Reduction of Patients’ Total Turn Around Time

1. Reduction of Patients’ Total Turn Around Time 6% 6% Waiting Time before leave Waiting Time Registration Time Waiting Time Scan Time 12% 12% 12% 12% 15.0 X-Ray CT 20 Others… Work Flow 23% 23% 6.5 Out-Patient 70% Work Flow Porter scheduling 1.5 15% 15% Facility layout 2.5 Process time variance = 2 min Process time variance = 1 min X-Ray 43% Facility layout Current Queue Length Improved Queue Length 32% 32% 2.5 2 Corridor A & E Contrast Preparation No. of cassette Others… 8 Other modalities Open hours 3.5 Queuing discipline Add on 7% Others… 2.0 No. of staff 10% Appointment Schedule 48% Others… 103 26.0 Waiting bay, A, C & E 37% Registration Floor Registration Counter 13.0 7% Queuing discipline Porter coordination CT Arrival rate Work Flow Total TAT 6.0 49 No. of terminals Type 16.0 Waiting bay design Tray location 18% Age Others… Stage 1 12.0 Disruption Education IT system Corridor C & E 0 9.0 Appointment handling 6 Fig.4.3 Comparison of queue length with different process time variance Others… Others… 53% 3.5 IP Registration Counter OP Registration Counter Patients X-Ray Fig. 4.1 Comparison of queue length with a supervisor 5.5 In-Patient 30% 10 5.5 3.5 A System Design Project conducted on Department of Diagnostic Imaging (DDI) By ISE-DDI team: Chong Jun Xiong, Fan Jiafang, Liu Xufeng, Wu Zhe Problem Description Department of Diagnostic Imaging (DDI) provides radiography services to in-patients (IP) and out-patients (OP) in NUH. This project focuses on two most important modalities: X-ray and CT, attempting to reduce the total turn around time (TAT) of patients, which comprises a large portion for waiting. Objective Reduce the total Turn around time through 1. Improvements on X-Ray processes and resource utilization 2. Modify CT appointment scheduling 3. Lean service & process standardization TAT Factors Generation Process Mapping • Solutions (X-Ray) • Assign Supervisor • Devote one radiographer for cassettes handling, including transfer cassettes • between X-ray rooms and processor; cassette developing, film & database entry • checking. He also serve as a supervisor to X-ray corridor to handle coordination • among radiographers and patients . • The use of “supervisor” is expected to reduce total TAT by up to 20-40%. • 2. “express-queue” • Nursing assistants direct all chest x-ray patients to Room 3 during peak hour upon • supervisor’s signal. Assign an experienced radiographer to achieve highest • efficiency to ensure fast scans for short procedures, so as to reduce total TAT • through reduction of machine setup time. • The “express-queue” is expected to reduce total TAT by 8-13%. • 3. Process standardization • By standardizing the process will results in the variation in service time, which • leads to significant reduction of TAT for about 15-25%. • Solutions (CT) • Long waiting for CT is largely due to • disruption of add-ons and unpunctual • arrival of appointment patients. Hence • more flexible appointment scheduling • rules is suggested: • Assign different appointment interval times • for patients of different process type and stage. • 2. Give buffer of 10 mins for each hour. 20 mins • buffers are given at 9:40 am and 1:40pm. • 3. Extend the schedule hour to 4pm • 4. Advise patients arrive 5-10 mins earlier • 5. Avoid scheduling consecutive long • procedures in one CT room • 6. Avoid long procedures scheduled after 3pm. • The diagram is an illustration with Excel VBA, different appointment intervals are calculated • with different combination of patients type and stage, base on current data analysis. Scheduled slots Reserved slots Available slots Lean service & process standardization Performance control & Continuous Improvements! Special thanks to Department of Diagnostic Imaging, National University Hospital for the kind help and support, Dr Yap Chee Meng and Dr Chai Kah Hin for the inspiring guidance and assistance.