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Ron,

Attached are the descriptions of three case studies.
Would you like to review the outcomes?
#1. To improve upon the design of a CT suite
recommended by a vendor.
#2. To expedite the installation of a radiographic room for
use by the Emergency Department.
#3. To refine the design of filmless reading rooms for the
transition from film-based reading rooms to digital reading
stations.

Ken
Example #1. Vendor’s recommended CT Design




Questions, concerns, suggestions for improvement?
Questions, concerns, suggestions for improvement?

                                    4’ 11”



      Key Takeaway
         Be extremely cautious of
         installation advice provided
         by vendors.
Example #2. Actual Case Study
 Expedite installation of an emergency radiographic room




                                             Room dimensions:
                                             20’ x 24’


Starting Point:
• Current room to be taken out of service within 30 days
• Am not to look at anything else whatsoever for following reasons:
   1. Any other changes would jeopardize getting this room installed
       quickly.
   2. There are – and will NOT be - any funds approved for doing
       anything else for at least one year if not more.
                                                                5
Key Takeaway
           Always identify an existing
           site to use as a benchmark
           for your design early in
           your planning process.
      Typical radiographic equipment
        • Chest board for chest x-rays on back wall
          • Radiographic table on which some patients lay
          • X-ray tube hangs from ceiling mounting so it can move
            about the room to aim in any direction
          • Casework for supplies
Source: Google: Radiographic room design. Then select: “Images for radiographic room design”,
Assignment
Seen below is a layout for a radiographic room that pops up if you go to the Google site
listed below*. Using this layout or other information from this web site, create a layout on
the attached slide which is to be turned in at the start of class on Tuesday.




          Key Takeaway
                Be extremely cautious of
                advice from Internet.
                Watch for red flags.


    *To see this drawing as well as many photographs of radiographic rooms, Google: Radiographic
    room design. Then select: “Images for radiographic room design”, “Images for . . .”
Classroom exercise #1 for ISE 541
Recommended design for a radiographic room
Turn in at start of class on Tuesday




      Print Name (legibly) _________________
                                               8
Actual Case Study
 Expedite installation of an emergency radiographic room




                                             Room dimensions:
                                             20’ x 24’


Starting Point:
• Current room to be taken out of service within 30 days
• Am not to look at anything else whatsoever for following reasons:
   1. Any other changes would jeopardize getting this room installed
       quickly.
   2. There are – and will NOT be - any funds approved for doing
       anything else for at least one year if not more.
                                                                9
2
                                              4




  Key Takeaway
     Create a “Functional Drawing”
     for conducting an initial
     current state assessment to
         ED
         Supplies
                                  3


     understand the big picture.
     1




                    Existing Conditions
Emergency           1. Current ED Radiographic Room to be taken out of service within 30 days to create new Corridor

Department          2. CT for Emergency use is in NE corner of Radiology Department
                    3. Single slice CT is obsolete, not used for Emergency work. CT to be replaced in future.
                                                                                                                10
                    4. Second MRI needed. Plans being developed to install in vacant interventional room.
New corridor




Outcomes:
1.Expanded space allocated from renovation from Angio Supply Room only to that seen above
2.Gained approval to install new CT within this space..
                                                                                            11
Key Takeaway
                 Use “Functional Drawing
                 Tools and Techniques to
                 improve upon drawngs
                 done by architects..
               New corridor




Outcomes:
1.Created an MRI suite which also freed up space for future interventional work..

                                                                                    12
Net Result of Intervention and
Use of Tools
  • Radiographic room was enlarged and
    redesigned.

  • An Emergency Room suite was created
    with CT and Radiographic Rooms along
    with ancillary support spaces..

  • A second MRI was justified and installed
    within space previously occupied by a CT
Example #3: Dartmouth-Hitchcock Medical Center
          “Minimizing the spaghetti.”
Conditions of Engagement:

1. “To look only at design of new filmless radiology
   reading rooms (PACS) and nothing else.”
2. “Do not expect to make any changes as project
   is over budget and behind schedule.”
3. “CT suite is absolutely off limits. It is done.”




                                                      KJA
Example of one of the proposed designs for
filmless reading room.
What, if any, changes would you propose for
this reading room?                    KJ/MCExam
AHRA 2003 Annual Meeting


      Optimizing Radiology
     Workflow and Productivity
               Monte G. Clinton, FAHRA
                 Administrative Director
           Dartmouth-Hitchcock Medical Center
             monte.g.clinton@hitchcock.org

                 Kenneth C. Johnson
                      President
          Kenneth Johnson and Associates, Inc.
                 kjandassoc@aol.com
Dartmouth-Hitchcock Medical Center
Dartmouth-Hitchcock
Medical Center Hospital
Corridor
Workflow Analysis Techniques
Create drawing to illustrate workflow at 15,000’
Case Study: Dartmouth-Hitchcock Medical Center
“No changes to be made to basic design, but was given
approval to suggest refinements.”
Workflow Analysis Techniques
Continue to zoom in and analyze workflow from everyone’s
perspective.
                                            OP, ED




           IP
Workflow Analysis Techniques
Analyze workflow by tracing everyone’s footsteps




      Key Takeaway
         Use “Spaghetti Drawings” to
         first understand workflow, then
         improve upon it.
                                               Color Code
                                               Red = Patient
                                               Blue = Technologist
                                               Green = Radiologist
Workflow Analysis Techniques
Zoom in until at “ground level.”




 Yellow shaded
 area represents                   Note challenge in
 operator’s line of                getting patient
 vision when                       into room,
 looking at                        particularly if IV
 console. To see                   pole, etc.
 patient, operator
 looks to left.
Workflow Analysis Techniques
Simulate the design using scale models putting yourself in the
driver’s seat.




    Proposed design before simulation
Workflow Analysis Techniques
Involve radiologists and all staff in simulating various designs.




        Key Takeaway
            Conduct full-scale mock-
            ups or use scale models to
            develop designs and
            illustrate the final outcome
            you desire..

         Design resulting from simulation.
Workflow Analysis Techniques
Strive to minimize the travel for all parties
(Minimize the spaghetti)




              Design resulting from simulation.
         4th CT moved to Emergency Department.
Net Result of Intervention and
Use of Tools
  • One CT was moved to ED.

  • CT Suite was redesigned to improve
    workflow.

  • Designs of PACS reading rooms were
    significantly improved upon.

                                         KJ/MC
Comments?
        Questions?
        Feedback?

Monte G. Clinton, CRA, FAHRA
monte.g.clinton@hitchcock.org

Kenneth C. Johnson, President
    kjandassoc@aol.com

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Kj case studies to rk ending point

  • 1.
  • 2. Ron, Attached are the descriptions of three case studies. Would you like to review the outcomes? #1. To improve upon the design of a CT suite recommended by a vendor. #2. To expedite the installation of a radiographic room for use by the Emergency Department. #3. To refine the design of filmless reading rooms for the transition from film-based reading rooms to digital reading stations. Ken
  • 3. Example #1. Vendor’s recommended CT Design Questions, concerns, suggestions for improvement?
  • 4. Questions, concerns, suggestions for improvement? 4’ 11” Key Takeaway Be extremely cautious of installation advice provided by vendors.
  • 5. Example #2. Actual Case Study Expedite installation of an emergency radiographic room Room dimensions: 20’ x 24’ Starting Point: • Current room to be taken out of service within 30 days • Am not to look at anything else whatsoever for following reasons: 1. Any other changes would jeopardize getting this room installed quickly. 2. There are – and will NOT be - any funds approved for doing anything else for at least one year if not more. 5
  • 6. Key Takeaway Always identify an existing site to use as a benchmark for your design early in your planning process. Typical radiographic equipment • Chest board for chest x-rays on back wall • Radiographic table on which some patients lay • X-ray tube hangs from ceiling mounting so it can move about the room to aim in any direction • Casework for supplies Source: Google: Radiographic room design. Then select: “Images for radiographic room design”,
  • 7. Assignment Seen below is a layout for a radiographic room that pops up if you go to the Google site listed below*. Using this layout or other information from this web site, create a layout on the attached slide which is to be turned in at the start of class on Tuesday. Key Takeaway Be extremely cautious of advice from Internet. Watch for red flags. *To see this drawing as well as many photographs of radiographic rooms, Google: Radiographic room design. Then select: “Images for radiographic room design”, “Images for . . .”
  • 8. Classroom exercise #1 for ISE 541 Recommended design for a radiographic room Turn in at start of class on Tuesday Print Name (legibly) _________________ 8
  • 9. Actual Case Study Expedite installation of an emergency radiographic room Room dimensions: 20’ x 24’ Starting Point: • Current room to be taken out of service within 30 days • Am not to look at anything else whatsoever for following reasons: 1. Any other changes would jeopardize getting this room installed quickly. 2. There are – and will NOT be - any funds approved for doing anything else for at least one year if not more. 9
  • 10. 2 4 Key Takeaway Create a “Functional Drawing” for conducting an initial current state assessment to ED Supplies 3 understand the big picture. 1 Existing Conditions Emergency 1. Current ED Radiographic Room to be taken out of service within 30 days to create new Corridor Department 2. CT for Emergency use is in NE corner of Radiology Department 3. Single slice CT is obsolete, not used for Emergency work. CT to be replaced in future. 10 4. Second MRI needed. Plans being developed to install in vacant interventional room.
  • 11. New corridor Outcomes: 1.Expanded space allocated from renovation from Angio Supply Room only to that seen above 2.Gained approval to install new CT within this space.. 11
  • 12. Key Takeaway Use “Functional Drawing Tools and Techniques to improve upon drawngs done by architects.. New corridor Outcomes: 1.Created an MRI suite which also freed up space for future interventional work.. 12
  • 13. Net Result of Intervention and Use of Tools • Radiographic room was enlarged and redesigned. • An Emergency Room suite was created with CT and Radiographic Rooms along with ancillary support spaces.. • A second MRI was justified and installed within space previously occupied by a CT
  • 14. Example #3: Dartmouth-Hitchcock Medical Center “Minimizing the spaghetti.”
  • 15. Conditions of Engagement: 1. “To look only at design of new filmless radiology reading rooms (PACS) and nothing else.” 2. “Do not expect to make any changes as project is over budget and behind schedule.” 3. “CT suite is absolutely off limits. It is done.” KJA
  • 16. Example of one of the proposed designs for filmless reading room. What, if any, changes would you propose for this reading room? KJ/MCExam
  • 17. AHRA 2003 Annual Meeting Optimizing Radiology Workflow and Productivity Monte G. Clinton, FAHRA Administrative Director Dartmouth-Hitchcock Medical Center monte.g.clinton@hitchcock.org Kenneth C. Johnson President Kenneth Johnson and Associates, Inc. kjandassoc@aol.com
  • 20. Workflow Analysis Techniques Create drawing to illustrate workflow at 15,000’ Case Study: Dartmouth-Hitchcock Medical Center “No changes to be made to basic design, but was given approval to suggest refinements.”
  • 21. Workflow Analysis Techniques Continue to zoom in and analyze workflow from everyone’s perspective. OP, ED IP
  • 22. Workflow Analysis Techniques Analyze workflow by tracing everyone’s footsteps Key Takeaway Use “Spaghetti Drawings” to first understand workflow, then improve upon it. Color Code Red = Patient Blue = Technologist Green = Radiologist
  • 23. Workflow Analysis Techniques Zoom in until at “ground level.” Yellow shaded area represents Note challenge in operator’s line of getting patient vision when into room, looking at particularly if IV console. To see pole, etc. patient, operator looks to left.
  • 24. Workflow Analysis Techniques Simulate the design using scale models putting yourself in the driver’s seat. Proposed design before simulation
  • 25. Workflow Analysis Techniques Involve radiologists and all staff in simulating various designs. Key Takeaway Conduct full-scale mock- ups or use scale models to develop designs and illustrate the final outcome you desire.. Design resulting from simulation.
  • 26. Workflow Analysis Techniques Strive to minimize the travel for all parties (Minimize the spaghetti) Design resulting from simulation. 4th CT moved to Emergency Department.
  • 27. Net Result of Intervention and Use of Tools • One CT was moved to ED. • CT Suite was redesigned to improve workflow. • Designs of PACS reading rooms were significantly improved upon. KJ/MC
  • 28. Comments? Questions? Feedback? Monte G. Clinton, CRA, FAHRA monte.g.clinton@hitchcock.org Kenneth C. Johnson, President kjandassoc@aol.com

Editor's Notes

  1. Among major flaws within this room are: Control booth too narrow as shown, let alone no raceway behind console. Virtually impossible to bring patient into room on stretcher. Boxes within room are for electronics. No allowance for any casework for supplies nor sink within room.
  2. Design is almost perfect. Illustrates almost all mistakes one can make. This example from the internet illustrates many red flags Not only is toilet not needed for a radiographic room, but internal entrance only should be avoided as a general rule. Preparation rooms are not used for radiographic rooms. No external access to control booth for staff. Two major red flags
  3. Note funtional header
  4. Note designs of rooms and additional functions