By Kimberly Harrell, RT(R)(MR), CRA, CMPE
On Monday I had the pleasure of attending Tina Peralta and Curt Bush’s presentation, “Multi-disciplinary Strategies to Improve Throughput and Improving Patient Experience.” Their presentation outlined significant obstacles with length of inpatient stays and ED throughput of patients who left before treatment was completed.
Tina and Curt shared their success and a wide variety of measurement tools and charts with us. They had too many success stories to share in one article! I am going to focus on their ED CT initiatives that significantly improved patient care, decreased patient length of stay, and created best practice benchmarks.
Tina and Curt’s CFO presented a challenge for the leadership teams to decrease average length of stay by 0.1 per day. In doing that, the additional revenue would equal $1 million per year. The teams were made up of multidisciplinary stakeholders and team members. Their hospital is a level one trauma center that performs 37,500 CT procedures annually. The baseline data showed that when a CT exam was ordered through the ED, it took 2.2 hours from time of order to obtain the results. The team, called RED, focused on reducing emergency delays (RED). The first step was to set a new goal for CT from the time of order to the receipt of results, which they determined to be 2 hours.
A dashboard was created, and radiology was tasked with capturing the reasons for the delays, providing ideas on how to solve them, and implementing the changes to hardwire for sustainability. Tina and Curt looked to their valued CT staff members for ideas, obstacles, and recommendations. Staff shared the feedback that one challenge was ongoing back and forth phone calls between the ED nurses and the CT department, asking if the patient was ready for the CT exam. In researching this obstacle, they discovered that many of the ED nurses were not using their online resource called “CT Ready.” It is a tool that alerts both units when a patient is ready for the CT exam, or “CT Ready.” The ED nurses were either not using it or were using it inappropriately.
The goal was to train all team members to utilize this valuable resource, as it would decrease phone calls between the departments. Tina and Curt educated the nursing team of what had to be done in the process to deem that a patient was truly “CT Ready.” They created a “CT Ready” process map (great visual tool) that identified action items broken down by the scrub color that the various departments wore. So, if your team wore gray scrubs, you looked at the items identified in gray for clarity of expectations.
The next hurdles identified by staff were delay(s) and/or lack of IV access. Additionally, in many cases the location and gauge size were not appropriate, based on the specific CT exam ordered. Another goal was set so that IV access was to be in place within 30 minutes of the CT order being placed. The radiology team worked closely with the nurses in ED department, educating them on the complexity of some of the CT studies. It was important the ED nurses understood why a larger gauge needle is required for some CT exams. It was also important the ED nurses learned the importance of IV placement in the body, due to the anatomy being imaged. A color-coded visual aid for nursing staff outlining the body and labeled for gauge size and IV site was created. This tool was a quick guide on “when” and “where” to place an IV when the nursing team was not sure.
Tina and Curt’s overall success on these initiatives resulted in a decrease in ED CT TAT from 2.2 hours to 1.9. They now review these measures daily and weekly. One key issue in their success is ownership. One specific manager is on task to continually monitor and ensure sustainability.
In closing, I love being part of a positive outcome based initiative. There was so much more to learn from this presentation. I only touched on one small part that was a big win. They had many other big wins. I encourage you to and review the presentation handouts and the many awesome visual tools they have created.
Kimberly Harrell, RT(R)(MR), CRA, CMPE is the ancillary services manager of imaging at Kaiser Permanente in Tacoma, WA. She can be reached at Harrell.firstname.lastname@example.org.