New London Hospital (NLH), a rural community hospital in New Hampshire, had been facing some long-standing challenges. In the radiology department, workflow and patient flow were not operating smoothly. Communication with the emergency department regarding patient preparedness was unclear, so patients often arrived unprepared and confused.

Through a recent consulting engagement, the hospital received a detailed assessment of the radiology department that identified multiple opportunities for improvement, and the team began to chart a prudent course for the future with a roadmap.

Gathering and Analyzing Data

During a comprehensive four-week project, the hospital’s radiology department and referring physicians worked with the consultant to collect information through interviews, direct observation and manual data collection in areas such as availability of services offered, scheduling and patient wait time, technology, throughput and marketing. New London’s scores were compared to national benchmarks and the hospital’s own standards.

The imaging roadmap followed a Six Sigma approach, leading up to creating an action plan for improvement to be followed by control. Twelve unique areas for improvement were identified and defined by the team during voice-of-the-customer interviews, and then most of these areas had baseline measurements captured during a data collection period. Those issues were then analyzed to determine the scope of the problem. Then during the work-out, action items were prioritized based on ease of implementation and overall impact that would be realized by the patient, staff and organization. A 30-day action plan for improvement was created detailing who was going to lead the improvement effort for a certain item and what timeline they would hold themselves accountable to.

Broad participation and input was key, and Debra Wilson, the Director of Radiology notes, “I liked this approach because it included everyone who is involved. We were able to talk about both the issues and potential solutions.”

The working session involved members of the radiology staff, and the final report-out included members of the hospital’s leadership team and other departments involved with the improvement opportunities. After hearing the final report-out presentation, the team reported that the project was valuable because:

• It validated some of the staff’s organizational issues by supporting them with data.
• It created buy in from the leadership and staff to address these issues.

Implementing Improvement Initiatives

Since the imaging roadmap was developed, New London Hospital has been able to identify and address some specific opportunities for improvements.

Improvement Initiative #1 – One of the findings was that no-show patients (patients who do not show up for a scheduled slot time) were problems for several modalities. This was news to the team because only one modality was previously seen as an issue in this regard. Improvement efforts have begun to focus on all modalities relative to the no-show issue. In tracking the results, a range of 3 – 22 percent of no-show patients has been reduced for three modalities due to improvement efforts.

Improvement Initiative #2 – One of the more significant opportunities for improvement identified involved emergency department patient handoffs and transport to radiology. This was scored as one of the most difficult areas to improve because it would involve efforts by two departments to resolve a long-standing issue.

Both departments had expectations of what was needed for a patient handoff, yet those expectations were not often clear. As a result, when patients were transported from the emergency department to the radiology department, they were not always prepared for exams or transported in a timely manner. This issue was cited by radiology technicians as one of their major issues – specifically when they were called in to work after hours only to find the patient was not ready for the exam. The first big step for the departments was simply to identify the problem and begin discussions.

“We’ve known the problems and have wanted to resolve them for some time,” says Wilson. “It was great to finally get the tools to be able to fix them in the right way. For example, we have been able to let the emergency department know that this is what slows us down, and that if they can help us, we can help them in terms of turnaround time.”

Since the roadmap was developed, the radiology staff has teamed up with the emergency department to tackle this issue. After numerous meetings and putting standard operating procedures in place, the transport and prep process has seen a great deal of improvement.

“After identifying and meeting about this issue,” says Wilson, “we decided to raise awareness and educate the teams. The feeling here is that things are finally getting better.”

Improvement Initiative #3 – The referring physicians and radiology staff identified a common concern around issues with scheduling procedures at the right time with the right resources available. Three improvements have since been implemented to address the concerns. The first is a scheduling guide, developed by the radiology department for the physician offices, which will help decrease errors in booking the wrong exams or the wrong time of day.

Another positive change was the creation of a daily communication meeting with the operating department to review which procedures will require radiology assistance for the following day. The recent hospital-wide implementation of an HIS/RIS computer system has also been pivotal, with the provision of a patient itinerary that gives the patients their exam times and dates and any preparations that will be need to be done prior to their exams. The system also alerts the radiology department that a patient has checked into admissions for an exam even before the patient arrives in the department. This new system will now help streamline on-time starts while reducing the time spent searching for patients.

Improvement Initiative #4 – Another finding was that many patients were unaware of the reason for scheduled procedures, potential outcomes from their visits, or what they were supposed to do or not do leading up to the day of their procedures. Many of these questions also came while the patient was in the exam room.

New London Hospital created a series of informational handouts for patients on all the procedures done in the radiology department. They explain the exam, preparations that are needed and post-procedure instructions. These pamphlets will help to answer many patient questions and concerns about a specific radiology procedure in advance of the patient visit.