reduction of patients’ total turn around time a system design project conducted on department of...
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Reduction of Patients’ Reduction of Patients’ Total Turn Around TimeTotal Turn Around Time
A System Design Project conducted on Department of Diagnostic Imaging (DDI) By ISE-DDI team: Chong Jun Xiong, Fan Jiafang, Liu Xufeng, Wu Zhe
Problem DescriptionProblem DescriptionDepartment of Diagnostic Imaging (DDI) provides radiography services to in-patients (IP) and out-patients (OP) in NUH.
This project focuses on two most important modalities: X-ray and CT, attempting to reduce the total turn around time (TAT) of patients, which comprises a large portion for waiting.
Problem DescriptionProblem DescriptionDepartment of Diagnostic Imaging (DDI) provides radiography services to in-patients (IP) and out-patients (OP) in NUH.
This project focuses on two most important modalities: X-ray and CT, attempting to reduce the total turn around time (TAT) of patients, which comprises a large portion for waiting.
ObjectiveObjectiveReduce the total Turn around time through1. Improvements on X-Ray processes and resource utilization2. Modify CT appointment scheduling3. Lean service & process standardization
ObjectiveObjectiveReduce the total Turn around time through1. Improvements on X-Ray processes and resource utilization2. Modify CT appointment scheduling3. Lean service & process standardization
Process MappingProcess MappingProcess MappingProcess Mapping
TAT Factors GenerationTAT Factors GenerationTAT Factors GenerationTAT Factors Generation
Solutions (X-Ray)Solutions (X-Ray)
1. Assign SupervisorDevote one radiographer for cassettes handling, including transfer cassettes between X-ray rooms and processor; cassette developing, film & database entry checking. He also serve as a supervisor to X-ray corridor to handle coordinationamong radiographers and patients .
The use of “supervisor” is expected to reduce total TAT by up to 20-40%.
2. “express-queue” Nursing assistants direct all chest x-ray patients to Room 3 during peak hour uponsupervisor’s signal. Assign an experienced radiographer to achieve highest efficiency to ensure fast scans for short procedures, so as to reduce total TAT through reduction of machine setup time.
The “express-queue” is expected to reduce total TAT by 8-13%.
3. Process standardizationBy standardizing the process will results in the variation in service time, which leads to significant reduction of TAT for about 15-25%.
Solutions (X-Ray)Solutions (X-Ray)
1. Assign SupervisorDevote one radiographer for cassettes handling, including transfer cassettes between X-ray rooms and processor; cassette developing, film & database entry checking. He also serve as a supervisor to X-ray corridor to handle coordinationamong radiographers and patients .
The use of “supervisor” is expected to reduce total TAT by up to 20-40%.
2. “express-queue” Nursing assistants direct all chest x-ray patients to Room 3 during peak hour uponsupervisor’s signal. Assign an experienced radiographer to achieve highest efficiency to ensure fast scans for short procedures, so as to reduce total TAT through reduction of machine setup time.
The “express-queue” is expected to reduce total TAT by 8-13%.
3. Process standardizationBy standardizing the process will results in the variation in service time, which leads to significant reduction of TAT for about 15-25%.
Solutions (CT)Solutions (CT)Long waiting for CT is largely due to disruption of add-ons and unpunctual arrival of appointment patients. Hence more flexible appointment scheduling rules is suggested:
1. Assign different appointment interval times for patients of different process type and stage.
2. Give buffer of 10 mins for each hour. 20 mins buffers are given at 9:40 am and 1:40pm.
3. Extend the schedule hour to 4pm4. Advise patients arrive 5-10 mins earlier5. Avoid scheduling consecutive long
procedures in one CT room6. Avoid long procedures scheduled after 3pm.
The diagram is an illustration with Excel VBA, different appointment intervals are calculated with different combination of patients type and stage, base on current data analysis.
Solutions (CT)Solutions (CT)Long waiting for CT is largely due to disruption of add-ons and unpunctual arrival of appointment patients. Hence more flexible appointment scheduling rules is suggested:
1. Assign different appointment interval times for patients of different process type and stage.
2. Give buffer of 10 mins for each hour. 20 mins buffers are given at 9:40 am and 1:40pm.
3. Extend the schedule hour to 4pm4. Advise patients arrive 5-10 mins earlier5. Avoid scheduling consecutive long
procedures in one CT room6. Avoid long procedures scheduled after 3pm.
The diagram is an illustration with Excel VBA, different appointment intervals are calculated with different combination of patients type and stage, base on current data analysis.
Current Queue Length Improved Queue Length
Fig. 4.1 Comparison of queue length with a supervisor
Process time variance = 2 min Process time variance = 1 min
Fig.4.3 Comparison of queue length with different process time variance
Lean service & process standardizationLean service & process standardizationLean service & process standardizationLean service & process standardization
Special thanks to Department of Diagnostic Imaging, National University Hospital for the kind help and support, Dr Yap Chee Meng and Dr Chai Kah Hin for the inspiring guidance and assistance.
Total TAT
X-Ray CT
OP Registration Counter
IP Registration Counter
Others…
Patients
Work Flow
Queuing discipline
Preparation
Facility layout
No. of staff
No. of cassette
Others…
Contrast
Add on
Work Flow
Facility layout
Open hours
Others…
Appointment Schedule
Queuing discipline Work
Flow
Tray location
No. of terminals
Disruption IT system
Others…
Porter coordination
Others…
Porter scheduling
Waiting bay design
Appointment handling
Arrival rate
Type
Stage Age
Education
Others…
Other modalities
Others…
Out-Patient
In-Patient
2
18%
53%
0
30%
1
8
70%43%
10% 32%15%23%12%
12%6%
CT
20
103
49
10
X-Ray
X-Ray
Waiting Time
32%15%23%
12%12%6%
7%37%48%7%
1.5
6
2.03.5
2.52.5
6.515.0
26.0
16.0
13.06.0
12.09.0
3.55.55.5
3.5
Waiting Time
Registration Counter
Waiting Time before leave
Scan TimeRegistration Time
Registration Floor
Corridor A & E
Corridor C & E
Waiting bay, A, C &
E
Performance control &Continuous Improvements!
Categorize activity
Internal system standardization
External system standardization Reduce external factor variations
(patients arrival pattern & behavior)
Standardize serviceprocedures
Standardize individual performance actions
Standardize overall performances
Take form From the tray
DevelopCassette
Give patient Instruction
Issue queue Number
Form Processing
ComputerData entry
Fetchcassettes
FeedbackTo patient
Scan
Instruct patient
Collection &Process form
AnalyzeFilm
Scan
Take oneForm
ScanPreparation
Call inPatient
FormProcessing
Take PatientOut
Registration X-Ray CT
Identify wastes
Value adding activities
No value, can eliminate
Categorize activity
Internal system standardization
External system standardization Reduce external factor variations
(patients arrival pattern & behavior)
Standardize serviceprocedures
Standardize individual performance actions
Standardize overall performances
Take form From the tray
DevelopCassette
Give patient Instruction
Issue queue Number
Form Processing
ComputerData entry
Fetchcassettes
FeedbackTo patient
Scan
Instruct patient
Collection &Process form
AnalyzeFilm
Scan
Take oneForm
ScanPreparation
Call inPatient
FormProcessing
Take PatientOut
Registration X-Ray CT
Take form From the tray
DevelopCassette
Give patient Instruction
Issue queue Number
Form Processing
ComputerData entry
Fetchcassettes
FeedbackTo patient
Scan
Instruct patient
Collection &Process form
AnalyzeFilm
Scan
Take oneForm
ScanPreparation
Call inPatient
FormProcessing
Take PatientOut
Registration X-Ray CT
Identify wastes
Value adding activities
No value, can eliminate
No value, cannot eliminate
Scheduled slots
Reserved slots
Available slots