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Elkerliek achieves major improvements in patient throughput

Best Practice
Hertenberg, Helma, M.Sc. Elkerliek Hospital • Netherlands
op ’t Hoog, Jan Elkerliek Hospital • Netherlands
Westerhof, J.P., M.D., Ph.D. Elkerliek Hospital • Netherlands

The recent installation of an Ingenia 1.5T with its potential for fast, easy workflow and enhanced scanning possibilities stimulated the MRI unit at Elkerliek Hospital (Helmond, The Netherlands), to re-evaluate its clinical strategies and scanning procedures and make plans to improve efficiency. The unit is now already seeing increased patient throughput and a reduction in patient waiting time, with further improvements expected in the future.
 Elkerliek Hospital, Helmond, The Netherlands From left to right: Jan op ’t Hoog, Section Manager responsible for support processes,
Helma Hertenberg, Radiology Department Manager for MRI and Dr. J.P. Westerhof, Medical Manager of the Radiology Department.
Elkerliek Hospital, Helmond, The Netherlands
From left to right: Jan op ’t Hoog, Section Manager responsible for support processes, Helma Hertenberg, Radiology Department Manager for MRI and Dr. J.P. Westerhof, Medical Manager of the Radiology Department.

Taking a fresh look at departmental procedures

Elkerliek Hospital has two MRI scanners: an Ingenia 1.5T system at its center in Helmond and an Achieva 1.5T in Deurne. The Ingenia is a recent acquisition, replacing an aging Intera 1.0T system. The installation of this state-of-the-art scanner at Helmond prompted the unit to perform a thorough reappraisal of its procedures. “The aim here was not only to realize the full potential of Ingenia’s advanced capabilities, but also to look at general improvements we could make in our current mode of working,” says Jan op ’t Hoog, Section Manager responsible for, among other things, the radiology department at Elkerliek.

Identifying areas for improvement

With the support of Philips Healthcare Consulting, the unit organized a Kaizen event, a one-week workshop involving radiologists, technologists, administrative support staff and management, aimed at analyzing processes and brainstorming to identify potential areas for improvement.

As a precursor to this, the MRI unit also subscribed to the Philips Utilization Services, which provides automated collection of usage data and a clear display of statistics on a secure page on NetForum. “The results were enlightening. The comparison with the performance benchmark, obtained from the cohort of similar Philips MRI systems, showed that our efficiency was already somewhat above the average before we undertook any actions,” says Helma Hertenberg, Radiology Departmental Manager responsible for MRI.

“Some shortcomings were still identified, however”, she says. “For instance, our patient waiting list had been growing steadily in recent years. During the workshop it quickly became clear that this was largely due to our planning system being far from optimal. The system had evolved over time, with minor adjustments on the fly to correct for small problems without ever looking at the whole picture. As a result, the planning no longer reflected the real situation. Some exams overran the allotted time and others were completed earlier than planned, which often left us with unproductive time between exams. Time was also reserved for urgent cases, which by their nature are difficult to predict. These were often planned during breaks, when only one technologist was available, putting further strain on the planning schedule.”

The lack of predictability in exam times was aggravated further by the fact that the radiologists in the unit all had their preferred sets of protocols for specific clinical questions, that they expected the technologists to follow. “It became clear during the Kaizen event that the exam scheduling and the work of the technologists could be much easier if the radiologists all agreed on the same protocols to follow,” observes radiologist J.P. (Hans) Westerhof, MD, PhD, Medical Manager of the radiology department at Elkerliek. 

Smarter exam planning

The first phase of the improvement plan was aimed at improving the efficiency of the planning system. Drawing on the experience of the Philips consultants, a new planning system was designed to improve usage over the working day. Elkerliek’s MRI schedule is divided into blocks of exams with similar characteristics. The old planning system used relatively large blocks over the day, increasing the risk of losing time between the exams within a block. So, one of the changes implemented was to decrease the duration of the blocks and to increase planning flexibility.
Old planning (top) and new planning (bottom)
Urgent exams (red) and inpatients (green)
were previously often planned during breaks
when only one tech is available. Waiting
times for outpatients (blue) used to be long.
Brown are simple exams, other colors
represent time dedicated to special exams.

“For the Achieva 1.5T in Deurne, the patients are grouped according to exam type to save on coil changes, for example, brain exams or orthopedic exams,” says Helma Hertenberg. “But the Ingenia 1.5T is less dependent on coil changes, so here the planning is based only on the scan time required, which makes the whole planning much easier and more flexible.”

The second phase aims at reducing the number of slots kept in reserve for urgent patients. Since waiting times were long, slots had to be reserved for patients who need to be scanned within 10 days. However, reducing the time lost between exams, reducing the exam duration and working some extra days have decreased waiting time and thus reduced the necessity to reserve slots for urgent patients during normal working time. 

Standardized and faster ExamCards

For Ingenia 1.5T, the team is looking at the possibilities to reduce scan times of ExamCards and to reduce the total number of ExamCards. This third phase is currently still in progress. The brain ExamCard was meticulously reviewed in relation to the clinical question and which sequences are really used by the radiologist, and to potential improvements offered by the Ingenia 1.5T system. The new brain ExamCard takes 10:42 minutes scan time, 30% faster than previously. For the knee, scan time is reduced by as much as 39% to 13:45 minutes.* In addition, some of the sequences in both knee and brain now also provide better image quality.

With the standardized exam protocols and ExamCard names, the radiologists can now specify well in advance which ExamCard they require for each referral, again making the time for the exam more predictable.

*These results are obtained by specific choices made by this facility and may not be typical for all facilities.
The new brain ExamCard shows a scan time reduction of 30%.

The new ExamCard for knee shows a scan time reduction of 39%.

Significant reductions in waiting time

“For us, a major criterion of success was clear: reduced patient waiting time. In the past waiting time was not only too long, but also inconsistent, varying in some instances from say 10 days to 35 days, depending on the exam,” points out Jan op ’t Hoog. “Now, waiting time is already significantly shorter. At this moment no exam has a waiting time of more than 23 days and we are working on further improvements in the future. We are also achieving more consistent waiting times for different exams.”

The unit’s radiologists also see important improvements. “For the radiologists, it was a useful opportunity to optimize all individual protocols in the ExamCards, to develop and discuss shortcuts, and to really evaluate what we need for our diagnoses and what would be superfluous to our needs,” says Dr. Westerhof. “Now the process is more strictly organized, and we know exactly what we can expect from the exams.”

Ingenia 1.5T performance improvement. Utilization graphs help to monitor the improvements achieved.

What helped improve efficiency at Elkerliek

•Use of Philips Utilization Services for monitoring performance

•Involvement of all stakeholders in defining improvement
Smarter exam planning:
   - Shorter blocks to reduce time loss within blocks
   - Combine exams in blocks: similar length for Ingenia, similar
      anatomy for Achieva
   - Reduce number of slots reserved for (relatively) urgent patients
• Better informed patients help reduce preparation time
• Better information exchange between radiologist, technologist 
    and referring physician
• Radiologists specify standardized exam protocols, making
   work easier for techs and planning more predictable
Standardized room layout and patient preparation
   (e.g. IV contrast) enhance efficiency

• Organizing continuous education/information sharing

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Sep 17, 2013

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Best Practice
Achieva 1.5T, Ingenia 1.5T
benchmark, Brain, efficiency, Knee, patient planning, standardizing, throughput, utilization management, waiting time reduction

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