Outline
- Abstract
- Introduction
- Methods
- Costing
- Improvement
- Results
- Limitations
- Take-Home Points
- Acknowledgments
- References
رئوس مطالب
- چکیده
- مقدمه
- روش ها
- هزینه یابی
- اصلاحات
- نتایج
- محدودیت ها
- نکات
Abstract
Purpose The aim of this study was to increase efficiency in MR enterography using a time-driven activity-based costing methodology.
Methods In February 2015, a multidisciplinary team was formed to identify the personnel, equipment, space, and supply costs of providing outpatient MR enterography. The team mapped the current state, completed observations, performed timings, and calculated costs associated with each element of the process. The team used Pareto charts to understand the highest cost and most time-consuming activities, brainstormed opportunities, and assessed impact. Plan-do-study-act cycles were developed to test the changes, and run charts were used to monitor progress. The process changes consisted of revising the workflow associated with the preparation and administration of glucagon, with completed implementation in November 2015.
Results The time-driven activity-based costing methodology allowed the radiology department to develop a process to more accurately identify the costs of providing MR enterography. The primary process modification was reassigning responsibility for the administration of glucagon from nurses to technologists. After implementation, the improvements demonstrated success by reducing non-value-added steps and cost by 13%, staff time by 16%, and patient process time by 17%. The saved process time was used to augment existing examination time slots to more accurately accommodate the entire enterographic examination. Anecdotal comments were captured to validate improved staff satisfaction within the multidisciplinary team.
Conclusions This process provided a successful outcome to address daily workflow frustrations that could not previously be improved. A multidisciplinary team was necessary to achieve success, in addition to the use of a structured problem-solving approach.
Keywords: Efficiency - enterography - MR - TDABC - time-driven activity-based costingConclusions
The TDABC methodology allowed radiology to develop a process to more accurately identify the cost of providing an MR enterography examination. The process change reduced the overall time the patient was in the scan room and successfully reduced the overall scan time without adding an incremental full-time equivalent. The baseline total time for the staff to provide the examination was a median of 198 min. By modifying the workflow to allow medication preparation and glucagon administration to be completed by the MRI technologist, several cascading positive impacts resulted.
The staff total process time decreased from a median of 198 to 165 min (a 16% reduction), and the patient in-process time decreased from a median of 102 to 85 min (a 17% reduction) (Fig. 4). Time savings resulted for the radiologist, resident, and fellow at a 22% reduction; the technologist at 18%, and the LPN at 17% (Table 1).
The radiologist, resident, and fellow time decreased slightly because of the reduced wait time and was noted to be variable because of observations completed on different radiologist, resident, and fellow teams. The overall radiologist, resident, and fellow time includes the resident and fellow interpretation, radiologist interpretation, and teaching and feedback. Further study would be required to understand the impact of the changes in relation to the variability in provider teams.
Additionally, the scanner time required was reduced, affecting space and equipment costs. The largest cost savings came from the space and equipment time reduction, resulting in a decrease of 21%. In total, this project led to a 13% reduction in the cost to provide an MR enterography examination. Future data collection will ensure that improvements have been sustained over time.
Anecdotal comments were captured to validate improved multidisciplinary staff satisfaction. Staff were quoted as follows: “It is so nice for the patient, much less waiting” and “It is very helpful for simplifying workflow and streamlining our exams.” This process provided a successful outcome for daily workflow frustrations that could not previously be improved. The change was made possible during this project because the TDABC methodology brought together multidisciplinary personnel in a safe environment to discuss how to reduce the cost of the process. The TDABC methodology allowed the team to use data to identify the process inefficiency, and the financial impact heightened the desire to change.