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Improving Efficiency in the Angiography Suite

Improving Efficiency in the Angiography Suite. Kamran Ahrar, M.D. Elizabeth Ninan, PA-C Jasmine NovoGradac, MBA,BSN, RN Terrell Evans, RT (R)(CT)(MR) Division of Diagnostic Imaging Section of Interventional Radiology. Background. Limited Capacity

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Improving Efficiency in the Angiography Suite

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  1. Improving Efficiency in the Angiography Suite Kamran Ahrar, M.D. Elizabeth Ninan, PA-C Jasmine NovoGradac, MBA,BSN,RN Terrell Evans, RT (R)(CT)(MR) Division of Diagnostic Imaging Section of Interventional Radiology

  2. Background • Limited Capacity • Total of 3 Angiography Suites at Alkek (Main Hospital) • 2 have up-to-date equipment, used routinely • 1 out-dated unit, used as an overflow room • Increasing Demand for Angiography or Fluoroscopy Guided Procedures • Increasing number of patients with liver tumors receiving liver-directed therapies • Alkek expansion project: Additional hospital beds • Anticipated 17% increase in overall volume for 2011

  3. AIM To Reduce the Inter-Procedure Time Interval in the Angiography Suite by 20% by August 6, 2010

  4. Inter-procedure Time Interval Vacant Angio Suite

  5. Baseline DataSnapshot of Angiography Suite UtilizationMay 24 to May 28, 2010 • Each box represents 10 minutes • Time intervals were rounded to the nearest 10-minute mark • Call cases are not included • A-10 and A-11: High Quality Angio Suites • A-9 Old Equipment, used as overflow procedure room Procedure in Progress Vacant Angio Suite

  6. Baseline DataMetric: Inter-procedure Time Interval

  7. Baseline DataMetric: Vacant Angio Suite (between procedures)

  8. Main Causes of Inefficiency

  9. Main Causes of Inefficiency

  10. Strategy to Improve Efficiency • Make sure patients are properly worked-up and ready to be transferred to the angiography suite • Make sure the angiography suite is clean and properly set-up to receive the patient • Make sure there is a nurse available to transfer the patient into the angiography suite as soon as the suite becomes available

  11. Inter-procedure Time Interval Vacant Angio Suite

  12. Other Interventions • Patient Preparation/Readiness • Confirmations of appointments • MLP worked up of patients (blood products, pre-medications, consents) • Anticipate Cancellations • Improve Coordination with the OR for combined interventions • Dedicated Two Transport staff to IR • Room Readiness • The Charge technologist will assist to complete tasks • Medical Assistant will help clean up the room and set up new procedure tray

  13. Final DataSnapshot of Angiography Suite UtilizationAugust 2 to August 6, 2010 • Each box represents 10 minutes • Time intervals were rounded to the nearest 10-minute mark • Call cases are not included • A-10 and A-11: High Quality Angio Suites • A-9 Old Equipment, used as overflow procedure room Procedure in Progress Vacant Angio Suite

  14. ResultsMetric: Inter-procedure Time Interval

  15. Testing for Statistical SignificanceInter-procedure Time Interval Two-Sample T-Test and CI: Inter-procedure Interval Two-sample T for Inter-procedure Interval Period N Mean StDev SE Mean Post 47 47.7 20.4 3.0 Pre 39 62.5 26.1 4.2 Difference = mu (Post) - mu (Pre) Estimate for difference: -14.85 95% CI for difference: (-24.82, -4.89) T-Test of difference = 0 (vs not =): T-Value = -2.96 P-Value = 0.004 DF = 84 Both use Pooled StDev = 23.1389 P-value <.05, so Pre and Post Means are statistically significantly different at the 95% level

  16. ResultsMetric: Vacant Angio Suite (between procedures)

  17. Testing for Statistical SignificanceVacant Angio Suite(between procedures) Two-Sample T-Test and CI: Vacant Room Time (between procedures) Two-sample T for Vacant Room(between procedures) Period N Mean StDev SE Mean Post 47 26.6 18.2 2.7 Pre 39 39.8 23.6 3.8 Difference = mu (Post) - mu (Pre) Estimate for difference: -13.22 95% CI for difference: (-22.21, -4.24) T-Test of difference = 0 (vs not =): T-Value = -2.93 P-Value = 0.004 DF = 84 Both use Pooled StDev = 20.8484 P-value <.05, so Pre and Post Means are statistically significantly different at the 95% level

  18. Return on Investment • Pilot Period: 5 days, tracked over 70 patients, reviewed 47 Intervals • 9.4 Intervals per day • Reduced Suite Vacancy by 13.22 minutes per interval • Total Gain: 124.27 minutes per day • Anticipated Gains: • Ability to accommodate additional patients and procedures • Increased patient satisfaction • Shorter length of stay • Additional revenues • Ability to finish scheduled cases in a timely fashion • Less overtime • Higher job satisfaction, improved morale, better staff retention • Unexpected secondary gain of charges from PA work up of patients the day prior to procedure

  19. Return on Investment: Most Optimistic

  20. Return on Investment: Most Conservative

  21. Return on Investment: Most Likely

  22. Moving Forward • Future Actions: • The float nurse was a temporary solution we had pulled from our outpatient facility • As of now, we are not able to provide the float nurse function to keep the vacant angiography suite time to a minimum • We have requested additional nurses for 2011 • If approved, a nurse will be assigned to the function tested in this pilot • Maintained Actions: • Work-up of patients the day before (generating $ 200K E & M charges) • Confirming appointments • Charge tech helping with room turn over • Quarterly Audits

  23. Conclusion • Reduction in the Inter-Procedure Time Interval for the Angiography Suiteby 24 % • Reduction in the Vacant Angiography suite by 33% Outcomes: • Accommodate additional patients • Provide a better work environment • Generate additional revenues • Allocation of resources is justified

  24. Thank you. Acknowledgements: • M. D. Anderson CS&E Faculty and Staff • Tatiana Hmar-Lagroun, Project Facilitator • James A. Terrell, Applied Statistics • Michael J. Wallace, MD; Sponsor

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