would run late, which meant that staff stayed longer, resulting in overtime,” Dr. Kothary said. “That was the monetary aspect of it: We needed to get better about using our labor efficiently.”
To better ensure cases started on time, morning rounds start times changed from 7:30 a.m. to 7:15 a.m., Tuesdays through Thursdays. They were shortened from 45 minutes to 30 and, to eliminate the frequent problem of rounds that went on too long, specific didactic lectures for trainees were moved to the end of the day. Mondays remained educational days with a later morning start time.
The individual times per IR and per type of procedure are now built into the EMS, which automatically selects the appropriate length of time based on that physician’s history.
The department also used analytics to improve scheduling. Instead of having one estimated time for a specific procedure, they used their electronic medical system (EMS) to analyze the actual time it took each IR to do certain procedures, on average, and scheduled accordingly. The individual times per IR and per type of procedure are now built into the EMS, which automatically selects the appropriate length of time based on that physician’s history.
“People work differently; they have different speeds,” Dr. Kothary said. “Smart scheduling using the EMS provides accurate historical data that allows accurate scheduling. One can’t assume that it takes them 60 minutes to do chemoembolization, for example, when in reality the data show that they routinely take an hour and 40 minutes.” If the IR expects the case to be more complex, they can override the scheduling system and add more time.
sirweb.org/irq | 31
The late start times and longer-than- scheduled cases would cause a cascade of delays throughout the day, which resulted in frustrated patients being forced to wait around for treatment, potentially putting them at risk. In addition, because inpatients are now seen earlier, they aren’t required to fast throughout the full day, which improves their comfort.
An analysis of the changes over a 10-month period, compared with 10 months before the intervention, showed start times improved from 56% on time before the intervention to 72%. Weekday patient volume did not fluctuate significantly. The length of allotted procedural times improved from 71% to 74%.
Perhaps most significantly, outpatient- designated IRs finished their last case by 5 p.m. 87% of the time. In fact, even including the inpatient on-call IR, all rooms finished their last case by 5 p.m. in 81% of the cases—compared to 53% before the intervention. The results, which were presented in the October 2021 issue of the Journal of Vascular and Interventional Radiology, were achieved through an entirely cost- neutral system, without adding staff, rooms or room hours.
“The largest impact to our practice is more predictability,” Dr. Hofmann said. “Life in an IR practice is organized chaos due to the emergent nature of many of our patients’ needs. The more you can structure your practice to deliver predictability, despite the ongoing chaos, the better. With more predictability, we have been able to do more cases in less time and provide more non-clinical time to our physicians.”
The Stanford workflow model Organization
Separate inpatient and outpatient services, and have an on-call IR handle all inpatient services.
Efficiency
Start rounds earlier and keep them short.
Smart scheduling
Invest in scheduling software that analyzes procedure times by provider and schedule accordingly.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48
