Reducing variation and imbalance in a Radiology procedure
Lean Academy
Green Belt, 2016
Mater Radiology
Operations Manager,
Mater Data manager,
Clinical Coder Midlands
Hospital Group, CEO
Royal Victoria Eye and
Ear Hospital
Patients receive chemotherapy and other critical medications through peripherally inserted central catheter (PICC) lines in the Interventional Radiology department.
At the outset of this process improvement project, the average wait time for this procedure was 3.7 days for an inpatient with 38% of patients waiting over 4 days.
This resulted in delays in treatment and ultimately, longer stays in hospital for patients.
Using Lean Six Sigma the team was able to reduce the waiting time for PICC lines from 3.7 days to 1.9 days, without any additional resources.
This improvement has been sustained within the department for over 2 years. The volume of PICC lines also increased by 35%.
“As manager of the Special Care Unit, I have seen the benefit of this work. It really makes a difference for patients, giving them access to their therapy sooner and it gives certainty to us, the nurses when you know the time slot for your patient’s PICC line insertion.”
Patricia McAuliffe, Clinical Nurse Manager, Special Care Unit
As part of a Mater Lean Academy Greenbelt programme, lean six sigma methodology was applied systematically to define, measure, analyse, improve and control the PICC process.
Detailed process mapping and data collection was carried out to analyse the workflow, divide it into its component parts, and identify unnecessary steps and variation within the process, with the following findings:
- There was significant variation in activity across the week. During a two week audit, there were some days where there was no procedure carried out despite consistent demand.
- Scheduling deficiencies were identified as playing a role in significant delays. Most notably, the team discovered that the interventional suite was significantly under-utilised in the first hour of the list each day.
- The form that was used to request the procedure was often incomplete or had incorrect information, which
caused delay. - Patients sometimes weren’t ready for the procedure when the porter arrived to bring them to Radiology.
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Significant day-to-day variation in PICC insertion was noted over the two weeks
Following root cause analysis and engagement with stakeholders, the team introduced the following interventions:
- 2 PICC insertions were routinely scheduled as the first cases on the list each morning, with the referring team, ward and portering services notified the night before.
- An electronic referral process was introduced in place of the previous paper based system. The referral steps were streamlined and condensed.
- A “PICC checklist” of basic preparatory steps was devised and distributed to wards with an emphasis on patients being prepared the night before,
where possible.
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