Background: Emergency Department (ED) boarding is associated with increased patient morbidity and mortality and low patient and provider satisfaction. Reducing inpatient Length of Stay (LOS) is one strategy to increase inpatient capacity and reduce ED boarding. Delay in obtaining Magnetic Resonance Imaging (MRI) results is associated with an increase in LOS in the inpatient setting.
Purpose: We describe a process improvement project at our institution to reduce MRI turnaround time in the inpatient setting.
Description: Our hospital is a 700-bed level 1 trauma center, academic medical center, and county hospital located in South Texas. Radiology is equipped with 3 MRI machines for inpatient studies. Surveys of hospitalists, nurses and case management staff identified delays in obtaining MRI results as one of top 3 reasons for delay in discharges. We partnered with our operational excellence team to apply Lean principles to this process improvement project to improve MRI turnaround time. A multidisciplinary team of hospitalists, nursing, radiologist, radiology technologists, cardiologist (Electrophysiology-EP), anesthesiologist, transport personnel and environmental services identified barriers to timely MRI completion. A process map was created to address barriers to timely MRI completion by eliminating and combining redundant steps and creating new processes (figure 1). The team broke down the process of obtaining an MRI into 3 parts: MRI order to schedule, MRI schedule to completion, and MRI completion to read time. Solutions were iteratively implemented January and November 2022 and are summarized in table 1.Between January-December 2021 to January-November 2022, we saw an improvement in turnaround time for MRIs on weekdays (34.9 hours to 33.5 hours) and weekends (34 hours to 31.3 hours). Exam order to exam begin time improved from 23.64 hours to 23.27 hours on weekdays, and 22.37 hours to 20.35 hours on weekends. Exam begun to exam completion time improved from 1.44 hours to 1.19 hours on weekdays, and 1.41 hours to 1.16 hours on weekends. Exam end to result time improved from 9.93 hours to 9.17 hours on weekdays, and 10.29 hours to 9.45 hours on weekends.
Conclusions: A multidisciplinary, Lean methodology guided performance improvement project involving all relevant stakeholders resulted in savings of 1.4 hours and 2.7 hours per MRI study on weekdays and weekends, respectively. We continue to iteratively test additional interventions to further reduce our MRI turnaround time.
