Emergency ED/CT Efficiency Radiology
UCH ED-Radiology Project Team Members: Gerald Dodd MD Chair, Department of Radiology Jim Borgstede MD Vice Chair, Department of Radiology Kristen Nordenholz MD, MSc Department of Emergency Medicine Stephanie Prevost RN, CEN, BAN Associate Nurse Manager, Emergency Department Denise Snuttjer Director of Radiology Ethan Cumbler MD IHQSE Coach Zach Robison MBA PI Consultant Scott Williams PI Intern Michelle Rove Data Analysis
What does 1 min mean to the patient?
What does 1 min mean to the team?
What does 1 min mean to the hospital?
ED RAD Project CT Type Baseline Data Order to CT Time Median Order to CT Time Average IV Contrast 0:44 0:55 PO Contrast 1:57 1:58 Without Contrast 0:23 0:30 15 minutes of these baseline values was transport time Goal: Decrease turn around time from CT order to CT read by 10 minutes
First Phase System Analysis: Voice of Patient Process mapping Data collection Process Improvement Events Designating ED Transporter CT Tech Assistant PDSA Cycles of order to CT Collaboration across multiple disciplines
Results Time savings = 7 minutes/scan
What does 7 minutes mean to the hospital?
Impacts Time Savings: 7 minutes per scan X 50 scans/day= 350 minutes/day Average LOS = 208 minutes Equates to the potential to see 1.7 more patients per day Each patient has a contribution margin of $800 Potential revenue gains of $496,400 per year Decreased waiting time for patients too!
Thank you! CT Techs CT Assistants Transport CT Leadership ED Leadership IHQSE Team Zach Robison and Michelle Rove
Entire TEAM : UCH ED-Radiology Project Team Members: Executive Sponsors: Derek Rushing - VP of Clinical Operations and Support Services, Richard Zane MD Chair, Department of Emergency Medicine, Gerald Dodd MD Chair, Department of Radiology, Jim Borgstede MD Vice Chair, Department of Radiology Clinical Champions: Kristen Nordenholz MD, Stephanie Prevost Associate Nurse Manager ED Process Owner: Yelena Zubareva CT Technologist Lead, Richard CT Tech Asst Core Team Members: Kristen Nordenholz MD, Denise Snuttjer Director of Radiology, Stephanie Prevost, Gerald Dodd MD, Jim Borgstede MD Extended Team Members: Jen Wiler MD, Kelly Bookman MD, Chris McStay MD, April Koehler Nurse Manager ED, Jonothan Porzondek Transport, Nancy Pritchard CT Manager IHQSE Coach: Ethan Cumbler MD PI Consultant: Zach Robison PI Intern: Scott Williams Data Analysis: Michelle Rove
Lessons Learned IHQSE principles work! Our project success was based on teamwork Projects crossing departmental silos promote interdepartmental collegiality in other areas
Making Change Stick Next steps Continuation of pilot with minor adjustments Pull dedicated transport from ED pool Use dedicated transport for other jobs during nonproductive times Surge plan? Celebrate small wins Second phase CT completed to CT read
Backup Slides to Follow
Business Case 1200 ED CT scan (all kinds) pts/month 250 average #ED pts/day *30 days = 7,500 ED pts/months 1200/7500 = 0.16 CTs/ ED pt Average LOS = 208 mins (all admits and d/cs) 24 *60 = 1440 mins/ day 1440/208 mins LOS= 6.9 ED pts per bed /day BUT if only 0.16 CT/ED pt then 10 mins saved= 1.6 mins saved per overall ED pt 208 mins- 1.6 mins= 206.4 mins 1440 mins/day/206.4 mins/pt= 6.98 new #of ED pts/ed bed So 6.98-6.90 = 0.08 new pts able to be seen * 70 treatment beds= 5.6 new pts /day 5.6 *365= 2,044 increased # of ED pts/year 2,044*$409 ( average charge $$) = $835, 996 profee charges Facility fee = $835,996 *3= $2,507,988 +$835,996 = $3343984 * $0.16 (what we collect) = $535,037.44
Making Change Stick Next steps Continuation of pilot with minor adjustments Pull dedicated transport from ED pool Use dedicated transport for other jobs during nonproductive times Surge plan? Celebrate small wins Second phase CT completed to CT read
Pilot data Transport times Pending to Arrival Average Pre-Pilot Pilot Δ from Pilot CT Only 0:15 0:08-0:07 All ED (with CT) 0:15 0:12-0:03 ED (without CT) 0:15 0:13-0:02 All AIP 0:25 0:24-0:01 Median Pre-Pilot Pilot Δ from Pilot CT Only 0:10 0:06-0:04 All ED (with CT) 0:10 0:08-0:02 ED (without CT) 0:10 0:10 0:00 All AIP 0:20 0:19-0:01 - All data pulled from teletracking - Pre-Pilot time period: Aug 31 Sep 20 - Pilot time period: Sep 23 Oct 6 - Hourly time period per day 12:00pm 8:00pm
Burning platform Opportunity to complete scans more efficiently in order for the ED provider to provide final read to patients: Decreased length of stay Increased patient satisfaction Financial benefit 1,789 # new patient potential 800 - $ profit/patient $1,431,200 Potential new revenue