David Rigual1, Zachary Robison2, Michelle Rove2, Stephanie Koenig2, Jonathan Porzondek2, Denise SnuAjer2, Kristen Nordenholz2, Ethan Cumbler2, Gerald Dodd1, James Borgstede1 1. University of Colorado, Anschutz Medical Campus, Aurora, CO. 2. University of Colorado Hospital, Aurora, CO. We have no financial disclosures to report. •  A collaboraQve inquiry by the Radiology and Emergency Medicine Departments idenQfied slow CT turnaround Qme as a target for process improvement to reduce the length of ED paQent stay. •  A reducQon of 10 minutes in CT turnaround Qme translates to increased paQent saQsfacQon and financial benefits. –  A “Voice of the PaQent” Survey administered to 10 paQents validated long CT wait Qmes as an area for improvement of paQent saQsfacQon. –  Over 1400 ED paQents undergo CT scans at our insQtuQon per month. At an operaQng cost of $2.50 per minute for each paQent, this may yield a potenQal annual savings of $420,000. –  The average contribuQon of each ED paQent is $800 per visit. A 10 minute reducQon in ED CT turnaround Qme would allow capacity to care for an addiQonal 1789 paQents per year in our ED, translaQng to an increase in annual revenue of $1,431,200. •  We engaged in an interdepartmental PDSA cycle project to reduce 10 minutes from the Qme of ED CT request to the producQon of an acQonable report. –  This represents the first interdepartmental process improvement project supported by the InsQtute for Healthcare Quality, Safety, and Efficiency (IHQSE)1 of the University of Colorado. •  We report our overall gains with an emphasis on process improvements between CT request and compleQon of image acquisiQon. 1. A professional development program founded at the University of Colorado to promote process improvement science in healthcare. 1. 
KEY STAKEHOLDERS IDENTIFIED FROM MULTIPLE DEPARTMENTS: –  Radiology: Radiologists, CT Technologists and CT Technologist Assistants –  Emergency Medicine: ED Physicians and Nursing staff –  Transport department: Leadership and staff –  Hospital administraQon 2. 
FOUR GENERAL INTERNAL PROCESSES FROM CT REQUEST TO ACTIONABLE REPORT WERE STUDIED IN TWO PHASES. •  Phase one: CT request to CT compleQon. •  PaQent preparaQon •  Transport •  Phase two: CT compleQon to producQon of acQonable report. •  Image processing and uploading to PACS •  InterpretaQon 3. 
EMR TIME STAMPS WERE USED TO TRACK TIME POINTS: •  CT request •  CT compleQon •  Uploading of an acQonable report. 4. 
TRANSPORTERS UPLOADED ADDITIONAL DATA TO TELETRAC ®, A TRACKING SYSTEM EXTERNAL TO THE EMR. • 
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Transport arrival to paQent bedside PaQent arrival to the CT scanner. 5. 
ANALYSIS OF 9 MONTHS OF BASELINE DATA REVEALED: –  Peak ED CT throughput between 12:00 – 20:00 –  Process inefficiencies targetable for improvement •  Delays in paQent transport –  Transport jobs to various other units took priority over ED CT jobs –  Wide variaQon in ED CT transport Qmes. •  Under uQlizaQon of CT staff during downQme between CT scans. •  Personnel awareness of CT delays. 6. 
ELECTED INTERVENTIONS: –  Phase one: •  Dedicated a transporter from the pool of ED transporters to ED CT jobs from 12:00 – 20:00. •  Redesigned the role of the CT technologist assistant to direct paQent flow to the ED CT scanner based on readiness. –  Phase two: •  Educated and rouQnely updated technologists and radiologists regarding ongoing efforts to reduce CT turnaround Qme. 1. 
PRE AND POST INTERVENTION DATA COLLECTED OVER 9, AND 6 MONTHS, RESPECTIVELY. –  19,821 CT scans •  6,676 with IV contrast •  1,848 with PO contrast –  Scans performed with IV and PO contrast were included in the PO contrast category. •  11,297 without contrast 2. 
WE REPORT ON PRE AND POST INTERVENTION AVERAGE TIMES FOR: –  Phase one: CT request CT compleQon –  Combined phases one and two: CT request to producQon of acQonable report (referred to as “overall CT turnaround.”) –  Data straQfied according to •  CT scans with IV contrast •  CT scans with PO contrast •  CT scans without contrast •  All CT scans Overall CT turnaround CT request to CT compleQon CT Scan Type Post intervenQon Qme reducQon (min : sec) P value CT Scan Type Post intervenQon Qme P value reducQon (min : sec) IV contrast 3:24 0.003 IV contrast 25:34 0.000 PO contrast -­‐ 1:47 0.535 PO contrast 21:40 0.007 Without Contrast 0:24 0.488 Without Contrast 7:14 0.057 All CT Scans 1:02 0.140 All CT Scans 14:17 0.000 • 
RESULTS SUMMARY –  Phase one: CT request to CT compleQon •  IV contrast enhanced CT scans significantly reduced by 3 min 24 sec. –  Overall CT turnaround •  StaQsQcally significant reducQons: –  IV contrast enhanced CT scans reduced by 25 min 34 sec. –  PO contrast enhanced CT scans reduced by 21 min 40 sec. –  All CT scans reduced by 7 min 14 sec. »  Significance preserved despite inclusion non-­‐contrast enhanced CT scans • 
StaQsQcally significant gains may have been limited to CT scans with IV and PO contrast due to their greater complexity compared to CT scans without contrast, thus lending them to greater opportunity for process improvement. –  AddiQonally, pre intervenQon phase one and overall turnaround Qme for CT scans without contrast were relaQvely low, thus limiQng potenQal for improvement. • 
PHASE ONE INTERVENTIONS IMPROVED EFFICIENCIES OF PHASE ONE AND TWO PROCESSES. –  CT technologist assistant •  Pre intervenQon –  Dedicated significant Qme to assisQng nursing and transport staff. –  DownQme between scans lead to under uQlizaQon •  Post intervenQon –  Shiming this role to coordinator of paQent traffic to the ED CT scanner relieved a previously unaccounted burden of from the CT technologist, who was then able to perform image processing and uploading to PACS faster »  Phase one intervenQon lead to phase two Qme savings. –  DedicaQon of an ED transporter to CT jobs •  No directly measurable decrease in phase one turnaround Qme resulted from this intervenQon. •  AddiQon of this role relieved the CT technologist assistant from intermiAently assisQng transport staff, the downstream effect of which was decreased interrupQon of the CT technologist. • 
BENEFITS OF PHASE TWO INTERVENTIONS WERE DIRECTLY RELATED TO EDUCATION AND REGULAR INVOLVEMENT OF CT TECHNOLOGISTS AND RADIOLOGISTS. –  Batch loading of studies to PACS idenQfied as a contributor to CT turnaround delays. •  PracQce addressed prior to implementaQon of phase one intervenQons, miQgaQng measurement of effects between pre and post intervenQon Qme points. –  RouQne updaQng of radiologists and CT technologists regarding trends in CT turnaround Qme may have yielded improvements in phase two by the Hawthorne effect. •  These stakeholders may have taken unmeasured steps to improve their individual efficiencies due to awareness of ongoing monitoring. • 
OUR PDSA CYCLE APPROACH TO IMPROVEMENT OF ED CT TURNAROUND TIME REQUIRES CONTINUOUS MONITORING AND MODIFICATION. –  Increasing ED CT volume related to the expansion of the ED populaQon presents challenges to the gains that we have achieved. • 
We will maintain the intervenQons we have implemented: –  New role of the CT technologist assistant as a director of paQent traffic to the ED CT scanner based on readiness. –  DedicaQon of an ED transporter to ED CT jobs during peak hours of ED CT throughput. –  EducaQon and rouQne updaQng of CT technologists and radiologists. • 
We will conQnually assess ED CT operaQons to idenQfy areas for future improvement. • 
THIS PDSA CYCLE APPROACH IS COMMONLY USED FOR PQI PROJECTS REQUIRED FOR PART IV OF MAINTENANCE OF CERTIFICATION BY MEMBERS OF THE AMERICAN BOARD OF MEDICAL SPECIALTIES. • 
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%20%26%20Resource%20Guide.pdf. Accessed: 1/24/2015. Knezevic A, StatNews # 73: Overlapping Confidence Intervals and StaQsQcal Significance. Cornell University – Cornell StaQsQcal ConsulQng Unit. Available at: hAps://www.cscu.cornell.edu/news/statnews/stnews73.pdf. Accessed: 4/24/15. Towbin AJ, Srikant BI, Brown J, et al. PracQce Policy and Quality IniQaQves: Decreasing Variability in Turnaround Time for Radiographic Studies form the Emergency Department. Radiographics 2013;33:361-­‐71 Krishnaraj A, Lee J, Laws S, et al. Voice Recognitoin Somware: Effect on Radiology Report Turnaround Time at an Academic Medical Center. AJR 2010;195:194-­‐7 Gale EA, The Hawthorne studies – a fable for our Qmes? Q J Med 2004;7:439-­‐49 Maintenance of CerQficaQon Part IV PracQce Performance Assessment. American Board of Medical SpecialQes. www.abms.org Available at: hAp://www.abms.org/media/84747/abms_memberboardsrequirementsproject_moc_parQv.pdf Accessed: 2/15/15.