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Decreasing the Turnaround Time (TAT) of Intra-operative Imaging and Interpretation of Potentially Retained Foreign Objects (RFO). Joseph R. Steele, M.D ., Janet Champagne MBA, Garrett L. Walsh, M.D. UT MD Anderson Cancer Center. Overview.
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Decreasing the Turnaround Time (TAT) of Intra-operative Imaging and Interpretation of Potentially Retained Foreign Objects (RFO) Joseph R. Steele, M.D., Janet Champagne MBA, Garrett L. Walsh, M.D. UT MD Anderson Cancer Center
Overview • RFOs after surgery can present considerable risk and potential patient harm • The rate of RFO ranges from 1/5500 to 1/7000 • Cima RR, et al. J Am CollSurg 2008; 207:80-7 • Egorova NN, et al. Ann Surg 2008;247:13-8 • Considered a sentinel event by the Joint Commission
Project Overview • Joint venture between the Division of Surgery, Perioperative Enterprise and Division of Diagnostic Imaging. • X-ray obtained if post-operative mismatched count occurs. • The turnaround times (TAT) for intra-operative imaging of potential RFOs was felt to be unacceptable by the Division of Surgery, potentially jeopardizing patient care. • A team consisting of OR staff, surgeons, radiologists, administrators and radiology technologists was organized to address and solve the problem.
AIM Statement • Theaim of this project was to decrease the average TAT for imaging and interpretation of potential RFOs to less than 30 minutes within 4 months. • The process begins when the OR calls Diagnostic Imaging requesting an operative radiograph, and ends when the radiologist calls back to the OR with their report.
Phase 1: Baseline Data Collection • Improving the RFO TAT was unsuccessfully attempted by a previous CS&E team. • Because of pressure to immediately begin improvement efforts, their data were used as a baseline. Problem #1
Phase 1: Baseline Data Mean TAT = 43 minutes, Not consistent with OR experience
Phase 2: Initial Interventions (The Good) TAT improved to 39 minutes and represents a lengthier, complete process. Since there were no complaints, the quality of the exams were assumed to be excellent. (Problem #2)
Phase 3: Re-engineering (The Ugly) Image acquisition segment of the project is redesigned, resulting in expected disruption. Mean TAT increases to 48 minutes with increased variation.
Phase 4: Final Interventions (The Redemption) Mean TAT decreased to 38 minutes, and variation decreased.
Revenue Enhancement • Additional technical charge (OR)- $1200/hr • Savings of approximately $100.00/case • Additional anesthesia charge (OR)- $342/hr • Savings of approximately $28.50/case • Additional professional anesthesia charge (OR) $648/hr • Savings of approximately $54.00/case
Revenue Enhancement • Total annual savings $182.50 X 264 (est.) = $48,180.00 • Avoidance of a RFO and potential litigation PRICELESS
Next Steps • Since we failed to meet our aim the following steps will be undertaken: • Evaluate stage 4 data • Improve communication (OR and DI staff) • Decrease repeat imaging • Initial PDSA cycles until the 30 minute TAT goal is accomplished
Conclusion • Quality improvement is not for the faint of heart. • You don’t know what you don’t know. • Understand what is going on before trying to measure it. • Don’t assume anything. • You don’t need to win every battle to win the war.