Increasing Efficiency in Interventional Radiology: A QI Project focused on First Case Start Times

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Carolyn Hammen, PA-C, RT(R) (she/her/hers)

Physician Assistant
Medical College of Wisconsin

Disclosure(s): HistoSonics: Advisor (), Stock Shareholder (excluding mutual funds) (); Neuwave: Research Grant or Support (), Speaker's Bureau ()

Author/Co-author(s)

Amanda R. Smolock, MD, PhD

Assistant Professor
Medical College of Wisconsin
MB

Michelle Back, BS, RT(R)(VI)(CIRCC)

Practice Coordinator
Froedtert and the Medical College of Wisconsin
SS

Sandra Slowik, n/a

Scheduling Coordinator
Froedtert Hospital
JS

Janet Ste Marie, BSN, RN

Manager
Froedtert Hospital
JA

Julie Aguilar, BSN, RN

Director Heart and Vascular Service Line
Froedtert Hospital
TP

Tracy Puttre, MSN, APNP, AGNP-C

Manager, Advanced Practice Providers
Medical College of Wisconsin
HD

Holly Dembny, RT(R)(CV)

Patient Flow Coordinator
Froedtert Hospital
KU

Katy Unferth, RN

Nurse
Froedtert Hospital
MW

Michelle Weithaus, RT(R)

Technologist
Froedtert Hospital
EH

Eric J. Hohenwalter, MD, FSIR

Professor, Chief of Vascular and Interventional Radiology
Medical College of Wisconsin

Disclosure(s):

Carolyn Hammen, PA-C, RT(R): HistoSonics: Advisor (), Stock Shareholder (excluding mutual funds) (); Neuwave: Research Grant or Support (), Speaker's Bureau ()

Amanda R. Smolock, MD, PhD: AstraZeneca: Advisory Committee or Review Panel Member (Ongoing); Histosonics Inc: Advisor/Shareholder (Ongoing); J&J / Ethicon / NeuWave: Research Grant Recipient (Ongoing), Speaking and Teaching (Ongoing)

Purpose:

Delays in first cases of the day not only set a trend toward a late day but can negatively impact institutional efficiency and revenue. The purpose of this project was to improve on-time start to 85% of cases by identifying causes of pre-procedure delays.

Materials and Methods:

The PDSA QI method was used for this project. Data was collected from 2018-present and included scheduled arrival time, patient check-in time, patient room time, scheduled procedure time, time of signed consent, time labs sent, time labs resulted, reason for delay and whether or not it was avoidable. The two main reasons for delay were identified and calculated as a percentage of total delays for the month. The study team meets monthly to discuss the data.

Results: The average on-time start was 39% in 2018 when this project commenced. The two main reasons for delay were identified to be: lab delays and vague plan for patients not previously seen in IR clinic. The intervention for this project was to have the APP team evaluate patient charts 2-3 days ahead of the scheduled procedure to clarify the plan and alert nurses to needed labs upon patient arrival. Additionally, a vascular access RN was utilized to start IVs for difficult stick patients, and a dedicated phlebotomist was utilized if there was a delay in IV start and labs were needed. After these changes, the percentage of patient procedures starting on time for the first case of the day improved to at or near goal of 85%. More importantly, the two targeted reasons for delays both decreased from about 5% to 0%.

Conclusion:

Our group has achieved a first case on-time start goal of 85% by utilizing the APP group for in-depth pre-procedure evaluation and more effective communication. Certain factors delaying on-time start remain unavoidable, such as patient arrival time and condition at presentation, proceduralist or anesthesia delay, and superseding urgent cases, but avoidable delays addressed in this project were reduced to 0%. Continued monitoring with this established study team can allow for ongoing improvements.