QF14 Storyboard Winner - Computed Tomography (CT) Island-Wide Improvement


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This was a winning storyboard from Quality Forum 2014. It was presented by:

Heather Nash
Process Improvement Consultant
Island Health

Published in: Health & Medicine
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QF14 Storyboard Winner - Computed Tomography (CT) Island-Wide Improvement

  1. 1. Improving CT Delivery & Access Across Island Health Island-Wide Standards - A Foundation for Improvement Context Computed Tomography (CT) is provided regionally at eight Vancouver Island sites. In 2011, Island Health approved an island-wide improvement initiative to address variation in booking and scanning processes and the fact that CT clinical protocols and wait-time benchmarks were not standardized. Key concerns were that physician ordering practices, patient wait times, and delivered procedures varied by where pa- tients lived. There were also concerns about patient radiation exposure. Aim Establish foundation for Island-wide CT improvement by March 2013 by:  Improving patient access to CT services  Increasing CT scan workflow efficiency  Improving safety by reducing radiation exposure  Improving Patient, Physician and Staff satisfaction  Increasing team capacity for continuous improvement Learnings  Patient acuity and CT exam complexity are increasing and contribute to the time to complete some exams.  The scan process is already efficient but Technologists are doing some non-technical work that modality aides, porters, and clerical staff could support.  There is a real opportunity to reduce the length of time from scan to final report and improve patient care.  The biggest gains were from improving communication between services that touched the patient CT scan jour- ney: Medical Imaging and unit nurses, emergency staff, physicians and porters. Key Challenges Work was launched late in the fiscal year which rushed plan- ning and impacted our ability to build a strong coalition for change with some stakeholders and proactively address some misconceptions about ‘Lean’ and staffing. Sponsor changes during the project impacted our ability to get timely decisions at key strategic points. One Year Later ...  Standard guidelines remain in place for clerks to process outpatient CT requests (now booked within 24 hours) and ensure backlogs are dealt with quickly.  The Modality Excellence team ensures standard CT Pro- tocols and Procedures stay current. A new CT/Radiology Team Lead has improved communication among sites.  A Modality Aide position is being posted in Nanaimo which will make it possible to book more outpatient scans. This is a direct result of evidence from the PDSA trial.  Voice recognition has been rolled out at all sites, significantly reducing CT report turnaround time.  Wait times are monitored corporately but it is an ongoing challenge to sustain a culture of continuous improvement at all levels from front-line to executive. Questions/Comments Contact Jeff Stevens or Heather Nash c/o heather.nash@viha.ca 250.519.3500 Ext.32651 Approach Collected baseline metrics inform mapping. Site visits and current state mapping with people who rep- resented all roles in the process. They identified & prioritized issues. We included CT supervisors from other sites to share expertise and solutions. Plan Do Study Act cycles to test ideas for improvement. For example, a trial to have a Modality Aide prep patients and switch over the room between scans. Visual Management Boards to share ideas and progress. BEFORE AFTER Results CT Scan Room 5S Improved Access to Supplies Modality Aide Trial Increased Outpatient CT Scan Capacity By 5 per Day (1300 more Scans Per Year) in Nanaimo 3.2 % Island-Wide Increase in CT Exams Performed (Emergency & Inpatients) Implementing Priority Guidelines Enabled Standard Booking Processes & Wait Time Comparisons Collected Voice of the Customer ideas for improvement through surveys of Patients, Referring Physicians and Staff Standardizing Scan Protocols reduced radiation exposure by 31% (50% at sites with dose reduction software)