Team explains how they improved ED length of stay for patients undergoing CT

A team at the University of Colorado Anschutz Medical Campus shaved 10 minutes and 46 seconds off of the average length of stay (LOS) for emergency department (ED) patients undergoing CT scans, and have now published a report on how they accomplished the feat.

David Rigual, MD, University of Colorado Anschutz Medical Campus department of radiology, and colleagues wrote about the experience for the Journal of the American College of Radiology, saying they recognized that turnaround times for patients undergoing CT scans at their institution needed to be shortened.

“A collaborative inquiry by the radiology and emergency medicine departments identified slow CT scan turnaround time as a target for process improvement to reduce the length of ED patient stay,” the authors wrote. “We conducted a ‘voice of the patient’ survey on a cohort of ten ED patients, which validated the negative effects of long wait times for CT scans on patient satisfaction.”

The authors estimated that decreasing ED LOS for patients undergoing CT scans by at least ten minutes could result in annual savings of up to $420,000. It could also give the physicians time to care for more than 1,700 additional patients, they calculated, potentially bringing in more than $1.4 million.

To achieve this goal, the team turned to the Plan-Do-Study-Act (PDSA) Cycle.

Plan

The authors examined nine months of data and concluded  that “delayed patient transport, underutilization of CT staff members, and personnel awareness of CT delays” were all areas that needed improvement.

Some minor changes were also made to the institution's staff. For example, to address another area that needed to be improved, inconsistent ED transportation for patients undergoing CT scans, the authors selected one experienced transporter to handle all ED CT transport jobs during peak hours. In addition, changes were made to the ED CT technologist assistant's responsibilities.

“We redesigned the role of the ED CT technologist assistant and worked to increase awareness of key stakeholders involved with ED CT operations,” the authors wrote. “The CT technologist assistant’s responsibilities in the past were centered in the CT suite assisting the CT technologist. We relocated the CT technologist assistant to the ED to direct patients to the ED CT scanner on the basis of readiness.”

Do

With the areas of improvement identified and changes put in place, the team collected six more months of data. Time of admission and time of transfer/discharge were tracked closely.

Study

Overall, ED LOS for all patients undergoing CT scans was reduced by 10 minutes and 46 seconds.

In addition, the authors were able to judge the impact of their changes to the institution’s staff by viewing their six months of data and analyzing all feedback.

“Dedication of a transporter to ED CT transport jobs did not improve the prescan interval turnaround time directly, possibly because of increasing ED CT scan volume,” the authors wrote. “However, the addition of this role relieved the CT technologist assistant from having to intermittently transport patients to the scanner, which allowed the assistant to perform the new coordinating role without interruptions that could have imposed an intermittent increased burden of work on the CT technologist.”

The other staffing change, redefining the role of the ED CT technologist assistant, appeared to have the expected positive impact. The actual CT technologist was relieved of a significant burden as a result and could perform his or her job at a faster overall pace.

“In effect, this prescan interval intervention resulted in postscan interval CT turnaround time savings,” the authors wrote.

Act

As ED patient volume continues to increase, the authors said they will continue to track the LOS for patients undergoing CT scans. And the CT technologist assistant will now permanently act as a director of patient flow to the ED CT scanner.

“We continue our efforts in this work, with the intention to improve patient satisfaction, to reduce operating costs, and to increase our capacity to care for an expanding population served by our ED; the latter of which has the potential to add significant revenue to our institution,” the authors wrote.