September 9, 2010

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Closer look at orders improves service for mammography patients

Plan, Do, Study, Act

TUESDAY, AUGUST 12, 2008

Value compass: Best service

Department: Mammography, Sunnyside Medical Center (Northwest)

Problem: Patient appointments were running late because information was missing from the file, additional forms were needed or the wrong test had been ordered. This was causing the technologist to have to spend time tracking down information or following up on needed documentation during the patient appointment. This made appointments run over the scheduled time, causing a delay for the next scheduled appointment.

Metric: Number of on-time appointments compared with baseline

Labor co-lead: Laura Wellnitz, technologist, UFCW local 555

Management co-lead: Cheryl Maize

First small test: Time was scheduled every day for a technologist to review all orders for the next day. Staff created a list of items to check for in the orders.

Result: By the end of the fourth PDSA cycle, a technologist was checking orders and printing out appropriate paperwork for diagnostic mammograms one day in advance of the appointments. This has eliminated the 10 to 20 minutes it was taking per appointment to generate correct paperwork and check the orders for accuracy once the patient arrived. The diagnostic appointments now rarely run over the scheduled 30 minutes, so subsequent appointments start on time.

Why change: "The implementation of the screening of orders 24 hours prior to patient arrival has allowed us to maintain our allotted appointment times and has made it easier to accommodate surprises such as late arrivals and walk-ins."
—Laura Wellnitz, UBT labor co-lead

Side benefit: "Many times patients who are coming in for an appointment are here because something has shown up on a prior screening and their anxiety and stress levels are high. By streamlining our appointments and ensuring appointments run on time, we are hoping to allay some of that stress."
—Cheryl Maize, manager of Mammography and UBT co-lead

Background

The Mammography Department at Sunnyside Medical Center sees about 370 patients per week. Some 25% to 30% of those appointments were running behind schedule, causing a service issue for our patients.

The unit-based team (UBT) realized that many of the issues causing delays during appointments could be handled in advance of the patient's arrival. The team came up with the idea of setting time aside every afternoon for a technologist to review the following day's orders. Initially, 3 to 4 p.m. was set as the window for this work, but as staff began to test the new process, they learned that starting the work that late in the afternoon was not ideal. In some cases, they needed additional information or return phone calls and they couldn't get everything done by the end of the day. The team tried doing the pre-work on the orders from 1 to 2 p.m. instead, and the result was favorable.

In addition, the team implemented a "double-check" system at 4 p.m., so orders were reviewed once again to make sure any outstanding items had arrived and everything was ready for the patient's appointment the following day. The technologist reviewing the orders also would leave notes in the file if there was something the technologist who was seeing the patient needed to know.

The new process was implemented and the time slot was blocked off the schedule permanently to ensure a technologist was able to preview the orders for the following day. This ensured a better patient experience. Patients are happier because their appointments are on time, and technologists are better prepared to work with their patients because the patient's orders had been reviewed in advance and the file is in order.

Staff members also prefer this process. They decided to take turns verifying the orders and reviewing orders, which provides a welcome break in the daily routine, according to Laura Wellnitz, UBT labor co-chair.