How 1 hospital cut its CT scheduling interval from 6 weeks to 3 days, adding $1.6M in revenue

Amid a growing backlog of exams, the University of Rochester Medical Center has reduced its CT scheduling interval from six week to three days using a few simple interventions. 

URMC operates two major imaging sites that handle most outpatient CT requests, completing an average of nearly 3,300 exams each month. Providers typically schedule appointments within two weeks of order placement. But with increased imaging demand and a “challenging” technologist staffing environment, the interval swelled to six weeks, experts detailed Thursday in Current Problems in Diagnostic Radiology [1]. 

To address this, the University of Rochester gathered feedback from radiologists, schedulers and technologists—implementing a few key interventions. The quality improvement project is paying off, with the hospital drastically cutting scheduling intervals while netting an additional $1.6 million in annual revenue. 

“Overall, the present quality improvement study demonstrated that changes to outpatient imaging scheduling and improving technologist efficiency leads to tangible and sustainable reductions in scheduling interval,” radiologist Ben Wandtke, MD, vice chair of quality and safety in the Department of Imaging at URMC, and co-authors concluded. “The challenge of simultaneously addressing examination backlog and reducing scheduling delay provided valuable insight into improving our institution's outpatient imaging process,” they added later. “These changes were extensible and successfully implemented across our entire health system.”

URMC used a lean six sigma approach for the project—identifying key stakeholders, outlining the problem-solving process, and creating a flowchart to identify bottlenecks in CT scheduling. Wandtke and colleagues also collected baseline data spanning 2021 to 2022, establishing the scheduling interval as the “third earliest available appointment.” 

“This metric was chosen to better reflect the date patients would select, as the first next available date may not always align with their schedules,” the authors noted. 

Researchers synthesized the data into a “key driver diagram” to begin identifying interventions. They also used a stepwise approach to implementation, starting with the most pressing issues to allow for analysis of the impact stemming from each change. 

From October to November 2022, URMC double-booked all CT exam slots to begin addressing the backlog. For each 20-minute appointment slot, schedulers were able to book two patients, including one study with contrast and one without. They also reduced exam durations from 20 minutes to 15 starting in late November 2022. At the same time, the medical center standardized the protocols for oral contrast studies to 60 minutes of pre-imaging wait times at both sites. 

In December 2022, Wandtke and colleagues adjusted staffing shifts by adding shift differentials, a “travel-at-home” program and recruitment bonuses. Shift differentials offer higher compensation for evenings and weekends, while the travel program is a staff-retention initiative offering flexible scheduling, arrangements to work between the two sites and higher compensation. URMC also extended evening hours on two weekdays and hired contractors for the weekend slots. Finally, an additional 64-slice CT scanner became available in January 2023, with researchers tracking the impact of each intervention over a four-month period. 

Double-booked appointment slots decreased the scheduling interval by 72%, from an average of six weeks down to 12 days. And shortening the exam slots to 15 minutes further reduced it by 41%, to seven days. By December 2022, URMC had reached its goal of reducing the scheduling interval for outpatient CT to under 10 days. Shift adjustments had no measurable impact on scheduling interval, but they garnered favorable feedback from staff, the authors noted. Adding the extra CT scanner, meanwhile, further reduced the interval by 57%, down to three days. 

Quarterly evaluations in the following months demonstrated a “steady rise” in turnaround time to 1.3 weeks by July of this year, remaining within the goals of the project. Average daily appointment delays remained at about 15 minutes, with “no substantial change” during the study period. However, URMC saw a brief increase to 30 minutes, coinciding with the training of a new staff member. During the double-booking phase, average weekly volumes climbed to 977 exams. But with the improvements, exam volumes were sustained for the next two months, stabilizing at an average of 860 CT exams per week (i.e., an extra 138 exams per week). 

This excess led to an additional $31,000 in weekly revenue for the University of Rochester Medical Center. Wandtke and co-authors calculated this figure based on 2023 American College of Radiology reimbursement by CPT codes. The top three exams were CT chest with contrast (CPT 72129, $178.92, 21%), CT abdomen and pelvis with contrast (CPT 74117, $322.61, 18%), and CT chest without contrast (CPT 72128, $136.23, 13%). A weighted reimbursement per study based on this distribution is about $226; annualized, this amounts to $1,612,000 in additional revenue. 

“Achieving success in quality improvement initiatives requires a well-rounded team to address the many facets of a challenge,” the study authors advised. “The first intervention of the project required a substantial increase in the number of studies performed by radiology technologists. Adequate buy-in from the staff performing the examinations was crucial for the success of the project. Approaching the backlog as a critical issue, employing mutually agreed upon interventions, and establishing a time-bound goal allowed for the success of temporary double booking. These changes were also implemented across our entire health system, including affiliated community hospitals and outpatient imaging centers, with comparable success.”

Read more, including potential study limitations, at the link below.