Optimizing MRI Logistics: Increasing
Efficiency and Patient Satisfaction
Beth Israel Deaconess Medical
Center, Harvard Medical Center
Current predictions in radiology practices regarding the utilization of advanced imaging techniques are increas- ingly uncertain. Moreover, health care is currently undergoing a shift from a traditional volume-based approach to
one where patient value is dominant.
Regardless of the expectations on imaging utilization, one of
the biggest burdens affecting health care-based service industries, especially radiology, is patient throughput. Therefore, our
radiology department has responded by implementing process
analysis procedures for the improvement of wait times, patient
throughput, scanner utilization, and patient satisfaction.
Our institution is well acquainted with the Lean philosophy.
The Lean approach is composed of a set of principles and tools
that were originally implemented by Japanese automotive manufacturers in the late 1980s but are still used to this day.
Lean philosophy focuses on identifying and eliminating
waste in the work environment through passive observation
and a set of distinct measuring and productivity tools. These
tools aid the process analysis by identifying and solving productivity and efficiency issues while embracing continuous transformation. Although this process can be time consuming and
laborious, it is crucial in industries that rely on customer flow
and equipment function. Exhaustive process analysis reveals
opportunities to reduce clinical and technical inefficiencies and
thereby reduce patient and report waiting time, improve outcomes, increase staff productivity, decrease cost, and improve
employee and customer satisfaction.
MRI scanners tend to experience longer scanning times, arduous delays, and increased patient wait times compared with
other imaging modalities. Therefore, our team decided to embark on a Lean process analysis in our outpatient MR scanning
department where patient throughput could experience the
maximum amount of improvement.
Initially, two research physicians observed the process, identi-
fying all the process steps and stakeholders in each step. One of
the most crucial steps during implementation of the Lean philoso-
phy is educating all personnel on the principles and objectives of
the undergoing analysis and improvements, because Lean trans-
formation is gradual and requires long-term commitment from all
levels of the organization. It is crucial that two objectives are met:
all staff independent of level must be involved in developing solu-
tions, and the team responsible must be acquainted with the
Lean principles and dedicated to implementing them.
After 2 weeks of observation where we measured each step
required for the successful imaging of each patient, we defined
all time intervals. For the purpose of including all possible time
intervals when “non-value added time” was present, we separately observed two time intervals: the first time interval focused on pure MRI utilization, where the total process cycle
was to fully assess the time when the scan room was idle (as
“non-value added time”) with differentiation between gradient
time versus nongradient time, and a second time interval that
focused on the patient’s complete length of stay, identifying any
patient wait time as “non-value added” time.
After specifying all the steps, we identified the time periods
where no value was added to the scanning process or to the patient and demonstrated that both time intervals had approximately 30% of “non-value added time” or waste.
By observation and feedback from the active personnel, we
classified the source of delay and measured their influence on
the total patient length of stay. We identified the specific delays
when continuous improvement could have the greatest impact
on decreasing wasted time. Our results attributed the delay
source with highest frequency to be issues with IV port placement when a specialized nurse had to be summoned, and the
process had to be halted until arrival of the nurse to the preparation room and proper placement of the IV port access.
On the other hand, the delay with highest impact was attributed to MR arthrograms when a joint injection of contrast and
confirmation with fluoroscopy was necessary but not accounted for in the schedule. With the results and the complete process analysis, we proposed specific solutions targeting the
underlying source of the delay, prioritizing the delays when
overall impact and frequency were higher.
As an example, our team proposed the implementation of an
IV placement competency course to increase the IV placement
skills of all technologists and to recognize the most capable technologists to assure that each shift of technologists has at least
Optimizing MRI Logistics continues on p. 14
[O]ne of the biggest burdens affecting health
care-based service industries, especially
radiology, is patient throughput.