03:27 PM Abstract No. 36 Process map for interventional radiology at a large tertiary children’s hospital: understanding the workflow and identifying areas for improvement

Abstract

Process mapping can be used to identify healthcare waste and inefficiencies. We chose to observe pediatric interventional radiology (IR) processes for inpatients undergoing procedures with general anesthesia to create a process map and identify delays in patient care. A fourth-year medical student was assigned to observe the process of coordinating inpatient IR procedures (2 IR rooms) at a tertiary care children’s hospital for 2 weeks. The medical student began following a single patient at initiation of transfer from the inpatient floor until the patient exited the IR suite. Predetermined variables were recorded for each patient observation. Post anesthesia Care Unit (PACU) nurses were tasked with recording discharge times from the PACU. During this process, team member duties were recorded chronologically for future integration into a process map. Overall, 19 inpatient procedures were completely tracked. We found notable delays in patient transport times (mean 38 mins, range 22–68 mins), pre-procedure evaluation (mean 22 mins, range 13–31 mins), and preoperative/PACU space availability. Estimated time for scheduling the procedure in the IR suite (mean 68.5 mins, range 60–120 mins) was shown to be an underestimate when compared to the measured procedure duration (mean 77 mins, range 31–181 mins). With all members of the IR team, including IR nurses and radiology technologists, a process map was created to map the roles of each team member. Results from the observation were discussed at a team meeting to receive input and feedback from all members of the IR team. We have implemented changes in our workflow to address these issues. Patient transport is now solicited at earlier times to reflect appropriate transport lags. We found our team to be efficient in preparing the patient for the procedure with most of our delays being attributable to PACU bed availability. By analyzing our processes, inefficiencies in workflow and delays in coordination of patient care were identified. Implementation of targeted changes at our institution should lead to improved efficiency. Process mapping can be used to help other IR departments in identifying their inefficiencies.