Streamlining Patient Access
NEURO-INTERVENTIONAL
ULTRASOUND
IBI OPUIYO,RDMS
EXECUTIVE SPONSOR - JOSEPH STEELE,MD
The project was a collaboration with ICCE,
OPI, NIR Ultrasound technologists,
nurses and faculty
Neuro-Interventional Ultrasound
 Provide ultrasounds of the thyroid and neck
regions
 Referrals from various clinics throughout the
institution including Endocrine, Melanoma, Head
and Neck Surgery, and Lymphoma services
 Number of completed patient exams in NIR US
has grown in 5 year period
from just over 4,000 in FY06 to 10,000 exams and
biopsies in FY11
PROBLEM
Who Is Impacted ?
Endocrine
Head and
Neck
Surgery
Thoracic
NIR
Melanoma
Other
Referring
Services
PATIENTS
NIR US Project Goal
Decrease
Delays
Increase
Access
NIR will decrease the number
of days for referring clinics to
obtain diagnostic scans for
patients from 25 or more
working days to less than 5
days by June 2011.
IDENTIFYING & ASSESSING
CAUSE ANALYSIS
Scheduling
Environment
CLINIC HOURS OF
OPERATION 8-4PM
Limited slots for clinics
Congestion of appts.
Allotted exam times:
SCANS: 1HOUR
BX: 2 HOURS
6 SCAN
ROOMS,TECHS
Certain US rooms are only
used for scanning
Procedures
Nursing documentation
take time
Multiple BXs @ once
Wait for requesting MD to reply
Floor Plan Issue: Waiting area,
holding area, and US rooms are
far apart
Wait for BX result and DIA
to set up
PATIENT
SCHEDULINGDictation between patientsWORKFLOW
Check in early and want to
be seen early
TEMPLATE Conferences and meetings
Arrive late (weather, traffic and other appts
No show
Lost in the hospital
.
Adding patients without
verifying current schedule
Double duties
Anxiety induce HTN
Patients
PERSONNEL
CAUSE ANALYSIS
Limited Patient
Access to NIR
Diagnostic
Scans and
Procedures
KEY ISSUES

SCHEDULING


LIMITATIONS
OPERATIONS

PROCESSES

WORKFLOW
PERFORMANCE ASSESSED
BASELINE DATA
Capacity Backlog : Scheduling
 Max 38 potential
appointment slots/day
 25 day delay for next
available appointment
Process Analysis: Scheduling
Issue: limited
appointment slots
available
Operations: Processes
Workflow
 Personnel
 Situational
Processes
 Practical
Processes
Operations:
Asset Utilization
PRE TEMPLATE ROOM UTILIZATION
HIGH
VOLUME
DATES
1/21/2011
1/24/2011
1/27/2011
1/31/2011
2/7/2011
2/9/2011
2/11/2011
2/15/2011
2/25/2011
2/28/2011
3/2/2011
3/4/2011
3/8/2011
3/9/2011
3/16/2011
3/23/2011
3/28/2011
3/29/2011
3/30/2011
4/1/2011
4/5/2011
NUMBER OF PROCEDURES
BEGIN TO LEAVE DEPT.
49
44
44
52
44
50
46
47
48
49
49
45
47
54
46
48
46
53
49
44
45
75.41
55.37
68.72
66.6
43.7
60.92
71.43
57.67
75.37
65.71
66.58
74.96
49.02
64.81
57.49
56.17
45.86
62.59
58.91
52.69
55.11
AVERAGE TIME IN MINUTES
47.57
61.19
40564
40567
40570
40574
40581
40583
40585
40589
40599
40602
40604
40606
40610
40611
40618
40625
40630
40631
40632
40634
40638
Average time in Rooms
Pre Template Room utilization
80
70
60
50
40
30
20
10
0
High Volume Dates
PHASED APPROACH
INTERVENTIONS
• Phase I
• Feb 1, 2011 to March 10, 2011
SCHEDULE


Management team began complete restructuring of
scheduling template
Opening of initial set of additional scheduling slots for
servicing clinics. This addressed immediate bottleneck
issues.
OPERATIONS

Personnel changes to accommodate expanded schedule.
1. New technologist schedule
2. New temporary Imaging Assistant
• Phase II
• March 11, 2011 to April 14, 2011
SCHEDULE

Process changed for ordering diagnostic
scans/biopsies

Communications and education of referring
service Clinical Coordinators on forthcoming
schedule template usage
OPERATIONS

Departmental operational hours expanded
• Phase III
• April 15,2011 to July 15, 2011

Go Live: opening of restructured
scheduling template

Data gathered for 90 day assessment of
combined changes
Results
The success of the project was
measured using two metrics

The number of available daily slots for
procedures or scans.

The time to next appointment for a diagnostic
ultrasound and biopsy
The data reveals that measured
improvements are attributed to :
SCHEDULE
 The new scheduling template
Available appointment slots increased from 38 to 55
NIR Clinical Operations Report Summary
Template Timeslots Available
Jan.
Feb.
March
April
May
June
July
Scan w/biopsy timeslots
10
10
10
14
16
16
16
Scan only timeslots
18
18
23
24
25
25
25
Overbook timeslots
10
10
10
12
14
14
14
Total Timeslots
38
38
43
50
55
55
55
Results
Scheduling Template
NUMBER OF WORKDAYS FOR NEXT AVAILABLE APPOINTMENT
80
70
# WORKDAYS
60
50
40
Scan/Biopsy Overbook
Scan/Biopsy Template
30
Scan Only Overbook
Scan Only Template
20
10
0
WORK WEEK
The data reveals that measured
improvements are attributed to :
OPERATIONS
 Pre assessments
 Extended department hours of operation
 Change in personnel (tech/MD) schedules
 Additional Imaging Assistant (personnel
changes)
 New lead technologist role
AVERAGE TIME IN MINUTES:
Pre Template
61.19 minutes
Post Template
54.63 minutes
Room utilization improved. The time to perform one complete procedure
(time from patient entering the room to exiting the room) decreased 6.6
minutes.
90 Day NIR Room Utilization Times
Room Usage Per Patient
Seen in Minutes
80
70
60
Pre Template Room
Utilization Times Jan
2011- Apr 2011
Post Template Room
Utilization Times Apr
2011- July 2011
50
40
30
20
10
0
90 Day Period
Calculation Summary /
ROI
Year 0
Cost of Capital
Investments/Costs
Benefit/Revenue
Annual Net Benefit/Revenue(Costs)
Benefit/Revenue Including Soft Savings
Annual Net Benefit (Costs) Including soft
Savings
Year 1
Year 2
Year 3
9.20%
(3,906)
(3,906)
(3,906)
0
0
0
120,919
120,919
120,919
120,919
120,919
120,919
120,919
120,919
120,919
120,919
120,919
120,919
Risk Adjusted ROI = Net Present Value of Cumulative Net Benefit / Net Present Value of Total
Costs
RA ROI
(Margin for yrs 1-3 discounted @ Cost of Capital %)
6959%
Net Present Value
$275,722.78
Internal Rate of Return (Expected Return)
3096%
NEXT STEPS
Thank You
NIR US Process Improvement Teams
 NIR US Manager Tonya Brightmon
 Executive Sponsor Dr. Steele
