title: Optimizing MRI Logistics: Focused Process Improvements Can Increase Throughput in an Academic Radiology Department.
abstract: OBJECTIVE
  The purpose of this study was to describe and evaluate the effect of focused process improvements on protocol selection and scheduling in the MRI division of a busy academic medical center, as measured by examination and room times, magnet fill rate, and potential revenue increases and cost savings to the department.
  
  
  METHODS
  Focused process improvements, led by a multidisciplinary team at a large academic medical center, were directed at streamlining MRI protocols and optimizing matching protocol ordering to scheduling while maintaining or improving image quality. Data were collected before (June 2013) and after (March 2015) implementation of focused process improvements and divided by subspecialty on type of examination, allotted examination time, actual examination time, and MRI parameters. Direct and indirect costs were compiled and analyzed in consultation with the business department. Data were compared with evaluated effects on selected outcome and efficiency measures, as well as revenue and cost considerations. Statistical analysis was performed using a t test.
  
  
  RESULTS
  During the month of June 2013, 2145 MRI examinations were performed at our center; 2702 were performed in March 2015. Neuroradiology examinations were the most common (59% in June 2013, 56% in March 2015), followed by body examinations (25% and 27%). All protocols and parameters were analyzed and streamlined for each examination, with slice thickness, TR, and echo train length among the most adjusted parameters. Mean time per examination decreased from 43.4 minutes to 36.7 minutes, and mean room time per patient decreased from 46.3 to 43.6 minutes (p = 0.009). Potential revenue from increased throughput may yield up to $3 million yearly (at $800 net revenue per scan) or produce cost savings if the facility can reduce staffed scanner hours or the number of scanners in its fleet. Actual revenue and expense impacts depend on the facility's fixed and variable cost structure, payer contracts, MRI fleet composition, and unmet MRI demand.
  
  
  CONCLUSIONS
  Focused process improvements in selecting MRI protocols and scheduling examinations significantly increased throughput in the MRI division, thereby increasing capacity and revenue. Shorter scan and department times may also improve patient experience.
authors.affiliation: 1 Department of Diagnostic Radiology, McGill University, Saint Mary's Hospital, 3830 Ave Lacombe, Rm 1100, Montreal, QC H3T 1L5, Canada.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: O'Brien
authors.affiliation: 2 Department of Diagnostic Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Stormann
authors.affiliation: 2 Department of Diagnostic Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Kelli
authors.initials: K
authors.lastname: Roche
authors.affiliation: 2 Department of Diagnostic Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Ines
authors.initials: I
authors.lastname: Cabral-Goncalves
authors.affiliation: 2 Department of Diagnostic Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Annamarie
authors.initials: A
authors.lastname: Monks
authors.affiliation: 2 Department of Diagnostic Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Donna
authors.initials: D
authors.lastname: Hallett
authors.affiliation: 2 Department of Diagnostic Radiology, Beth Israel Deaconess Medical Center, Boston, MA.|3 Harvard Medical School, Boston, MA.
authors.forename: Koenraad J
authors.initials: KJ
authors.lastname: Mortele
mesh_terms: D000046:Academic Medical Centers / Q000191:economics* / Q000706:statistics & numerical data; D001900:Boston / Q000453:epidemiology; D017598:Efficiency, Organizational / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D017064:Process Assessment, Health Care / Q000191:economics*; D058996:Quality Improvement / Q000191:economics*; D011872:Radiology Department, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D016526:Workload / Q000191:economics / Q000706:statistics & numerical data
keywords: MRI; focused process improvement; throughput