Implementation of an Electronic Work Flow in a Diagnostic Imaging Department

PURPOSE The purpose of this initiative was to evaluate the workflow for x-ray examinations to optimise turnaround times and eliminate the use of paper. In the original workflow, examination requests arrived in the department via an order comms system which sent requests electronically to the departments Radiology Information System (RIS), but it was a printed version of this request which initiated the examination taking place. This print out was produced automatically, often in the incorrect location within the hospital. This therefore created a delay in the turnaround of the imaging requests until staff moved the paper to the correct location. METHODS A Lean review was undertaken with key staff in the department. The process involved mapping our current state. This showed a number of value-added and non-value added steps and the time taken for one request to go from initial referral to completion of the examination. A target state was then devised which required a reduction in the number of non-value added steps, the turnaround time and the use of an electronic process of managing requests. Gap analysis was undertaken to assess the key areas of issue which would need to be addressed to achieve the target state. These were then ranked and solutions to the problems determined. The first issue to be changed was to remove the requirement to have printed requests. This was achieved by adapting how the RIS solution was utilised within the trust, teaching staff how to use the RIS to meet this adaptation and placing PC’s in all examination rooms. The second was to reorganise the radiographers work pattern to increase efficiency in the x-ray rooms. This would be achieved by introducing a Co-ordinator role to organise the day’s patients, be the sole communicator between clinicians, porters and wards. This then allowed a “buddy system” to be implemented which enabled two radiographers to work together in one examination room and continually perform examinations without distraction. A rapid experiment was performed which showed that the implementation of the proposed changes would create the benefits required to achieve the target state. All changes were therefore adopted. RESULTS Since implementation, all referrals are managed electronically using the RIS which has eliminated all paper from the process. This in turn has reduced the number of non-value added steps and decreased the time spent dealing with each paper request in the wrong place. By reorganising the radiographers work pattern, this has improved staff morale and therefore helped increase productivity and efficiency within the department. Data analysis was performed using the trusts RIS. This showed that before the event the average turnaround time for inpatients was 11 hours and after had reduced to 7 hours (36.5% decrease). CONCLUSION Implementing an electronic workflow resulted in a reduction in the number of non-value added steps and reduced the turnaround time.

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Implementation of an Electronic Work Flow in a Diagnostic Imaging Department