," said Mortele. "Ongoing continuous improvement, if applied systematically, can potentially cut costs and increase efficiency and patient satisfaction."

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