Priority in Echocardiography is given to outpatients, so requested inpatient echocardiograms are not scheduled. Inpatients are brought to Echocardiography only when an opening in the scheduled outpatients occurs.
Reduce bed capacity constraints by eliminating delays in discharges due to waiting on final inpatient echocardiograms. Hospital reimbursements are negatively impacted when extra days, deemed to be “not medically necessary,” are denied.
The goal is to reduce turnaround time for inpatient echocardiograms from baseline of 42 hours on average to within 8 hours of time ordered.
The team initiated the process by gauging the hospital’s readiness for change and gaining agreement to defined metrics for success. Initial meetings between physicians, leadership and staff provided opportunities to assess issues and needs and to begin improving communication and alignment. High-level process mapping included analysis of cycle times, resource constraints and bottlenecks. Finally, a simulation model was created to understand the overall system flow within the Center. This served to guide executives and physicians in developing insight into the most critical “pain points” and in prioritizing the specific transformational projects required to achieve objectives.
Top leverage points or key findings:
Analysis of the process map identified significant delays between the time a sonographer is ready for an inpatient and the time the inpatient can be readied and transported to Echocardiography. Volume, cycle time and capacity analysis utilizing simulation modeling proved the combined inpatient and outpatient volumes could be met with existing staff.
Scheduled inpatient slots were created by assigning one full-time sonographer per day to work only in-patients. Not only does this significantly reduce the time participants wait for an opening in the schedule, but it also allows for the pre-scheduling of patient preparation and transportation to Echo.
- Inpatient echo turnaround time reduced by 83%
- Increase in outpatient echo volume by an average of 5 patients per day
- $1.8 million in new annual net revenue
- No additional FTE resources needed
- Overtime decreased