Increased Access in PET Through Data Analytics

Introduction: The purpose of this project was to increase patient access of care and decrease the backlog for specialty PET/CT exams. Barnes-Jewish Hospital’s PET department is one of a few in the Midwest region that performs specialty, novel Neuroendocrine Tumor (NET), prostate cancer, and cardiac perfusion PET imaging. At initiation and beyond, the demand for these studies led to extensive backlogs, at times being more than 25 days out. This PET exam backlog led to restricted access to patient care, delay in cancer treatment, and non-optimized revenue for Barnes-Jewish Hospital (BJH). In order to expand access to these services, we needed to re-evaluate and optimize the PET/CT clinical schedule.

Barnes-Jewish Hospital’s PET/CT department operates with two scanners and has only a finite number of scheduling spots. The problem that we faced was the need to add appointments for specialty PET exams without losing our capacity to perform our most requested study, FDG oncology PET/CT. When this project was started, FDG PET/CTs accounted for 86% of all PET/CT imaging done in our department, and often the demand was even greater.

Methods: The FOCUS PDCA approach was used for this project to conduct coordinated process improvement. A team was formed to discuss current PET backlog, why the backlog existed for specialty studies, and what options existed for decreasing the backlog. To audit, and measure progress, the team built and then utilized the Weekly PET/CT Dashboard to analyze utilization rates and backlogs of all the PET/CT studies offered by our department. The team also discussed current staffing schedules and the need to expand and adjust staff schedules and shifts. Multiple stakeholders were consulted to evaluate whether altering the clinical schedule was possible, and what impact it would have on technologists, radiologists, referring physicians and patients. In addition, the team collaborated with BJH supply chain leaders, who helped us reach out to each radiopharmaceutical vendor to discuss production schedules, delivery times, and opportunities for adjustment to their current operations to assist our clinical operations.

Results: Throughout this project, there have been multiple iterations of the PET/CT schedule. Since the inception of the project, access to these specialty studies have increased, while FDG PET/CTs have decreased slightly. Access to prostate cancer PET/CTs increased by 260%, while access to NET and cardiac perfusion PET/CTs increased by 10% and 50%, respectively. Access to FDG PET/CTs decreased by 4.2%.

While access to specialty PET services has been increased overall, the backlog still fluctuates week-to-week. We have seen a substantial decrease in the backlog for NET and prostate cancer PET exams, with a 70.8% decrease for NET and a 54.4% decrease for prostate cancer PET/CTs. The Cardiac PET backlog has decreased by 26.9%, and we are currently working to get that backlog down even further.

Conclusions: Overall, this project has been deemed successful for the key stakeholders and our patients. Patients and physicians can get testing completed in a more timely manner, and now more equipped to make treatment decisions sooner, which will lead to better outcomes for their patients. According to data from the National Oncologic Registry, it was determined that PET/CT imaging changed patients’ treatment plans in approximately 36% of patients being evaluated for initial staging and cancer detection (Farwell, Pryma, and Mankoff, 2014, p. 3435-3436), making the need to increase access that much more firm. Also, this data showed that treatment plans changed for 50% of patients when ordering physicians utilized PET/CT imaging to monitor response to treatment (Farwell et al., 2014, p. 3435-3436).

Barnes-Jewish Hospital’s PET/CT schedule is continually evolving. The increase in demand for myocardial perfusion PET/CTs and the emergence of new radiopharmaceuticals, has led us to continue this project.