Reduction of Patients’ Total Turn Around Time A System Design Project conducted on Department of Diagnostic Imaging (DDI) By ISE-DDI team: Chong Jun Xiong, Fan Jiafang, Liu Xufeng, Wu Zhe Problem Description Department of Diagnostic Imaging (DDI) provides radiography services to in-patients (IP) and out-patients (OP) in NUH. This project focuses on two most important modalities: X-ray and CT, attempting to reduce the total turn around time (TAT) of patients, which comprises a large portion for waiting. Problem Description Department of Diagnostic Imaging (DDI) provides radiography services to in-patients (IP) and out-patients (OP) in NUH. This project focuses on two most important modalities: X-ray and CT, attempting to reduce the total turn around time (TAT) of patients, which comprises a large portion for waiting. Objective Reduce the total Turn around time through 1. Improvements on X-Ray processes and resource utilization 2. Modify CT appointment scheduling 3. Lean service & process standardizationObjective Reduce the total Turn around time through 1. Improvements on X-Ray processes and resource utilization 2. Modify CT appointment scheduling 3. Lean service & process standardization Process Mapping TAT Factors Generation Solutions (X-Ray) 1.Assign Supervisor Devote one radiographer for cassettes handling, including transfer cassettes between X-ray rooms and processor; cassette developing, film & database entry checking. He also serve as a supervisor to X-ray corridor to handle coordination among radiographers and patients. The use of “supervisor” is expected to reduce total TAT by up to 20-40%. 2. “express-queue” Nursing assistants direct all chest x-ray patients to Room 3 during peak hour upon supervisor’s signal. Assign an experienced radiographer to achieve highest efficiency to ensure fast scans for short procedures, so as to reduce total TAT through reduction of machine setup time. The “express-queue” is expected to reduce total TAT by 8-13%. 3. Process standardization By standardizing the process will results in the variation in service time, which leads to significant reduction of TAT for about 15-25%. Solutions (X-Ray) 1.Assign Supervisor Devote one radiographer for cassettes handling, including transfer cassettes between X-ray rooms and processor; cassette developing, film & database entry checking. He also serve as a supervisor to X-ray corridor to handle coordination among radiographers and patients. The use of “supervisor” is expected to reduce total TAT by up to 20-40%. 2. “express-queue” Nursing assistants direct all chest x-ray patients to Room 3 during peak hour upon supervisor’s signal. Assign an experienced radiographer to achieve highest efficiency to ensure fast scans for short procedures, so as to reduce total TAT through reduction of machine setup time. The “express-queue” is expected to reduce total TAT by 8-13%. 3. Process standardization By standardizing the process will results in the variation in service time, which leads to significant reduction of TAT for about 15-25%. Solutions (CT) Long waiting for CT is largely due to disruption of add-ons and unpunctual arrival of appointment patients. Hence more flexible appointment scheduling rules is suggested: 1.Assign different appointment interval times for patients of different process type and stage. 2. Give buffer of 10 mins for each hour. 20 mins buffers are given at 9:40 am and 1:40pm. 3. Extend the schedule hour to 4pm 4. Advise patients arrive 5-10 mins earlier 5. Avoid scheduling consecutive long procedures in one CT room 6. Avoid long procedures scheduled after 3pm. The diagram is an illustration with Excel VBA, different appointment intervals are calculated with different combination of patients type and stage, base on current data analysis. Solutions (CT) Long waiting for CT is largely due to disruption of add-ons and unpunctual arrival of appointment patients. Hence more flexible appointment scheduling rules is suggested: 1.Assign different appointment interval times for patients of different process type and stage. 2. Give buffer of 10 mins for each hour. 20 mins buffers are given at 9:40 am and 1:40pm. 3. Extend the schedule hour to 4pm 4. Advise patients arrive 5-10 mins earlier 5. Avoid scheduling consecutive long procedures in one CT room 6. Avoid long procedures scheduled after 3pm. The diagram is an illustration with Excel VBA, different appointment intervals are calculated with different combination of patients type and stage, base on current data analysis. Current Queue LengthImproved Queue Length Fig. 4.1 Comparison of queue length with a supervisor Process time variance = 2 minProcess time variance = 1 min Fig.4.3 Comparison of queue length with different process time variance Lean service & process standardization Special thanks to Department of Diagnostic Imaging, National University Hospital for the kind help and support, Dr Yap Chee Meng and Dr Chai Kah Hin for the inspiring guidance and assistance. Total TAT X-RayCT OP Registration Counter IP Registration Counter Others… Patients Work Flow Queuing discipline Preparation Facility layout No. of staff No. of cassette Others… Contrast Add on Work Flow Facility layout Open hours Others… Appointment Schedule Queuing discipline Work Flow Tray location No. of terminals Disruption IT system Others… Porter coordination Others… Porter scheduling Waiting bay design Appointment handling Arrival rate Type Stage Age Education Others… Other modalities Others… Out-Patient In-Patient 2 18% 53% 0 30% % 43% 10% 32% 15% 23% 12% 6% CT X-Ray Waiting Time 32% 15% 23% 12% 6% 7% 37% 48% 7% Waiting Time Registration Counter Waiting Time before leave Scan TimeRegistration Time Registration Floor Corridor A & E Corridor C & E Waiting bay, A, C & E Performance control & Continuous Improvements! Scheduled slots Reserved slots Available slots