ECR 2018 / C-1325
Improving order-to-scan time for emergency department unenhanced CT examinations
Keywords:
Emergency, Management, CT, Safety
Authors:
K. S. Burk, S. Tajmir, R. R. D. Almeida, M. H. Lev; Boston, MA/US
DOI:
10.1594/ecr2018/C-1325
Methods and materials
- Baseline Data Collection: To better understand the source of these delays,
we conducted a survey of technologists inquiring about the reasons for CT exam delays.
A pareto chart of survey responses showed that 75% of delays were related to patient readiness,
including waiting for labs to result and for an IV to be placed (Figure 1).
- Baseline Data Collection: Timestamps of “exam ordered” and “exam begun” were extracted from the electronic medical record,
subtracted from each other (OtB or “order-to-scan” time),
and averaged daily. These were turned into Statistical Process Control (SPC) charts with 3-sigma control limits around the center line differentiating between special cause change and expected variance within the system. SPC charts showed that it took an average of 90 minutes for I- C-spine CTs and I- Stone protocol Abd/Pelvis CTs to be performed after the exams were ordered (Figure 2).
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Understanding the Problem: To better understand factors contributing to delays,
our team created a detailed Process Map (Figure 3).
Steps and closed-loops denoted in the figure in RED are those eventually targeted by our interventions.
We also created a Fishbone,
or Cause and Effect Diagram,
to better understand which factors contributed to each other (Figure 4).
- Interventions: Our team brainstomred potentional solutions and created a prioritization matrix to classify interventions by ease of implementation and potential impact (Figure 5).
By vote,
the team decided to focus our efforts on the interventions denoted in the figure in RED.
Plan-Do-Study-Act (PDSA) methodology was employed and two interventions were executed: The first was auto-protocoling algorithms coupled with educational presentations to ED PA/NPs,
physician staff,
and trainees to instruct them how to place exam orders.
This automation removed an unnecessary manual step in our process map.
An example of the algorithm for I- C-spine CTs is seen in (Figure 6).
The second intervention was the launch of a text-communication system and design of a standardized communication workflow between CT technologists and ED RNs regarding patient readiness for transport,
addressing the most common causes for delays as identified in our baseline survey data.