Use of Lean Six Sigma methodology shows reduction of inpatient waiting time for peripherally inserted central catheter placement.

AIM: The aim of this study was to assess the use of Lean Six Sigma methodology to improve the turnaround time (TAT) for inpatient peripherally inserted central catheter (PICC) placement. MATERIALS AND METHODS: Value stream mapping was used to analyse the workflow process for inpatient PICC placement and to divide it into its component parts. Unnecessary steps were eliminated and variation minimised in the remaining processes. The TAT for PICC line placement was recorded for the 6 months prior to implementation of changes, and subsequently, at the 6-month and 2-year follow-up points. RESULTS: Prior to implementing the changes, the mean TAT for PICC line placement was 3.74±3.28 days (95% confidence interval [CI]=3.3-4.17). Six months after implementation, the mean TAT was 1.89±1.82 days (95% CI=1.72-2.06, p<0.0001). The reduction was sustained such that at 2 years post-implementation the mean TAT was 1.88±1.87 days (95% CI=1.78-1.99, p<0.0001). This was achieved despite a 13.8% increase in overall interventional radiological activity. CONCLUSION: By applying Lean Six Sigma methodology to the complex multifactorial processes involved from ordering a PICC to its final insertion, it was possible to identify areas for improvement and to introduce simple, effective measures that resulted in a significant sustained decrease in the TAT without additional resources.

Subtraction of time-resolved magnetic resonance angiography images improves visualization of the pulmonary veins and left atrium in adults with congenital heart disease: a novel post-processing technique.

To describe a novel time-resolved magnetic resonance angiography (TR-MRA) postprocessing technique using the time-resolved angiography with interleaved stochastic trajectories (TWIST) method to evaluate the pulmonary veins and left atrium in adults with congenital heart disease undergoing cardiac MRI. Institutional ethics committee approved the study. 21 consecutive adult patients (14 female, 7 male patients, mean age 28 years) with known congenital heart disease who underwent a cardiac MRI were included. Post-processing of the TR-MRA sequences created novel "subtracted" datasets. Two independent observers reviewed the conventional TWIST and novel subtracted TWIST data sets in source and maximum intensity projection (MIP) coronal reformats to assess visualization of the pulmonary veins and left atrium based on a 5-point scale. Quantitative signal to noise (SNR) comparison was performed. TR-MRA yielded diagnostic image data in 20/21 patients (95.2%). The novel "subtracted" TR-MRA technique improved visualization of the pulmonary veins and left atrium compared to the source TR-MRA sequence in 16/20 patients (mean scores 3.34 ± 0.69 vs. 2.92 ± 0.69, p < 0.008). Further improved visualization of the pulmonary veins and left atrium was observed in the subtracted MIP TWIST sequences compared to the MIP TWIST images (mean scores 4.43 ± 0.80 vs. 3.02 ± 0.87 vs., p < 0.001). No significant SNR difference between the source and novel subtracted group was observed (85.4 vs. 70.4, p = 0.57). Compared to source TR-MRA images, subtraction of TR-MRA images is a novel postprocessing technique that improves visualization of the pulmonary veins and left atrium in a substantial number of patients.