Optimizing Inpatient Body MRI Utilization: A Granular Look at Trends, Quality, Yield, and Timing.

OBJECTIVE: We sought to analyze body MRI utilization trends, quality, yield, and timing among inpatients in a tertiary care academic medical center. MATERIALS AND METHODS: By use of billing data from fiscal years (FYs) 2006-2015, the volume of admissions was compared with the total number of inpatient body MRI examinations. MRI examinations per admissions and discharge were adjusted using the Centers for Medicare & Medicaid Services case mix index by FY. Linear regression was used to assess trends. In addition, each inpatient body MRI examination performed in FY 2015 was evaluated and graded on its quality and yield and was judged as to whether it could have been performed on an outpatient basis. RESULTS: There was an increase in the number of inpatient body MRI examinations, from 637 examinations in FY 2006 to 871 examinations in FY 2015 (p = 0.005). By adjusting for case mix, the upward trend for body MRI use persisted (p = 0.012). Regarding quality, 2.3% of all inpatient body MRI examinations were nondiagnostic, 40.4% were limited quality, and 57.3% were of diagnostic quality. Concerning yield, 20.8% of all examinations had no yield, 5.1% of examinations had no yield but incidental findings, and 74.1% of examinations had a positive yield. Finally, regarding timing, 30.2% of examinations could have been performed as outpatient examinations. CONCLUSION: At our institution, the number of inpatient body MRI examinations has increased significantly over the past 10 years. Many of the examinations, however, are poor quality, often give redundant information, and could be performed in the outpatient setting.

Impact of Performing Nonurgent Interventional Radiology Procedures on Weekends.

Most clinical services limit weekend care to urgent or emergent situations. However, providing access to nonemergent procedures on weekends may reduce length of hospital stay and unnecessary admissions. No data are available on the impact of providing nonemergent interventional radiology (IR) procedural services on weekends. A retrospective review of nonurgent IR inpatient services on weekends over a 12-month period was performed. Using intent-to-treat analysis, 453 procedures were performed on 447 patients on 100 weekend days. Procedures included venous access (116 of 453, 25.6%), dialysis interventions (83 of 453, 18.3%), enteral access (73 of 453, 16.1%), genitourinary interventions (37 of 453, 8.2%), venous interventions (35 of 453, 7.7%), biliary interventions (33 of 453, 7.3%), percutaneous drainage (32 of 453, 7.1%), biopsy (24 of 453, 5.3%), arterial interventions (14 of 453, 3.1%), and other (3 of 453, 0.7%). Routine weekend procedural services allowed 108 of 447 (24.2%) patients to be discharged earlier than anticipated if such services were not available, resulting in 174 hospital days gained. Procedures were performed earlier than anticipated in 268 of 447 (60.0%) patients resulting in 415 days of progression of care gained over the 12-month period. For dialysis interventions, 35% (29 of 83) of patients received hemodialysis within 24 hours of intervention, and 25 patients were discharged early with 33 hospital days saved. IR procedures were performed on patients from 97% of the hospital inpatient units (22 of 23 inpatient or observation units, and 10 of 10 intensive care units) over the 12-month period. In conclusion, increased availability of nonurgent IR services on weekends can directly reduce hospital length of stay as well as improve progression of inpatients toward an early discharge.

Optimizing MRI Logistics: Prospective Analysis of Performance, Efficiency, and Patient Throughput.

OBJECTIVE: The objective of this study is to optimize MRI logistics through evaluation of MRI workflow and analysis of performance, efficiency, and patient throughput in a tertiary care academic center. SUBJECTS AND METHODS: For 2 weeks, workflow data from two outpatient MRI scanners were prospectively collected and stratified by value added to the process (i.e., value-added time, business value-added time, or non-value-added time). Two separate time cycles were measured: the actual MRI process cycle as well as the complete length of patient stay in the department. In addition, the impact and frequency of delays across all observations were measured. RESULTS: A total of 305 MRI examinations were evaluated, including body (34.1%), neurologic (28.9%), musculoskeletal (21.0%), and breast examinations (16.1%). The MRI process cycle lasted a mean of 50.97 ± 24.4 (SD) minutes per examination; the mean non-value-added time was 13.21 ± 18.77 minutes (25.87% of the total process cycle time). The mean length-of-stay cycle was 83.51 ± 33.63 minutes; the mean non-value-added time was 24.33 ± 24.84 minutes (29.14% of the total patient stay). The delay with the highest frequency (5.57%) was IV or port placement, which had a mean delay of 22.82 minutes. The delay with the greatest impact on time was MRI arthrography for which joint injection of contrast medium was necessary but was not accounted for in the schedule (mean delay, 42.2 minutes; frequency, 1.64%). Of 305 patients, 34 (11.15%) did not arrive at or before their scheduled time. CONCLUSION: Non-value-added time represents approximately one-third of the total MRI process cycle and patient length of stay. Identifying specific delays may expedite the application of targeted improvement strategies, potentially increasing revenue, efficiency, and overall patient satisfaction.

Optimizing MRI Logistics: Focused Process Improvements Can Increase Throughput in an Academic Radiology Department.

OBJECTIVE: The purpose of this study was to describe and evaluate the effect of focused process improvements on protocol selection and scheduling in the MRI division of a busy academic medical center, as measured by examination and room times, magnet fill rate, and potential revenue increases and cost savings to the department. MATERIALS AND METHODS: Focused process improvements, led by a multidisciplinary team at a large academic medical center, were directed at streamlining MRI protocols and optimizing matching protocol ordering to scheduling while maintaining or improving image quality. Data were collected before (June 2013) and after (March 2015) implementation of focused process improvements and divided by subspecialty on type of examination, allotted examination time, actual examination time, and MRI parameters. Direct and indirect costs were compiled and analyzed in consultation with the business department. Data were compared with evaluated effects on selected outcome and efficiency measures, as well as revenue and cost considerations. Statistical analysis was performed using a t test. RESULTS: During the month of June 2013, 2145 MRI examinations were performed at our center; 2702 were performed in March 2015. Neuroradiology examinations were the most common (59% in June 2013, 56% in March 2015), followed by body examinations (25% and 27%). All protocols and parameters were analyzed and streamlined for each examination, with slice thickness, TR, and echo train length among the most adjusted parameters. Mean time per examination decreased from 43.4 minutes to 36.7 minutes, and mean room time per patient decreased from 46.3 to 43.6 minutes (p = 0.009). Potential revenue from increased throughput may yield up to $3 million yearly (at $800 net revenue per scan) or produce cost savings if the facility can reduce staffed scanner hours or the number of scanners in its fleet. Actual revenue and expense impacts depend on the facility's fixed and variable cost structure, payer contracts, MRI fleet composition, and unmet MRI demand. CONCLUSION: Focused process improvements in selecting MRI protocols and scheduling examinations significantly increased throughput in the MRI division, thereby increasing capacity and revenue. Shorter scan and department times may also improve patient experience.

Electronic Kiosks for Patient Satisfaction Survey in Radiology.

OBJECTIVE: The purpose of this article is to analyze patient satisfaction surveys obtained via electronic kiosks in a tertiary-care academic radiology department to detect potential areas of improvement and to identify ways to improve survey response and completion rates. MATERIALS AND METHODS: All patient satisfaction surveys submitted via electronic kiosks and via online surveys between January 2015 and January 2016 were included in this retrospective study. The surveys consisted of questions regarding the patients' overall experience, cleanliness of the department, and interactions with the receptionist, technologist, nurse, and physician. Ratings were assessed using a 5-point scale (where 1 denotes poor and 5 denotes optimal) with an option for free-text comments. The likelihood of recommendation was regarded as an indicator of satisfaction and was our primary evaluation metric. Surveys with less than optimal ratings were analyzed in detail. RESULTS: Of 99,289 patients who visited the department, 6736 (6.8%) initiated surveys, and 4938 (73.3%) of those completed them; 4257 of 4865 (87.5%) patients reported optimal satisfaction. More patients responded via electronic kiosk compared with the online survey (4564/4938 [92.4%] vs 374/4938 [7.6%]; p < 0.001). The frequency of completion rate was lower for kiosks in changing and waiting areas compared with that for kiosks next to elevators (1509/2365 [63.8%] vs 3059/3927 [77.8%]; p < 0.0001). Cleanliness of the department (329/1656 [19.9%]) and courtesy of the receptionist (299/1656 [18.1%]) were the most frequent reasons for the lowest ratings. Wait time (61/278 [21.9%]) and communication (37/278 [13.3%]) were associated with the most frequent free-text complaints. CONCLUSION: Survey kiosks led to a higher response rate than online surveys. The completion rate can be further improved by placing kiosks next to elevators. Cleanliness, wait time, patient-staff communication, and especially courtesy of the receptionist were found to be important factors for patient satisfaction.

Application of failure mode and effect analysis in a radiology department.

With increasing deployment, complexity, and sophistication of equipment and related processes within the clinical imaging environment, system failures are more likely to occur. These failures may have varying effects on the patient, ranging from no harm to devastating harm. Failure mode and effect analysis (FMEA) is a tool that permits the proactive identification of possible failures in complex processes and provides a basis for continuous improvement. This overview of the basic principles and methodology of FMEA provides an explanation of how FMEA can be applied to clinical operations in a radiology department to reduce, predict, or prevent errors. The six sequential steps in the FMEA process are explained, and clinical magnetic resonance imaging services are used as an example for which FMEA is particularly applicable. A modified version of traditional FMEA called Healthcare Failure Mode and Effect Analysis, which was introduced by the U.S. Department of Veterans Affairs National Center for Patient Safety, is briefly reviewed. In conclusion, FMEA is an effective and reliable method to proactively examine complex processes in the radiology department. FMEA can be used to highlight the high-risk subprocesses and allows these to be targeted to minimize the future occurrence of failures, thus improving patient safety and streamlining the efficiency of the radiology department.

Implementation of online radiology quality assurance reporting system for performance improvement: initial evaluation.

PURPOSE: To evaluate an online system developed and implemented for reporting and managing quality assurance (QA) events occurring in a radiology department. MATERIALS AND METHODS: This HIPAA-compliant study had institutional review board approval; informed consent was not required. Using repeated plan-do-study-act cycles, a radiology quality management team applied a 10-step process to implement an online reporting system. The system permits remote submission of cases by staff members. The number of weekly submissions to the system over a 9-month period was evaluated and compared with that for the preceding 6 months by using the Mann-Whitney test. Sources and nature of data, actions initiated, and final outcomes were also analyzed. Recorded data included forum of discussion, dimension of care, action items, monitoring of follow-up and compliance, and notification status. RESULTS: During the first 9 months of implementation, 605 cases were submitted (mean, 21.4 cases per week), a significant increase (P < .005) compared with the preceding 6 months (mean, 3.2 cases per week). Cases, which were submitted by residents (121 cases [20.0%]), fellows (94 cases [15.5%]), faculty members (319 cases [52.7%]), or technologists (54 cases [8.9%]), reported technical (33.1%) or administrative (8.0%) issues. The 329 clinical cases (54.4%) included 60 errors in communication (18.2%), 67 errors in interpretation (20.4%), 78 diagnostic delays (23.7%), 99 missed diagnoses (30.1%), and 54 procedural complications (16.4%); some cases were in more than one category. Twenty-three cases (3.8%) resulted in submission-related QA projects, and 69 cases (11.4%) resulted in individuals or sections of the hospital undergoing additional training. CONCLUSION: A secure online QA reporting system promotes reporting of QA events and serves as a database for identifying and managing trends, initiating performance improvement projects, and providing feedback to staff members who submit cases.