title: No More Waits and Delays: Streamlining Workflow to Decrease Patient Time of Stay for Image-guided Musculoskeletal Procedures.
abstract: Long wait times limit our ability to provide the right care at the right time and are commonly products of inefficient workflow. In 2013, the demand for musculoskeletal (MSK) procedures increased beyond our department's ability to provide efficient and timely service. We initiated a quality improvement (QI) project to increase efficiency and decrease patient time of stay. Our project team included three MSK radiologists, one senior resident, one technologist, one administrative assistant/scheduler, and the lead technologist. We adopted and followed the Lean Six Sigma DMAIC (define, measure, analyze, improve, and control) approach. The team used tools such as voice of the customer (VOC), along with affinity and SIPOC (supplier, input, process, output, customer) diagrams, to understand the current process, identify our customers, and develop a project charter in the define stage. During the measure stage, the team collected data, created a detailed process map, and identified wastes with the value stream mapping technique. Within the analyze phase, a fishbone diagram helped the team to identify critical root causes for long wait times. Scatter plots revealed relationships among time variables. Team brainstorming sessions generated improvement ideas, and selected ideas were piloted via plan, do, study, act (PDSA) cycles. The control phase continued to enable the team to monitor progress using box plots and scheduled reviews. Our project successfully decreased patient time of stay. The highly structured and logical Lean Six Sigma approach was easy to follow and provided a clear course of action with positive results. (©)RSNA, 2016.
authors.affiliation: From the Departments of Radiology (Y.Y.C.) and Performance Improvement (T.O.O.), Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756; and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (E.M.G.).
authors.forename: Yvonne Y
authors.initials: YY
authors.lastname: Cheung
authors.affiliation: From the Departments of Radiology (Y.Y.C.) and Performance Improvement (T.O.O.), Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756; and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (E.M.G.).
authors.forename: Eric M
authors.initials: EM
authors.lastname: Goodman
authors.affiliation: From the Departments of Radiology (Y.Y.C.) and Performance Improvement (T.O.O.), Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756; and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (E.M.G.).
authors.forename: Tomiwa O
authors.initials: TO
authors.lastname: Osunkoya
mesh_terms: D017598:Efficiency, Organizational; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D009140:Musculoskeletal Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D015279:Organizational Culture; D009937:Organizational Objectives; D017060:Patient Satisfaction; D017064:Process Assessment, Health Care; D058996:Quality Improvement; D011872:Radiology Department, Hospital / Q000458:organization & administration*; D015642:Radiology, Interventional / Q000458:organization & administration*; D014850:Waiting Lists; D057188:Workflow