improve the patient preparation instructions that are tagged to each test type in
the scheduling program in anticipation of
this pilot. While a great deal of time was
spent to improve this process, it was unable to be rolled out during this pilot due
to delays in the legal process to ensure
HIPAA laws would still be respected.
0– 5 Min 6–10 Min
StdOverall – The Imaging Departments AVERAGE
mean for that group
MinAftAppt – Minutes after appointment,
before called to test area
Figure 2 • Retrospective Review of Outpatient Imaging Press Ganey Data
A multidisciplinary group was created to use Six Sigma techniques to
identify areas of opportunity to reduce
a patient’s appointment time to procedure start time. First, the workflow was
outlined from the time the patient made
the appointment to the time the test was
performed. (Figure 4.) As outlined, the
committee identified key areas of interest
that could potentially impact a patient’s
procedure start time. These opportunities
fell into one of four categories: scheduling, registration, imaging (referring to the
common local reception/waiting area of
all modalities), and the specific modality.
Next, the pilot workflow was outlined
from the time the patient made the appointment to the time the test was performed. (Figure 5.)
Scheduling: Defining Appointment Times
Defining the appointment time seemed
like it would carry the most impact.
It was identified that there were numerous ways for this to be interpreted by
the patient. Is it the time the patient is
scheduled to be on the table? Is it the
time the patient arrives on campus?
Is it the time the patient is first greeted
by healthcare personnel?
Compound this with how the appointment time is communicated and
there is a canvas of failure opportunities. All appointments are scheduled
over the phone whether it is by the patients themselves or their physicians.
Feedback from the schedulers was that,
most often, a great deal of distraction
can be heard over the phone during either workflow.
Emailing an itinerary to the patient
was proposed. Much work was done to
Registration: No Orders or Wrong Orders
Patient access outlined the steps taken
when a patient arrived without orders
or the orders they arrived with needed
clarification or modification. This was a
very complicated process which involved
a non-clinical registrar calling the physician’s office, asking for an order, and
waiting for a written fax to arrive. This
could cause significant delays during
the registration process. The alternative
to this would be for the imaging nurse
or a licensed imaging technologist in
the department to be contacted and informed of the need for a new order. The
imaging nurse or the licensed imaging
professional could be the one to call the
physician’s office and take a verbal order
while waiting for the final order to arrive.
Using the approved verbal order process,
a temporary order would be documented
in order to move the patient along more
efficiently. The physician’s office would
be alerted of the need for a written order
as soon as possible. Both would return
to patient access for final documentation.
Registration: Prioritizing Scheduled
When patients arrived on campus, it was
discovered that they were registered as
they signed in. There was no priority to
register a scheduled patient over a walk
in. This first come, first served registration process created operational challenges when it impacted a scheduled time
in a department juggling emergency and
inpatients, as well. Patient access took the
lead on this by creating a priority index
for those patients who had a scheduled
appointment. Walk-in patients would
be worked in as quickly as possible, but
priority was given to those that were expected at a particular time.