Removing the Bottleneck: How To Increase Throughput

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Carrie Stiles Head ShotBy Carrie Stiles

Boy, this was one popular session!  Robert Junk and Tobias Gilk had a full house Tuesday afternoon when they discussed ways to increase throughput. They started the session off by playing a video clip of two blacksmiths hitting iron together in perfect harmony. If you closed your eyes and didn’t realize what they were doing you would think you were just listening to music. The next video clip showed three children playing and chasing each other. They were running all over the place and yelling! Tobias said he would be willing to bet that the second clip was a better representation of our departments. We all laughed because we knew it was true. He then asked us what the “music” of our departments sounded like.

Throughput is so important, especially in today’s healthcare environment where every penny matters. Throughput affects our efficiency, competitiveness, and profitability. To really understand throughput we first need to understand how it is measured. The most common ways to measure throughput include: total time patient spends in scan room, the time it takes from order to delivery of report, or total time the patient spends in the imaging department.

Robert and Tobias suggested that the best and most accurate way to measure throughput is the total time the patient spends in the scan room and we learned that the throughput formula is: Average Time Per Exam  x  Number Of Exams  ÷  Net Work Hours  = Throughput

I am sure we have all heard that if we upgrade our CT or MRI machine to the latest and greatest model we can shave 20% off of our scan time. I was surprised to learn that it doesn’t really matter. The limiting factor is how fast we can get the patient to the scan room. It doesn’t matter if our scanner is super fast if we can’t get the patient to the scan room in an efficient manner –  we are not doing our patients or ourselves any favors.

Tobias also made the distinction that patient satisfaction still matters. This isn’t about speeding up the process so much that the patients don’t feel cared for or appreciated. We still need to care for the patient while they are with us! Increasing throughput is a win/win for both of us though. The patient doesn’t have to wait unnecessarily long times in our department, and we can scan more patients each day which equals higher revenue. In fact, they pointed out how shaving just five minutes off of the average 30 minute MRI scan can amount to an increase of $520,000 in revenue a year.

Throughput impacts costs in a number of ways. It effects the number of referrals we receive, our ability to justify providing more complicated routines or procedures, both patient and staff satisfaction, and our growth potential. Robert and Tobias taught us that three major areas affect our throughput: facility layout and design, staffing and procedures, and operational protocols. With facility layout and design it’s all about location, location, location. We have to think about not only our technical spaces, but we also have to remember that it’s the support spaces that drive throughput. Where are the changing rooms? How big are they? Are the lockers inside or outside of the dressing room? Where are the bathrooms located and how big are they? Where do we do our patient screening and what’s the HIPPA impact? Inpatient spaces have a different set of needs than outpatient spaces do. So many departments think it’s better to combine CT & MRI control areas but it’s actually not for a number of reasons. The MRI ACR 4 Zone safety guideline is also a huge factor to consider when designing the layout of a department. The bottom line with department layout and design is we need to minimize the number of steps that the patient takes once they are dressed and ready for their exams.

The staff impact on throughput is also huge. Look at what the technologists are doing compared to support staff. One tech assistant for example, can have a big impact on your efficiency. It is also important to bring the support services that the technologist needs to where they are working. Technology can also help us with throughput. For example, patient monitoring systems, electronic medical record systems, automated check-in, and screening support can all help speed up the process.

Lastly, operations also have a big impact on throughput. You want to minimize the time the patient spends in the scan room. Set up processes that take patient prep and recovery outside of the scan room. You also want to maximize your scanner use and make sure that the patient is ready to go. Make sure your equipment meets your needs. Another important thing is ensuring that housekeeping and maintenance don’t interfere with scan time. Be sure that your service contracts maximize equipment uptime and try to do service and PMs after hours if possible. It may cost more money doing it this way, but compare that extra cost to what you would lose in reimbursements. Try to select equipment and building materials with low maintenance/long life items.

This was a fantastic session, and all of us that attended really learned a lot. I highly encourage you to check out the session handouts online if you can. So often hospitals hire companies to take care of all of these details, but we learned today that we have to be involved in the process and know what works and what doesn’t.

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