MPH CNMT RT(N)(CT)

Objectives Work flow efficiency is highly impacted by the timeliness of all the cases through the day in a department like PET-CT that require longer physiological preparation before a scan can be done. At Johns Hopkins PET center patient scheduling is handled very carefully to avoid camera down time between subsequent patients throughout the day. Any delay between continuous patients will have a compounding effect on the remaining cases and results in delayed completion of the last case scheduled for the day that might necessitate unplanned residents and staff overtime. The Residents overtime violates the residency duty hours standard set by Accreditation Council for Graduate Medical Education (ACGME). Moreover the Technologists overtime may lower staff satisfaction and incurs additional avoidable expense to the department. Therefore the objective of this study was to apply lean sigma quality improvement principles in an effort to improve last-case efficiency in our PET-CT department leading to reduction in unplanned over time, compliance with residency duty hours, and increase staff and patient satisfaction.

Methods A lean sigma quality improvement principle that constitutes five stages namely define, measure, analyze, improve and control was used. A multi-disciplinary team including Patient Service Coordinators, Technologists, and physicians formed a team to assess the problem and propose solutions to improve last case efficiency in the department. A data collection form was created to record the completion time for the last case of the day. At the end of each month these data will be compared with the computer generated time stamps from the radiology information system. Then the data will be analyzed and shared with the staff and management team responsible to determine and implement the appropriate intervention required to improve the last case efficiency. This process continued for six month starting from September, 2014 until the target goal was achieved in April, 2015.

Results The percentage of last case completion on or before 5:00 pm showed a 37% increase from a baseline of 47% (7) in September, 2014 to 91% (20) in April, 2015. Similarly, cases completed between 5:01 and 6:00 pm significantly declined from 46% (7) in September, 2014 to 9% (2) in April, 2015. Whereas the 7% completion rate for the after 6:00 pm was completely eliminated to zero. The average last case completion time from September 2014 through April, 2015 was 4:22 pm with a standard deviation of 9 minutes and 95% confidence interval between (4:04 - 4:40). The latest completion time was 6:53 and earliest completion time was 12:30. Technologists and Residents overtime hours decreased from average of 2 hrs per day from September, 2014 to zero in April, 2015. On the contrary, patient volume increased by 20 % from September, 2014 to April 2015.

Conclusions Systematic study of workflow efficiency and application practical interventions using quality improvement principles like lean sigma can significantly enhance efficiency of imaging departments. $$graphic_73F1F2EC-90F4-49D1-B7E8-E5540FAF22A5$$