-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/0495e96fbfcccc8da404819ea7d2a836.pdf?Expires=1712793600&Signature=vbB8klwSRTeggt6-%7EAlMCFFsWAf21-gJY3V8CZj1F%7EVzNnx7vgzvJzuDNSPS5UNN8r4PhSSVsA6Q3J%7EbSF3cTAWZ91PXMlZBt373VcUBo5nY714TFihlHMTWgGC7KgUzdTdovDessG4QgbGh5E2yAUEEchbusynlQNVvvDuWi1YNHsSDFeEvOm9hCYAxNnXMwSOubZrZXOBn0GKos-8nGjsapu5uvOhKZT84YDBEr3MNvJa7V2yzBorAPuFSnP-i-dHIzZgE9BfY2tlC1tqP16CUfr6hPX4-qYni48LFzwZLRkk5n6mXvE6Ifw7iN-rs0aNRK4xSWqJ8XJ09uGrwcQ__&Key-Pair-Id=K6UGZS9ZTDSZM
85ffc96487ba8e459f8d2eccee9bf20d
PDF Text
Text
Improving the Mammography workflow in the Radiology Unit at Cambridge Health Alliance
Aliysa Rajwani, BDS, MPH; Mary Kearns, RN; Leah Harrington; Hetal Verma, MD; Carol Hulka, MD, MBA; Gouri Gupte PhD, MHA
Cambridge Health Alliance
Introduction to the Problem
• The Radiology unit identified problems with getting patients through the unit and delays in
completing mammograms during the scheduled appointment time.
• A multidisciplinary team was created with radiologists, technologists and administrative
staff in the mammography unit.
• Increase patient wait and cycle times affected efficiency and effectiveness of care.
Interventions-Process Mapping and Benchmarking
Mammography Unit Process Flow
Registration
Patient checks into
Registration for
appt
Registration
verifies patient and
appointment
Patient is given a
band with their
name and appt
date
Aim
Patient heads over
to Mammography
unit
To develop an efficient process and schedule for ultrasound and mammography to allow
performance of tomosynthesis on all patients and reduce patient cycle time.
The Team
Quality Management
Aliysa Rajwani, BDS, MPH: Quality
Project Improvement Advisor
Mary Kearns, RN- Director, Quality
Management
Gouri Gupte, PhD, MHA- Director of
Performance Improvement
Radiology
Leah Harrington, RT. (R)(M)-Manager,
Breast Imaging
Linda Lowery- Radiation Technologist
Hetal Verma, MD-Director, Breast Imaging
Doris Gentley- Senior Director, Radiology
Carol Hulka, MD, MBA-Chief of Radiology
Waiting Room
(usually a slight wait due to procedure delay)
Patient checks
in with
Debbie who
verifies name
and appt on
schedule and
patien t band
Debbie calls
nurse to inform
& follows
regular process
Yes
if availability
No
Debbie calls
interpreter to
fill form with
patien t
Label is placed
on documen t
to avoid error
and name is
striked off list
Patient
accommodated
if not behind
schedule
GEMBA walks and observational studies
Data analysis using observational study data and analyzing current schedule
Process Mapping and Root Cause Analysis using Fishbone diagram
Benchmarking
Developing and implementing recommendations using the Impact Effort Matrix
MD Room
Keeps document
on table in tech
room. For U/S
keeps inside slot
Complete imaging
and send patien t
back to waiting
room
Techs view the
previou s images
on PACS before
patien t is taken in
Debbie gives
patien t changing
instru ctions
Techs wait till
images enter the
PACS and study
images
Screening patients
sent back unless
additional imaging
is needed
Radiologist
performing
procedure
Yes
Patient waits in
changing waiting
room till tech calls
Epic order
released in
epic and
other records
printed
No
Taken into
procedure room
depending on case
(radiologist for
procedures)
No
U/S OR
Diagnostics may
need addi tional
imaging
Slight delays in
readings due to
case
MD views images
and may request
additional images
for diagnostic or
U/S patients
Yes
Additional
images
No
Techs confirm
pat ient history
findings on the
form with patient
Patient sent back
PROCESS REPEATS AGAIN
Tech Busy/
Rooms full
Yes
Patient in
waiting room
PROCEDURE TYPES
Screenings
No
Breast Center
or other may
add on
patien ts
Tech Room
(us ually a s lig ht wait)
Debbie walks to Tech room
Walks patient
to changing
room
Debbie prints
screening reports
and sends to
patien t in a week
Screenings: 15 mins
Dx: 30 mins
U/S: 30 mins (unilateral only)
Diagnostics
Screenings
diagnostics
Ultasound
Procedures
Addition al
questions or
Interpretor
Techs and MD
view report and
complete findings
and scan report
into epic for PCP
Yes
Take patient out to
confirm with
radiologist or call
interpreter
Screenings: 20 mins
Dx: 15 mins
U/S: 30 mins
Tech aide
responsibilities
daily if previous
images not
locat ed
• Process
mapping
was
completed
with all
members of
radiology
team.
• It helped
highlight
inefficiencies
and waste in
process
Screenings: 15 mins
Dx: 30 mins
U/S: 30 mins
Benchmarking
The Interventions
Usual process
follows but
patien t does
not change
and waits till
their turn
No
Patient speaks
English
Changing Area
Waiting Room
Patient taken in
after previous
images studied
Patient Late
Debbie gives
patien t a form
to fill in
Yes languages
av ailable
(some bottlenecks and inefficiencies in orange)
Screenings: 15 mins
U/S: 30 mins
Screenings: 20 minutes
U/S: 30 minutes
Screenings: 20 mins
Dx: 30 mins
For more information, contact:
Aliysa Rajwani, BDS, MPH- Quality Project Improvement Advisor: Cambridge Health Alliance
�Improving the Mammography workflow in the Radiology Unit at Cambridge Health Alliance
Aliysa Rajwani, BDS, MPH; Mary Kearns, RN; Leah Harrington; Hetal Verma, MD; Carol Hulka, MD, MBA; Gouri Gupte PhD, MHA
Cambridge Health Alliance
Interventions: Data Analysis and Impact Effort Matrix
Room utilization rate (in minutes)
• Room 4 is utilized for
Ultrasounds and Rooms 1 & 3
for Mammograms
• Near equal utilization of
rooms 1, 3 and 4
• Ultrasounds took longer than
the scheduled time and
caused backlogs that affected
workflow for screening
mammograms and also led to
increased patient wait times
250
200
74
150
34
100
37
Day 3
54
78
34
Day 2
50
58
0
Room 1
73
56
40
0
Room 2
Room 3
●
IMPACT
●
●
●
Low
Day 1
Room 4
Change U/S time slots to
30 minutes
Include Quality Check
time in daily schedule
Algorithm for double
booking- contingent on
capacity
More double bookings as
first appointments to counter
patient delays
●
●
●
EFFORT
Results
Wait time variation in waiting room
(in minutes)
Wait time variation in waiting room
(in minutes)
70
25
60
58
20
50
17
15
40
30
10
20
13
5
10
0
-10
12 11 13
17
7 10 8 10 9 10 8 4 6 5 7 10 9
8
12
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
12
12
10
9
8
5
5
0
-5
-20
0
1
2
3
4
5
6
7
8
9
10
High
An Impact Effort Matrix was created based on findings from Gemba walks, root cause
analysis and data. The team focused efforts on:
• Increasing the time in appointment slots for ultrasounds to prevent future backlogs
• Including Quality Check time as part of the current schedule to reduce variability
• Implementing patient delay policies
12
-15
Waiting room wait time (mins)
Mean
UCL
LCL
Waiting room wait time (mins)
Mean
UCL
Patient delay policies - to be
provided during appointment
scheduling and reminder
phone calls
Periodic check ins with entire
mammography team
Design communication
workflow and escalation
process for machine
efficiency related matters
11
-10
-30
7
5
Before Implementation
LCL
Success metrics
impacted positively
include:
• Reduced lead time
which includes wait
time and other non
value added time per
patient
• Decrease in total
cycle time per patient
• Decreased variability
in imaging time for
mammograms and
ultrasounds
• Increased patient
and staff satisfaction
After Implementation
Lessons Learned
The optimization of the workflow and schedule improved Patient Access in the unit.
Lean methodology tools, leadership and staff engagement have been useful in
successfully implementing evidence based recommendations for the PDSA cycles.
Next Steps
Next steps would be to utilize the unit to its complete capacity by scheduling more
mammograms due to improved throughput within unit. This would increase volume of
screening mammograms done in the unit using 3D tomosynthesis.
For more information, contact:
Aliysa Rajwani, BDS, MPH- Quality Project Improvement Advisor: Cambridge Health Alliance
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Aliysa Rajwani (<a href="mailto:arajwani@challiance.org">arajwani@challiance.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Department of Quality Management
Radiology
Project Team
Aliysa Rajwani
Mary Kearns
Gouri Gupte
Leah Harrington
Linda Lowery
Hetal Verma
Doris Gentley
Carol Hulka
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
Cambridge Health Alliance
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Improving the Mammography Workflow in the Radiology Unit at Cambridge Health Alliance
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Timeliness