Average scheduling intervals for outpatient CT exams at the University of Rochester Medical Center had grown to six weeks, but a quality improvement initiative succeeded in not only reducing scheduling delays, but increasing overall scan volumes.

Interventions resulted in a 19% increase in exams, from a weekly average of 722 to 860, and approximately $1,612,000 in added annual revenue.

The plan, executed by a team of radiologists and technologists, was put into action in October of 2022, with the goal of bringing the scheduling interval down to 10 days by the beginning of 2023. Utilizing a Lean Six Sigma approach, the impact of each intervention was monitored with a control chart with weekly appointment delays tracked as a balancing measure.
Initially, examination slots were double-booked for a period of four weeks to address the backlog, resulting in a reduction of the scheduling interval to 12 days (72% decrease). Subsequently, examination slot duration was reduced from 20 to 15 minutes and contrast protocols were standardized across all sites. These adjustments further decreased the interval to 7 days (41% reduction) over the following nine weeks.

"I was particularly impressed when our CT technologists volunteered to double book examinations for the first two weeks to as rapidly as possible decompress our imaging wait list," radiologist Dr. Ben Wandtke, vice chair of quality and safety in the Department of Imaging at University of Rochester Medical Center, told HCB News. "They realized this was unsustainable in the long term but trusted administration would not extend this workflow indefinitely."

While staffing shift adjustments had no impact on the scheduling interval, the introduction of an extra CT scanner reduced the interval to three days (57% decrease). Notably, there was no change in the average appointment delay, which remained at 15 minutes over the study period.

While the initiative successfully addressed scheduling inefficiencies across the health system, the rise in exam volumes led to an increased turnaround time for completed reports.

"Our radiologists’ workload also significantly increased as a result of this work. Prior to kicking off this project, we developed an internal moonlighting system so radiologists were incentivized to increase their capacity while the backlog was addressed," Wandtke told HCB News. "One lesson we learned was that the CT backlog only represented the 'tip of the iceberg' with respect to the unmet demand for our CT services. We ultimately had to recruit additional radiologists, which we have now accomplished and are stronger for the effort."

Looking ahead, the medical center is setting its sights on expanding online scheduling platforms, implementing systems to assess imaging appropriateness, and developing urgency stratification to prioritize time-sensitive examinations.

According to Wandtke, the success is likely reproducible at other imaging centers, particularly those with multiple sites of operation where unnecessary variability is more likely to be present.

"In our department, we have successfully performed improvement projects to enhance efficiency of CT, MR, and ultrasound service lines at multiple locations, and have found similar results using a this approach," he said.

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