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Department of Human Services Toolkit Radiology A toolkit of the Patient Flow Collaborative Click here to continue.

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Presentation on theme: "Department of Human Services Toolkit Radiology A toolkit of the Patient Flow Collaborative Click here to continue."— Presentation transcript:

1 Department of Human Services Toolkit Radiology A toolkit of the Patient Flow Collaborative Click here to continue

2 Toolkit Radiology Department of Human Services Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Introduction What is the radiology tool kit for? The radiology toolkit has been designed to assist radiology teams and departments to resolve constraints to innovation in patient care. Who should use the toolkit? The tool kit provides ideas and solutions to possible constraints within radiology, anyone who is responsible for patent flow will benefit from using this tool. What are the aims of the toolkit? The Patient Flow Collaborative aims to remove unnecessary constraints or delays in patient flow by promoting a continuous flow of care. Radiology innovation is essential to providing a seamless efficient service to waiting patients. How should we implement the concepts in this toolkit and change in our local context? The toolkit will assist with provoking discussion and ideas, health service teams should operationalise any innovation idea to their local context. End of section Back to menu

3 Toolkit Radiology Department of Human Services Goals of the toolkit Introduction The radiology toolkit is based on whole system thinking and includes a whole of hospital approach. Goals The specific goals of the toolkit are: Provide possible solutions to flow issues Build awareness of the management of capacity and demand Identify systematic methods to innovate in radiology Your feedback This first version of the radiology toolkit will stimulate discussion and innovation ideas and methods. The Patient Flow Collaborative welcomes feedback to enable subsequent versions of the toolkit. End of section Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Back to menu

4 Toolkit Radiology Department of Human Services Whole system approach A whole system approach is needed to effectively manage the variation in capacity and demand involved in radiology. Radiology is recognised to be a central point in this continuous flow of diagnosis and treatment for our patients. Overview and strategy Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 1 of 4 Back to menu

5 Toolkit Radiology Department of Human Services Overview and strategy Rigorous diagnostics Agreed process Access and administration Patient information Organisational whole of hospital delivery Radiology investigations and treatment modalities Capacity and demand Staff resource Administration Policy and leadership Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 2 of 4 Back to menu

6 Toolkit Radiology Department of Human Services Overview and strategy Capacity and demand Staff resource Administration Policy and leadership Priority given to radiology services by board and local health community awareness of capital investment and issues. Identified board level report for radiology, leadership high priority for radiology management team. Policy stating maximum waiting times for emergency admitted and waiting patients. Essential data collected on capacity and demand for radiology services Staff resource plans undertaken regularly to promote, mentoring development and training. Roles redefined to maximise skill base and promote up-skilling of staff team. Administration systems in place which promote smooth allocation and booking of appointments and reporting results. Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 3 of 4 Back to menu

7 Toolkit Radiology Department of Human Services Overview and strategy Rigorous diagnostics Agreed process Access and administration Patient information Capacity and demand, process mapping, tally chart data to be collected per diagnostic/treatment stream. High demand stream to be completed first. Once process is reviewed, redesign process to provide continuous process, advertise to staff/hospital as required. Advertise access timescales to all stakeholders. Promote appointment system which pulls patients. Agree date and time with patient. Ask to confirm before appointment. Manage DNA/FTA as per policy Provide patient information to promote quick appointment examination. Make sure information given previous to attendance. Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools End of section Back to menu

8 Toolkit Radiology Department of Human Services Health service team Introduction Essential components of effective radiology services are skilled, trained and dedicated radiology staff. Teams who have clear roles, responsibilities, support and reporting lines will underpin effective patient flow. Check list for radiology team Whole of hospital service strategy Executive sponsor for radiology team Clear reporting to supervisor or manager Skills recognised within whole team Opportunity for skill development Innovation champion Patient involvement champion Clinical improvement team It is important to identify a clinical and managerial lead for the Clinical Improvement team who will lead the innovations within radiology. A reporting line will be needed to an executive sponsor for the Patient Flow Collaborative executive team. Agree executive sponsor Agree clinical lead Agree managerial lead Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools End of section Back to menu

9 Toolkit Radiology Department of Human Services Processes Appointment Administration Triage Reporting DNA/FTA Treatment Discharge Plain film Ultrasound Mammograph CT head and neck MRI Fluoroscopy Nuclear medicine Demand Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 1 of 25 Back to menu

10 Toolkit Radiology Department of Human Services Example of simple process maps to start process Processes Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 2 of 25 Back to menu

11 Toolkit Radiology Department of Human Services Processes REFERRALS ARE ONLY ACCEPTED FROM MR ALLEN OR ONCOLOGY CLINIC REFERRALS RECEIVED IN APPOINTMENTS OFFICE REFERRALS ARE CHECKED TWICE A WEEK BY MAMMOGRAPHERS. PATIENT RADIOLOGY HISTORY CHECKED. FORM AUTHORISED REQUEST FORM RETURNED TO PAT IN APPOINTMENTS FOR BOOKING PAT CHECKS WHETHER ULTRASOUND SCAN IS REQUESTED AS WELL AS MAMMOGRAPHY PAT CHECKS THE US APPOINTMENT BOOK AND THE MAMMO APPOINTMENTS SHEET TO FIND SAME DAY AVAILABILITY IF THIS MAKES APPOINTMENT TOO LONG TO WAIT FOR – SEPARATE APPOINTMENTS ARE MADE APPOINTMENT BOOKED ON COMPUTER. DATE WRITTEN ON FORM LETTER AUTOMATICALLY GENERATED AND SENT TO PATIENT FORM FILED IN OFFICE UNDER DATE APPOINTMENT IS BOOKED FOR ATTEMPTS TO FIND CONVENIENT DATE FOR MAMMOGRAM AND ULTRASOUND TO BE CARRIED OUT ON SAME DAY Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 3 of 25 Back to menu

12 Toolkit Radiology Department of Human Services Analysing the patient process Processes Having mapped the patient process, analyse by considering the following: How many steps are in the process? How many times is the patient passed from one person to another (hand-off)? What is the approximate time of each step? What is the approximate time between each step? What is the approximate time between first and last step? Where does the patient have a wait or have to queue? Where are there waiting lists in the system? How many steps add no value to the patient? (Ask patients) Where are there problems for patients – what do patients complain about? Where are there problems for staff? Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 4 of 25 Back to menu

13 Toolkit Radiology Department of Human Services Identify referral entry points Processes Single or multiple entry points? Electronic or paper referrals? All referrals to imaging room or reception? Are there locations referrals could go to? That is, theatre, ED, other sites. What work is done outside of normal hours that generates referrals? Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 5 of 25 Back to menu

14 Toolkit Radiology Department of Human Services Develop a process map of the time it takes to see a patient Processes Check in – Undress – Preparation – Procedure - Reporting Method: Identify start and end points of the procedure. Agree how many activities in process. That is, check-in, pre check, consent, discussion, patient changes, etc. Identify the time it takes for each step. Cross check with actual process. Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 6 of 25 Back to menu

15 Toolkit Radiology Department of Human Services Process steps examples Processes StepTime per step Patient checks in2 Patient gets undressed4 Consent taken3 Patient positioned2 Scan2 Patient get dressed4 Patient waits3 Post scan check3 Patient leaves2 Report on scan10 Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 7 of 25 Back to menu

16 Toolkit Radiology Department of Human Services Process steps examples Processes StepTime per step Colour code Patient checks in2 Patient gets undressed4 Consent taken3 Patient positioned2 Scan2 Patient get dressed4 Patient waits3 Post scan check3 Patient leaves2 Report on scan10 Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 8 of 25 Back to menu

17 Toolkit Radiology Department of Human Services Build your schedule Processes Use graph paper with one square per minute to sequence time scales per procedure. 1 MINUTE 35 MINUTES Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 9 of 25 Back to menu

18 Toolkit Radiology Department of Human Services Build your schedule Processes Transfer graph sequence timescales to chart clinic time am start pm end Align steps to maximise use of equipment/radiology room/staff. Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 10 of 25 Back to menu

19 Toolkit Radiology Department of Human Services Processes Understand existing backlog Once schedules and processes have been reviewed, capacity and demand can be calculated for: backlog and current demand backlog = existing request still waiting current demand = demand which will be made on service. Calculating backlog To calculate backlog you will need to use the previous time series calculations. Identify time of request. Identify from your sequence charts the time for this type of request. Identify number of requests waiting. Multiply time needed to do the procedure by number waiting. This will give you a measure of the time needed to clear your backlog. Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 11 of 25 Back to menu

20 Toolkit Radiology Department of Human Services Processes Current demand Daily demand calculations will promote effective management of radiology resources. Simple tally sheets can assist with this. Referral type Time to do Referrals received MTWTFSS e.g. CT Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 12 of 25 Back to menu

21 Toolkit Radiology Department of Human Services Processes Assistance with backlog Options for assisting with backlog include: Waiting list telephone validation. Reduce inefficiencies – FTA rates, start times, cancelled sessions. Increase number of procedures in session by redesigning process and schedule. Introduce changes to working day; extended working days, evening sessions. Access capacity elsewhere. Use other resources/staff. Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 13 of 25 Back to menu

22 Toolkit Radiology Department of Human Services Processes Identity constraints that limit radiology equipment/specialists availability Constraints may be due to: Waiting for portering FTA patients Short notice or cancellations (reasons?) Availability of clinical staff to prescribe and administer Availability of recovery areas or preparation areas Poor patient preparation Clinical staff performing no clinical duties Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 14 of 25 Back to menu

23 Toolkit Radiology Department of Human Services Appropriate imaging –evidence based protocols –registrar/consultant sign-off –electronic prompts –Easy consultation Process improvement Imaging initiatives Appropriateness Evidence based protocol Consultant consultation Personal consultation Traffic light triage Electronic prompts Processes Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 15 of 25 Back to menu

24 Toolkit Radiology Department of Human Services Evidence Based Medicine Cervical spine injury? Head Injury Pulmonary Embolism? Deep vein thrombosis? 1st trimester bleeding Renal colic? Meningitis, Lumbar puncture or CT scan or treat? Pulmonary Embolism and Evidence Based Medicine Before 7 protocols 75% with PE have too many or too few tests After one protocol 93% compliance Processes Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 16 of 25 Back to menu

25 Toolkit Radiology Department of Human Services Radiology Test Ordering (RTO) Traffic Light Guidelines Clinical Indications must be on form Red Tests Must beauthorised by Specialist Amber Tests Radiology form must be signed by a Registrar Green Tests No restrictions on ordering All results must be checked before patient discharged · Skull/Sinus/KUB · CT Chest/Abdo CT · Angiography/CT Angio · MRI · Paediatric CT · All radiology call backs · AXR · T/L/S spine · CT Brain/CT C Spine · Abdo U/S · Pelvic US/O&G US · OPG/Facial Bones · F/B soft tissue · Renal Colic CT · CXR · C-Spine · M/Skel. X-rays (excl. T/L/S Spine) · Pelvis Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 17 of 25 Example from Southern Health Back to menu

26 Toolkit Radiology Department of Human Services Measures Request to film completion Request to dictation complete Request until report typed Unreported cases at 5pm Protocol adherence The Requesting Process Nurse initiated Faxing Electronic The consultation Processes Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 18 of 25 Back to menu

27 Toolkit Radiology Department of Human Services Filming/Scheduling Process Next waiting Reduced downtime Emergency AM slots Peripherally Inserted Central Catheter (PICC) story Porters story Responsiveness in CT, CXR No Porters Data! 2 day audit was undertaken 22 observations of porters in room was made On 20 occasions between porters were available in the porters room. Processes Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 19 of 25 Back to menu

28 Toolkit Radiology Department of Human Services Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 20 of 25 Example from Southern Health Back to menu

29 Toolkit Radiology Department of Human Services Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 21 of 25 Example from Southern Health Back to menu

30 Toolkit Radiology Department of Human Services Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 22 of 25 Back to menu

31 Toolkit Radiology Department of Human Services Time from IP Request To Film 5/ HR(6.15) (Max) Time from ED Request to Film (average) 8/ – 13.2 hours(23) 10/012.0 – 3.5 hours(11) 2/023/10 - hours (8) 5/ hours(3.3) (Max) Imaging Capacity Audit CT, 25days, no show 49/751 ED 2 days, 38%, 64% waiting Processes Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 23 of 25 Improvements to time it takes Emergency Department patients to have radiology tests done Back to menu

32 Toolkit Radiology Department of Human Services Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 24 of 25 Back to menu

33 Toolkit Radiology Department of Human Services The Reporting Process Hot reporting IP Digital dictation Weekend reporting Evening reporting Tele-reporting Interims Less priors Clerical Process Digital dictation and dial-in Interims Remote reporting Computer report distribution Return films without reports Eliminate report storage Processes Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools End of section Back to menu

34 Toolkit Radiology Department of Human Services Data Core data Other Suggested Measures Capacity and Demand - Existing Capacity v Utilisation v Number Waiting Did not Attend (DNA) rates per day/week Cancellation rates (Hospital and Patient initiated) Delays - Monitor Radiology delays for one week to agree on the top 10 reasons. When this is agreed, 4 weeks data will be collected against the top 10 delays. Once 4 weeks of 10 delays have been gathered SPC charts can be produced. Time needs to be collected against each reason(s) per day, as the top ten offenders may not amount to the longest waste in time. Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools End of section Back to menu

35 Toolkit Radiology Department of Human Services Resources End of section Change Concepts Redesign process to eliminate hands off, waste and complexity Implement daily performance monitoring Redesign admin, booking and scheduling systems Increase scope and skills of radiology team, develop non-clinical staff as radiology technicians, develop consultant radiographer roles and extend scope of professional groups via development and protocols Develop electronic communication between primary care, in patient requests and radiology department Develop multi-skilled radiology administration and portering team Maintain permanent portering staff in radiology Develop and redesign request forms with supporting training, information and feedback Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Back to menu

36 Toolkit Radiology Department of Human Services Diagnostics and tools End of section Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Change Concepts Rigorous diagnostic handbook Data collection charts Back to menu


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