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9-5 IR: How Stanford’s new workflow structure improves efficiency and prevents delays
By Melanie Padgett Powers T
o address physician and staff burnout, a Stanford interventional radiology practice made several
workflow changes that improved efficiency, allowing IRs to head home on time at the end of their workday.
“The burnout rate amongst physicians is high, approaching 40%, and IRs are not immune,” said Nishita Kothary, MD, FSIR, a professor in Stanford School of Medicine’s IR department, which implemented the changes.
IR Division Chief Lawrence V. “Rusty” Hofmann, MD, FSIR, said burnout and wellness have always been his guiding
30 IRQ | FALL 2022
leadership principles. “I have been chief at Stanford for 16 years, and none of the 10 faculty members I’ve hired has left,” he said. “I think wellness and burnout need to be top of mind, almost daily, to ensure that you take care of physicians so they can take care of themselves, their families and their patients.”
But maintaining a work–life balance in an IR practice can be a challenge because practices often perform the scheduled outpatient procedures and then address inpatient emergencies toward the end of the workday. This frequently causes physicians and support staff to work later than planned, Dr. Kothary explained.
The Stanford IR team wanted to find a better way. So, in fall 2019 the department implemented several changes.
First, the team separated procedural rooms for the inpatient population and the scheduled outpatients, which was essential, Dr. Kothary said. One room, close to the intensive care units, was reserved for inpatients so they would not have to wait to be squeezed in at the end of the day.
“IR typically has four to six add-on cases every day, so this room is well utilized,” Dr. Kothary said. The on-call IR was now designated to handle inpatient calls, while the other IRs on service focused on scheduled outpatient procedures. This meant each IR went on call every 10 days, rather than knowing they might work late on any given day.
Next, they focused on using staff in a more efficient manner. Previously, nurses and techs would arrive to work around 7 a.m., but cases didn’t start until closer to 8:30 a.m. “At least in California, labor’s extremely expensive, and the cases would start late even though the techs were coming in early. And we
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