Streamlining Patient Access NEUROINTERVENTIONAL ULTRASOUND IBI OPUIYO RDMS

Streamlining Patient Access NEUROINTERVENTIONAL ULTRASOUND IBI OPUIYO, RDMS EXECUTIVE SPONSOR - JOSEPH STEELE, MD

The project was a collaboration with ICCE, OPI, NIR Ultrasound technologists, nurses and faculty

Neuro-Interventional Ultrasound v Provide ultrasounds of the thyroid and neck regions v Referrals from various clinics throughout the institution including Endocrine, Melanoma, Head and Neck Surgery, and Lymphoma services v Number of completed patient exams in NIR US has grown in 5 year period from just over 4, 000 in FY 06 to 10, 000 exams and biopsies in FY 11

PROBLE M

Who Is Impacted ? Endocrine Head and Neck Surgery Thoracic NIR Melanoma Other Referring Services PATIENTS

NIR US Project Goal Decrease Delays Increase Access

NIR will decrease the number of days for referring clinics to obtain diagnostic scans for patients from 25 or more working days to less than 5 days by June 2011. AIM

IDENTIFYING & ASSESSING CAUSE ANALYSIS

v. PATIENT SCHEDULING TEMPLATE v. WORKFLOW v. PERSONNEL CAUSE ANALYSIS

KEY ISSUES v SCHEDULING v v LIMITATIONS OPERATIONS v PROCESSES v WORKFLOW

PERFORMANCE ASSESSED BASELINE DATA

Capacity Backlog : Scheduling v Max 38 potential appointment slots/day v 25 day delay for next available appointment

Process Analysis: Scheduling

Operations: Processes v. Workflow v Personnel v Situational Processes v Practical Processes

Operations: Asset Utilization

PHASED APPROACH INTERVENTIONS

• Phase I • Feb 1, 2011 to March 10, 2011 SCHEDULE v v Management team began complete restructuring of scheduling template Opening of initial set of additional scheduling slots for servicing clinics. This addressed immediate bottleneck issues. OPERATIONS v Personnel changes to accommodate expanded schedule. 1. New technologist schedule 2. New temporary Imaging Assistant

• Phase II • March 11, 2011 to April 14, 2011 SCHEDULE v Process changed for ordering diagnostic scans/biopsies v Communications and education of referring service Clinical Coordinators on forthcoming schedule template usage OPERATIONS v Departmental operational hours expanded

• Phase III • April 15, 2011 to July 15, 2011 v Go Live: opening of restructured scheduling template v Data gathered for 90 day assessment of combined changes

Results The success of the project was measured using two metrics v The number of available daily slots for procedures or scans. v The time to next appointment for a diagnostic ultrasound and biopsy

The data reveals that measured improvements are attributed to : SCHEDULE v The new scheduling template

Available appointment slots increased from 38 to 55 NIR Clinical Operations Report Summary Template Timeslots Available Jan. Feb. March April May June July Scan w/biopsy timeslots 10 10 10 14 16 16 16 Scan only timeslots 18 18 23 24 25 25 25 Overbook timeslots 10 10 10 12 14 14 14 Total Timeslots 38 38 43 50 55 55 55

1/ 13 1/ /20 14 1 1 1/ /20 18 1 1 1/ /20 19 1 1 1/ /20 21 1 1 1/ /20 24 1 1 1/ /20 25 1 1 1/ /20 26 1 1 1/ /20 27 1 / 1 2/ 201 4 1 2/ /20 11 1 1 2/ /20 18 1 1 2/ /20 25 1 / 1 3/ 201 4/ 1 3/ 20 11 1 1 3/ /20 18 1 1 3/ /20 25 1 / 1 4/ 201 1/ 1 4/ 201 8 1 4/ /20 15 1 1 4/ /20 22 1 1 4/ /20 29 1 / 1 5/ 201 6/ 1 5/ 20 1 1 5 3/2 1 /2 01 0 1 5/ /20 27 1 / 1 6/ 201 3 1 6/ /20 10 1 1 6/ /20 17 1 1 6/ /20 24 1 / 1 7/ 201 1/ 1 7/ 201 8/ 1 20 11 # WORKDAYS Results Scheduling Template NUMBER OF WORKDAYS FOR NEXT AVAILABLE APPOINTMENT 80 70 60 50 40 Scan Only Template 30 Scan Only Overbook Scan/Biopsy Template 20 Scan/Biopsy Overbook 10 0 WORK WEEK

The data reveals that measured improvements are attributed to : OPERATIONS v Pre assessments v Extended department hours of operation v Change in personnel (tech/MD) schedules v Additional Imaging Assistant (personnel changes) v New lead technologist role

AVERAGE TIME IN MINUTES: Pre Template Post Template 61. 19 minutes 54. 63 minutes Room utilization improved. The time to perform one complete procedure (time from patient entering the room to exiting the room) decreased 6. 6 minutes. 90 Day NIR Room Utilization Times Room Usage Per Patient Seen in Minutes 80 70 60 Pre Template Room Utilization Times Jan 2011 - Apr 2011 50 40 Post Template Room Utilization Times Apr 2011 - July 2011 30 20 10 0 90 Day Period

Calculation Summary / ROI Year 0 Cost of Capital Investments/Costs Benefit/Revenue Annual Net Benefit/Revenue(Costs) Benefit/Revenue Including Soft Savings Annual Net Benefit (Costs) Including soft Savings Year 1 Year 2 Year 3 9. 20% (3, 906) 0 0 0 120, 919 120, 919 120, 919 Risk Adjusted ROI = Net Present Value of Cumulative Net Benefit / Net Present Value of Total Costs RA ROI (Margin for yrs 1 -3 discounted @ Cost of Capital %) 6959% Net Present Value $275, 722. 78 Internal Rate of Return (Expected Return) 3096%

NEXT STEPS

Thank You � NIR US Process Improvement Teams � NIR US Manager Tonya Brightmon � Executive Sponsor Dr. Steele