Review process drops MRI wait times

Sudbury’s hospital has dramatically improved the way it runs its MRI service, eliminating unnecessary procedures and making the process far more efficient. As a result, it’s able to complete 40 more scans every week and wait times to get an MRI have plummeted.

Speaking at Health Sciences North’s board meeting May 8, Tyler Speck, the director of the medical imaging program, said the results were a surprise to everyone involved in the review process. Before the provincially mandated review began, Sudbury’s MRI service was considered among the most efficient anywhere.

“We routinely fielded calls from peer hospitals asking how we achieve (our) productivity performance,” Speck said in his presentation to the board.

So when the Ministry of Health asked Ontario hospitals to begin what it called a LEAN Process Improvement Project, Speck and others expected the results would tell them that Sudbury’s service was already top-notch. But they were in for a surprise.

A number of benchmarks were set up to evaluate how Sudbury was doing, such as how long it takes for someone to get an MRI, from the request from the doctor to the patient accessing the service, how many people fail to show up for scans, what percentage of scans actually start at the scheduled time, and so on.

They then identified every step of the process and found that for patients who were in hospital, there were 56 steps taken before they received a scan; for outpatients, there were 67 steps. Then they took a hard look at each step to see which, if any, could be eliminated.

Of those 67 steps, three were immediately identified as valuable to maintaining patient care and so the focus was placed on the remaining 64.

“So sat with the staff and we said to them, if you actually had to pay for all these steps, which one of them do you really care about enough to pay for?” Speck said. “And from that we discovered of the remaining 64 steps we had in our system, we could cut out all but nine. There were many steps that were added over the years — certain physicians wanted certain things … some lab techs wanted only to do a certain number of scans in a day. But when we took a closer look, the arguments for those steps began to fall apart.”

Also identified were 49 wasteful practices in the MRI system, and they were able to eliminate 41 of them. 

“We had 20 people punching paper 36 times before a person would book an outpatient scan. It seems ridiculous when we look at it now, but at the time, we believed it was the best way to do it.”

Before the process began, each MRI was scheduled to take an average of 45 minutes each. But through discussions with staff — and Speck emphasized this was a staff-driven process — they found that the average time was only 35 minutes. 

“No one on our staff will tell you we directed them to do anything,” Speck said. “These are all improvements they suggested themselves.

“So we started to eliminate a lot of waste in the system — five minutes here, five minutes there really does add up to hours at the end of the process.”

And the results were dramatic: wait times for an MRI dropped from 109 days in January 2011 to 29 days in March 2012. Today, that has dropped to 25 days. Weekly meetings are also held to review how the process is working and whether more changes can or need to be made to make the process patient-centered and efficient.

“This is good news for us (and patients) on many levels. We can do more scans and patients can see their doctors faster with the MRI results.”

And these results were achieved with relatively little investment from the hospital: 700 hours of staff time and $30,000 in consultant fees, which were paid for by the province. And the more efficient process means the equivalent of more than $500,000 of extra scan time. Compared to what the hospital was achieving last October when the process began, they have added more than a full day of scans per week.

“We didn’t get a cheque for $500,000, but we now have that extra capacity,” he said. “And we’re not done yet. This is just the beginning.”

All other hospital departments are interested in going through a similar review, Speck said.

“Other departments are excited for it.”
 
Posted by Darren MacDonald