Background: Demand for imaging services continues to rise in medical practice, including Magnetic Resonance Imaging (MRI) studies, for both the inpatient and outpatient settings. Demand for imaging services that exceed capacity can translate into prolonged hospitalizations when imaging is not performed in a timely manner. Delays in discharges lead to increased risk of infections, falls, negative patient experiences, and increased costs to patients, insurers, and the hospital. At our institutions approximately 50% of the inpatient MRI studies were performed within 16 hours of order time. Our SMART goal was to increase the percentage of inpatient MRI studies performed within 16 hours of order placement to 75% within 9 months.
Methods: In partnership with the American College of Radiology Learning Network ®, this project was performed at a large academic medical center (Hospital 1) and a community hospital (Hospital 2) within one health care system. A multidisciplinary project team included residents, attending physicians from several disciplines, radiology technologists, and nurses. Using A3 performance improvement methodology, including Gemba walks, process maps, and fishbone diagrams, the team was able to identify multiple root causes for delays in imaging acquisition after ordering. Key drivers were identified, and interventions were developed, implemented, and analyzed using rapid Plan-Do-Study-Act (PDSA) cycles. Baseline data was obtained and validated including the average and median turnaround time from order placement to MRI study completion over the preceding 9 months. Descriptive statistics and control charts were utilized in weekly audits to identify potential delays and monitor results of interventions over 24 weeks. Various interventions were targeted at addressing key drivers that included a shared understanding of MRI exam time and priority status, streamlining workflow for patients that failed screening, delegation of responsibilities amongst MRI staff, and standardizing communication between inpatient teams using electronic health records.
Results: At Hospital 1 the key drivers were 1) agreement on priority status expectations and measures, 2) clear and consistent communication between inpatient teams and radiology, 3) effective utilization of MRI scanners, and 4) ensuring patients are prepared for MRI exams. At Hospital 2 the key drivers were identified as 1) agreement on priority status expectations and measures 2) clear and consistent communication of MRI status with inpatients teams 3) consistent utilization of MRI scanners and 4) increase MRI utilization.During the active project phase, the percentage of exams performed within 16 hours increased from an average of 50% to 64% (28%) (Fig 1) at Hospital 1 and from 50% to 68% (36%) (Fig 2) at Hospital 2. Since December of 2024 the time saved by both hospitals equates to over 2000 bed days. Unexpected MRI technologist staffing challenges were identified as the primary reason for increased data variability in the sustainability phase.
Conclusions: The initial improvement demonstrates that simple interventions focusing on workflows and shared expectations can have a significant impact on a complex problem. Reducing the time from order to performed can improve care delivery efficiency equivalent to millions of dollars in savings while improving the timeliness of care for patients. A commitment to sustainability is required to ensure that the interventions have long-lasting effects.
.jpg)
.jpg)