Increasing CT Productivity: Good for Patients, Referring Physicians, and the Bottom Line

CT has become indispensable tool for physicians to use in diagnosing and managing a vast array of medical conditions. The use of CT to aid triage of patients in emergency departments is now routine. Most patients with cancer are diagnosed and monitored by CT. Even many benign diseases are best diagnosed and monitored using CT. In short, referring physicians are demanding more and more CT as they continue to see increasing value from exams performed using newer and faster machines, combined with innovative protocols that expedite the diagnostic process. The success of CT, however, has come with a price. Many radiology departments are struggling to keep up with the increasing demand, yet patients and referring physicians expect, and even demand, that requested scans be performed quickly. Any wait for appointments can delay an important diagnosis, and both patients and referring physicians may choose to be scanned elsewhere if they can obtain an earlier appointment. Meanwhile, CT has become highly profitable, and any loss of patient volume, either due to poor productivity or because of loss of market share, can have a significant negative effect on the organization’s bottom line. The net sum of all these pressures is that radiology managers are expected to provide rapid access to CT for referred patients and, in turn, increase CT capacity. A frequent initial response to the demand for increased capacity is to purchase new equipment. While this ultimately may be necessary, invariably, many CT machines are not operating at optimal capacity. Too often, managers purchase additional CT equipment before full capacity has been realized, resulting in an unnecessary financial burden to many cash-strapped health care facilities. A more suitable approach would be to re-evaluate the existing workflow and operations critically to look for opportunities to increase capacity without resorting to purchasing new equipment. This makes financial sense, given the expense of the equipment, its requirements for additional space and staff, and the competition from other capital requests within health care facilities. CT productivity is increased by performing more scans during a given time period and/or scanning for longer hours. These two concepts, while simple, are often neglected. Scanning more patients in a given time period (say, per hour) is initially achieved by evaluating the workflow of the CT operation to look for bottlenecks and inefficiencies in the system. This will usually require preparing flowcharts for the whole CT operation and providing solutions where performance is suboptimal. This may be as simple as ensuring that inpatients are delivered to the CT suite on time (requiring an efficient patient-transport service) or that outpatients check in on time for their scans (patient reminders the day before their scan are essential). The goal is to reduce any delays in the workflow process so that patients arrive on time, are scanned on time, and leave on time. This can be challenging for hospital CT scanners, where inpatients and outpatients are typically imaged on the same scanner. Urgent inpatient/emergency scans will usually trump nonurgent scans for outpatients, who are then sometimes left waiting for hours for their scans. Further, due to the complexity of maneuvering critically ill patients in and out of CT scanners, workflow can be severely disrupted. It may make sense, therefore, to image inpatients and outpatients on different scanners so that CT workflow can be optimized for both groups of patients. One of the largest bottlenecks in the workflow is the speed with which CT technologists can move patients in and out of the CT suite. There are numerous tasks that these technologists (or technologist aides) have to perform in order to process a patient though the CT scan. These range from preparing the CT machine itself for the appropriate scan to explaining the procedure to the patient, inserting IV catheters (which should be inserted in a CT-preparation area, outside the CT suite, while another patient is being scanned), and getting the patient on and off the table, among many other, smaller tasks. Given the multiplicity of tasks required, it is surprising that many managers operate CT machines with a single technologist. These managers may believe that they are saving costs, but in reality, they are missing a huge opportunity to increase productivity (and, consequently, customer service and financial return). Rather, it is far more prudent to operate these expensive machines with multiple personnel who can now divide the workload between them so that many procedures can be performed simultaneously, rather than one after the other (as would be necessary with a single technologist). For instance, the CT machine can be prepared and an IV catheter can be placed in a patient while another patient is put onto the CT table, all at the same time. This multitasking by multiple individuals should considerably expedite the transfer of patients in and out of the CT suite. Not all of the individuals need to be technologists. Some could be nurses or technologist aides. While the cost is clearly more than that of having a single employee, CT productivity can triple, with the resulting revenue far outstripping (by a factor of 10 to 20) the cost of employing these new individuals. At the same time that patient CT throughput is optimized, radiology managers should seriously consider extending their hours of operation. Many organizations operate their scanners after hours for emergency purposes only, either believing that the costs are too high to operate at full staffing levels or that outpatients are unwilling to attend after hours. For hospital facilities, the scanner should continue to operate after hours in order to scan the less urgent inpatients (who are on-site anyway), while outpatients can be scanned during the regular working hours. For outpatient-dedicated scanners (either in hospitals or in freestanding centers), patients are frequently willing to be scanned after hours, particularly if their scans can be obtained more expeditiously. Given patients’ frequently busy work-week schedules, many prefer to be scanned on the weekend. Managers can be comforted that the revenue from two to three patients will usually cover the operating costs of opening on a weekend day (and the per-scan cost will be less if other modalities are operating concurrently). Combining an extended CT schedule with increased patient throughput should result in CT operators meeting (and sometimes exceeding) all their stakeholders’ expectations. Patients are comforted by being scheduled quickly, referring physicians can move on to the next management decision for their patients, and administrators are reassured that the radiology department is providing superior customer service—a key priority for retaining and increasing market share and financial return.