Process analysis to reduce MRI access time at a German University Hospital.

QUALITY PROBLEM OR ISSUE: Long access times for magnetic resonance imaging (MRI) can negatively impact the quality of care provided to patients. We investigated improving access by reducing MRI processing time. INITIAL ASSESSMENT: Data were collected for scans (n= 360) performed over 3 weeks (April-May 2008) at the University Hospital of Mannheim, Germany. Average access time, excluding emergencies, was 44 (±44) days for outpatients and 3 (±5) days for inpatients. Factors influencing total MRI processing time were identified using multivariate linear regression. In addition to region scanned, the total MRI processing time was significantly related to performing multiple scans (β = 33.57, P< 0.01), using oral contrast media (β = 13.58, P< 0.01), placing an intravenous (IV) catheter (β = 5.00, P= 0.04) and scanning patients ≤8 years old (β = 0.41, P= 0.03). Contrary to prior perceptions, emergency cases (5.6%) and late arrivals (12.8% >5 min late) were less than expected. CHOICE OF SOLUTION: Increasing scheduling flexibility to address non-modifiable process variation and completing preparatory activities outside the scanner room were identified as process improvement targets. IMPLEMENTATION: Scheduling was adapted to utilize three expected total MRI processing times and IV placement was moved outside the scanner room. EVALUATION: Planned hardware and software upgrades were completed concurrent to the process improvements. As a result, it was not possible to accurately measure the effect of implementing the scheduling and preparatory activity changes. LESSONS LEARNED: Clinical study team members' prior perceptions of workflow obstacles did not match the study findings. Utilizing insiders and outsiders during process analysis may limit bias in identification of process improvement opportunities.