title: Process analysis to reduce MRI access time at a German University Hospital.
abstract: OBJECTIVE
  Long access times for magnetic resonance imaging (MRI) can negatively impact the quality of care provided to patients. We investigated improving access by reducing MRI processing time.
  
  
  METHODS
  Data were collected for scans (n= 360) performed over 3 weeks (April-May 2008) at the University Hospital of Mannheim, Germany. Average access time, excluding emergencies, was 44 (±44) days for outpatients and 3 (±5) days for inpatients. Factors influencing total MRI processing time were identified using multivariate linear regression. In addition to region scanned, the total MRI processing time was significantly related to performing multiple scans (β = 33.57, P< 0.01), using oral contrast media (β = 13.58, P< 0.01), placing an intravenous (IV) catheter (β = 5.00, P= 0.04) and scanning patients ≤8 years old (β = 0.41, P= 0.03). Contrary to prior perceptions, emergency cases (5.6%) and late arrivals (12.8% >5 min late) were less than expected.
  
  
  METHODS
  Increasing scheduling flexibility to address non-modifiable process variation and completing preparatory activities outside the scanner room were identified as process improvement targets.
  
  
  METHODS
  Scheduling was adapted to utilize three expected total MRI processing times and IV placement was moved outside the scanner room.
  
  
  RESULTS
  Planned hardware and software upgrades were completed concurrent to the process improvements. As a result, it was not possible to accurately measure the effect of implementing the scheduling and preparatory activity changes.
  
  
  CONCLUSIONS
  Clinical study team members' prior perceptions of workflow obstacles did not match the study findings. Utilizing insiders and outsiders during process analysis may limit bias in identification of process improvement opportunities.
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine and the Competence Center for Social Medicine and Occupational Health Promotion, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Tokur
authors.forename: K
authors.initials: K
authors.lastname: Lederle
authors.forename: D D
authors.initials: DD
authors.lastname: Terris
authors.forename: M N
authors.initials: MN
authors.lastname: Jarczok
authors.forename: S
authors.initials: S
authors.lastname: Bender
authors.forename: S O
authors.initials: SO
authors.lastname: Schoenberg
authors.forename: G
authors.initials: G
authors.lastname: Weisser
mesh_terms: D000367:Age Factors; D017598:Efficiency, Organizational; D004630:Emergencies; D005858:Germany; D006297:Health Services Accessibility / Q000458:organization & administration; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D017064:Process Assessment, Health Care / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration; D014850:Waiting Lists