A quality improvement initiative at Children’s Hospital of Philadelphia has helped significantly improve the percentage of on-time starts for cardiac MRI, experts detailed Friday in JACR [1].
Such delays can result in longer patient fasts, extended wait times, and poor synchronization of anesthesia induction and contrast administration. CHOP aimed to address this issue by forming a multidisciplinary team that included representatives from radiology and cardiac services, utilizing RITE (Realizing Improvement Through Team Empowerment) methodology to pinpoint root causes of these delays.
Corresponding author Mohammad Jalloul, MD, and colleagues highlighted four main factors that contributed to late MRI start times. They included late patient arrivals, variability in preparation time, unavailability of equipment, and inefficient scheduling. Implementing strategies to address these factors helped CHOP increase on-time starts from 10% prior to the intervention up to 34% afterward.
“The study’s systematic approach proved to be valuable in both understanding and resolving the identified problems,” Jalloul, with Children’s Hospital of Philadelphia’s Department of Radiology, and co-authors concluded. “Through the continuous application of [Plan-Do-Study-Act] cycles, we effectively pinpointed obstacles and tested multiple potential measures to overcome them. This approach enabled us to comprehend the issue and implement targeted interventions to address it.”
Solutions devised by CHOP included:
- Standardized appointment scripts: Investigators surveyed patients to better understand reasons for late arrivals, with traffic, parking and confusion about where to report all common answers. To address this, the team created an updated standard script for pre-visit calls that included instructions on how to get there and where to find parking and the registration desk.
- Timely patient prep: Challenges in getting patients ready for anesthesia also delayed start times, the study found. To minimize delays, Jalloul and colleagues dedicated two rooms to this process: the MRI preparation room and the cardiac prep and recovery unit. They also created a status board indicator to notify anesthesia nurses about patients’ readiness and better coordinate patient prep and timely induction. The new processes required the anesthesia team to prepare patients for induction 40 minutes before the scheduled start time, regardless of whether the individual undergoing an MRI was on schedule or not.
- Equipment readiness: The investigation also found that required MRI machines and ancillary equipment/supplies often were not accessible due to malfunctions, unavailability or inadequate prep/maintenance. To address this, CHOP considered steps to improve MRI equipment maintenance, along with reinforcing inventory management practices to ensure that necessary supplies were available.
After implementation, Jalloul and colleagues measured the number of on-time cardiac MRIs, tracked patient arrivals and recorded readiness times. Following the intervention, estimated delays fell from 40 minutes down to 27.
“Despite limitations such as redesigning the scheduling process and staff unavailability, the project’s outcomes highlighted the value of utilizing a diverse team of healthcare professionals and quality improvement specialists to address performance challenges systematically,” the authors advised.
Read much more in JACR at the link below.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.