Defusing the Patient Safety Timebomb in Radiology

The purpose of this project was to improve the quality of care of inpatients and reduce patient events in the Department of Radiology at TJUH. After reviewing the current state performance data a cross-functional team was convened and led through a 5-step Kaizen problem-solving process to devise a solution. Based on a Pareto-type analysis, the team identified the early evening hours as the greatest opportunity for improvement and formulated a plan providing for three off-hours (4PM-8PM) inpatient coverage teams—neuroradiology (NR), abdominal imaging (AI) and general (x-ray)—composed of attending and resident/fellow radiologists. Comparing pre-implementation fiscal year 2016 data to post-implementation fiscal year 2017 showed substantial improvement with a reduction in the number of studies exceeding the 6-hour benchmark complete-finalize time. The percentage of NR CT and MRI studies exceeding the turnaround time (TAT) benchmark of 6 hours dropped from approximately 90% to approximately 20%; the percentage of x-ray studies dropped from approximately 70% to approximately 10% and; the percentage of AI CT studies dropped from approximately 60% to approximately 15%, while AI US studies declined from approximately 35% to the 12% range. Regarding survey results, residents and fellows reported a substantial improvement in off-hours coverage; faculty members reported a modest improvement and; technologists noted a compensatory improvement in their daytime workflow. While a positive impact on resident morale was reported, a polarizing effect on faculty morale was observed with some citing a positive impact and others reporting a negative impact of the off-hours plan. Finally, critical results reporting improved substantially with percentages of pneumothorax and intracranial hemorrhage cases meeting the 1-hour benchmark rising from 46% to 65% and 46% to 83%, respectively. Changing staffing patterns to better match patient demand and diurnal workflow patterns dramatically improves turnaround times and provides a safer environment, limiting the number of patient safety events. However, this must be balanced against the impact on morale and managed accordingly. Presentation: 42:3