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{
    "pk": 10312,
    "title": "Applying Systems Engineering Reduces Radiology Transport Cycle Times in the Emergency Department",
    "subtitle": null,
    "abstract": "INTRODUCTION \n \nEmergency Department (ED) crowding is prevalent and can result in care delays, medical errors, increased costs and mortality. Simultaneously, capacity constraints on EDs are worsening, yet patient arrival rates and inpatient bed capacity are often outside the influence of ED administrators. Therefore systems engineering to improve throughput and reduce waste and waits holds the most readily available promise. Decreasing radiology turnaround times improves ED patient throughput and decreases patient waiting time. We sought to investigate the impact of systems engineering science targeting ED radiology transport delays, and determine the most effective techniques.\n \n \n \nMETHODS \n \nThis prospective, before and after analysis of radiology process flow improvements in a academic hospital ED was exempt from Institutional Review Board review as a quality improvement initiative. We hypothesized that reorganization of radiology transport would improve radiology cycle time and reduce waste. The intervention included systems engineering science-based reorganization of ED radiology transport processes, largely utilizing Lean methodologies, and adding no resources. The primary outcome was average transport time between study order and complete time. All patients presenting between 8/2013-3/2016 and requiring plain film imaging were included. Electronic medical record data were analyzed using Microsoft Excel and SAS version 9.4.\n \n \n \nRESULTS \n \nFollowing the intervention, average transport time decreased significantly and sustainably. Average radiology transport time was 28.1 ± 4.2 minutes during the 3 months pre-intervention. It was reduced by 13% in the first three months (3.8 minutes; to 24.3 ± 3.3 min, P=0.021), 17% in the following six months (4.8 minutes; to 23.3 ± 3.5 min, P=0.003), and 24% one year following the intervention (6.8 minutes; to 21.3 ± 3.1 min, P=0.0001). This result was achieved without any additional resources, and demonstrated a continual trend towards improvement. This innovation demonstrates the value of systems engineering science to increase efficiency in Emergency Department (ED) radiology processes.\n \n \n \nCONCLUSION \n \nIn this study, reorganization of the ED radiology transport process using systems engineering science significantly increased process efficiency without additional resource use.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "emergency department"
        },
        {
            "word": "Systems Engineering"
        },
        {
            "word": "Operational Improvement"
        },
        {
            "word": "Lean"
        }
    ],
    "section": "Emergency Department Operations",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/93m63284",
    "frozenauthors": [
        {
            "first_name": "Benjamin",
            "middle_name": "A",
            "last_name": "White",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Harvard Medical School",
            "department": "None"
        },
        {
            "first_name": "Brian",
            "middle_name": "J",
            "last_name": "Yun",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Harvard Medical School",
            "department": "None"
        },
        {
            "first_name": "Michael",
            "middle_name": "H",
            "last_name": "Lev",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Harvard Medical School",
            "department": "None"
        },
        {
            "first_name": "Ali",
            "middle_name": "S.",
            "last_name": "Raja",
            "name_suffix": "",
            "institution": "",
            "department": "None"
        }
    ],
    "date_submitted": "2016-09-13T19:23:47Z",
    "date_accepted": "2016-09-13T19:23:47Z",
    "date_published": "2017-02-21T23:20:23Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/10312/galley/5669/download/"
        }
    ]
}