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Improving the PICC line workflow
JVIR
’
Scientific Session
2:24 PM
Monday
Abstract No. 124
Retrospective evaluation of free-responses questions in outpatient satisfaction surveys: how to improve CGCAHPS (clinician and group consumer assessment of healthcare providers and systems) scores in interventional radiology (IR) K. Specht, R. Sheridan, J.A. Hirsch, G.M. Salazar; Radiology, Massachusetts General Hospital, Boston, MA
S61
Materials and Methods: A multidisciplinary team of Radiology and QA staff evaluated the PICC line workflow and identified areas of improvement utilizing a PDCA (Plan-DoCheck-Act) methodology. Delays were due to poor information management and lack of staff/patient readiness. Interventions included consolidating forms, using a pre-procedure checklist, screening for competing procedures, and ensuring staff availability. Our outcome measurement, to gauge overall effectiveness, was the time from patient call-down to transport out of the IR suite. Process subintervals were: call-down to patient arrival; patient arrival to timeout called; dressing placement to line verification x-ray; and transporter notification to pick-up. The length of the actual procedure (timeout to dressing placement) was independent of our interventions and not included in our analysis. Baseline and postintervention data were collected for successive three-month intervals. Results: We reviewed 41 baseline and 33 post-intervention cases. Pre-procedure metrics, call-down to arrival and arrival to timeout, demonstrated mean improvements of 24.8% (42.7 to 32.1 min) and 7.4% (53.2 to 49.2 min). Post-procedure metrics, dressing to x-ray and transporter notification to pick-up, improved 2.7% (7.9 to 7.7 min) and 35.2% (13.3 to 8.6 min). The mean outcome measures were 117.1 minutes baseline and 97.6 minutes post-intervention, a 16.7% total improvement with statistical significance (two-tailed p-value ¼ 0.041). Conclusion: Multiple small policy changes can have a large impact on PICC line workflow efficiency. By using a checklist and identifying competing procedures, patient preparedness was optimized and scheduling conflicts were avoided. Ensuring staff availability and alerting key personnel prior to procedure completion was equally integral to expediting workflow. Our main challenges were deciding which interventions to focus on and convincing staff to adopt our proposals. By including nurses, technologists, and residents, we promoted a vested interest in our success.
Distribution of free response comments Free responses Positive Negative Systems Professionalism Safety General
2:33 PM
Abdominal 265 (77.3%) 78 (22.7%) 59 (17.2%) 204 (59.5%) 11 (3.2%) 69 (20.1%)
Breast 372 (84.7%) 67 (15.3%) 40 (9.1%) 309 (70.4%) 8 (1.8%) 82 (18.7%)
MSK 667 (83.5%) 132 (16.5%) 84 (10.5%) 536 (67.1%) 22 (2.8%) 157 (19.6%)
Abstract No. 125
Improving the PICC line workflow J.P. Agrawal, S. Gupta, S. Gilani, S. Lev; Radiology, Nassau University Medical Center, East Meadow, NY Purpose: To analyze the PICC line workflow and implement time-saving measures.
2:42 PM
Neuro 116 (86.6%) 18 (13.4%) 14 (10.5%) 94 (70.1%) 2 (1.5%) 24 (17.9%)
Vascular 234 (82.1%) 51 (17.9%) 50 (17.5%) 162 (56.9%) 14 (4.9%) 59 (20.7%)
Total 1654 (82.7%) 346 (17.3%) 247 (12.4%) 1305 (65.2%) 57 (2.9%) 391 (19.5%)
Abstract No. 126
Clinical efficacy, safety, and feasibility of using video glasses during interventional radiologic procedures A. Fang1, S. Ahmed2, D.L. Waldman1, J. Xue1; 1Imaging Science, University of Rochester Medical Center, Rochester, NY; 2School of Medicine, University of Rochester School of Medicine and Denistry, Rochester, NY
MONDAY: Scientific Sessions
Purpose: To perform a qualitative analysis of the free-responses from CGCAHPS patient satisfaction surveys applied in IR to understand how to improve patients’ satisfaction scores. Materials and Methods: In this retrospective study, 1,139 CGCAHPS surveys including 2,000 free-response answers concerning ambulatory IR care were identified between 1/ 2011 and 12/2012 (195 Abdominal, 247 Breast, 454 MSK, 78 Neuro, and 165 Vascular). This survey contains 27 questions aimed at organizational access, provider communications, and staff courtesy/respect, as well as 3 open-ended questions regarding possible improvements, providers, and staff. Qualitative evaluation of free response answers involved categorization by IR specialty, positive or negative nature, and content: general, safety (including pain/sedation and complications), systems (delays, coordination of care, and privacy/environment), and professionalism (competency and attitude of staff). Results: The majority of the free response comments were positive in nature 82.7% (n¼1654). The proportion of positive and negative comments was equal across all specialties. The distribution of comments is shown in the table. The majority of positive comments concerned professionalism related to staff attitude/behavior in 50.0% (827/1654) and staff competency in 25.0% (414/1654) of the responses. The majority of negative comments concerned systems issues (delays in 32.4%, and coordination of care in 12.4%). Conclusion: Overall the patient experience in IR is positive, largely due to provider and staff professionalism. However, patient experience can be improved by focusing on systems issues, including decreasing wait times and improving the coordination of care.
’
’
Scientific Session
2:24 PM
Monday
Abstract No. 124
Retrospective evaluation of free-responses questions in outpatient satisfaction surveys: how to improve CGCAHPS (clinician and group consumer assessment of healthcare providers and systems) scores in interventional radiology (IR) K. Specht, R. Sheridan, J.A. Hirsch, G.M. Salazar; Radiology, Massachusetts General Hospital, Boston, MA
S61
Materials and Methods: A multidisciplinary team of Radiology and QA staff evaluated the PICC line workflow and identified areas of improvement utilizing a PDCA (Plan-DoCheck-Act) methodology. Delays were due to poor information management and lack of staff/patient readiness. Interventions included consolidating forms, using a pre-procedure checklist, screening for competing procedures, and ensuring staff availability. Our outcome measurement, to gauge overall effectiveness, was the time from patient call-down to transport out of the IR suite. Process subintervals were: call-down to patient arrival; patient arrival to timeout called; dressing placement to line verification x-ray; and transporter notification to pick-up. The length of the actual procedure (timeout to dressing placement) was independent of our interventions and not included in our analysis. Baseline and postintervention data were collected for successive three-month intervals. Results: We reviewed 41 baseline and 33 post-intervention cases. Pre-procedure metrics, call-down to arrival and arrival to timeout, demonstrated mean improvements of 24.8% (42.7 to 32.1 min) and 7.4% (53.2 to 49.2 min). Post-procedure metrics, dressing to x-ray and transporter notification to pick-up, improved 2.7% (7.9 to 7.7 min) and 35.2% (13.3 to 8.6 min). The mean outcome measures were 117.1 minutes baseline and 97.6 minutes post-intervention, a 16.7% total improvement with statistical significance (two-tailed p-value ¼ 0.041). Conclusion: Multiple small policy changes can have a large impact on PICC line workflow efficiency. By using a checklist and identifying competing procedures, patient preparedness was optimized and scheduling conflicts were avoided. Ensuring staff availability and alerting key personnel prior to procedure completion was equally integral to expediting workflow. Our main challenges were deciding which interventions to focus on and convincing staff to adopt our proposals. By including nurses, technologists, and residents, we promoted a vested interest in our success.
Distribution of free response comments Free responses Positive Negative Systems Professionalism Safety General
2:33 PM
Abdominal 265 (77.3%) 78 (22.7%) 59 (17.2%) 204 (59.5%) 11 (3.2%) 69 (20.1%)
Breast 372 (84.7%) 67 (15.3%) 40 (9.1%) 309 (70.4%) 8 (1.8%) 82 (18.7%)
MSK 667 (83.5%) 132 (16.5%) 84 (10.5%) 536 (67.1%) 22 (2.8%) 157 (19.6%)
Abstract No. 125
Improving the PICC line workflow J.P. Agrawal, S. Gupta, S. Gilani, S. Lev; Radiology, Nassau University Medical Center, East Meadow, NY Purpose: To analyze the PICC line workflow and implement time-saving measures.
2:42 PM
Neuro 116 (86.6%) 18 (13.4%) 14 (10.5%) 94 (70.1%) 2 (1.5%) 24 (17.9%)
Vascular 234 (82.1%) 51 (17.9%) 50 (17.5%) 162 (56.9%) 14 (4.9%) 59 (20.7%)
Total 1654 (82.7%) 346 (17.3%) 247 (12.4%) 1305 (65.2%) 57 (2.9%) 391 (19.5%)
Abstract No. 126
Clinical efficacy, safety, and feasibility of using video glasses during interventional radiologic procedures A. Fang1, S. Ahmed2, D.L. Waldman1, J. Xue1; 1Imaging Science, University of Rochester Medical Center, Rochester, NY; 2School of Medicine, University of Rochester School of Medicine and Denistry, Rochester, NY
MONDAY: Scientific Sessions
Purpose: To perform a qualitative analysis of the free-responses from CGCAHPS patient satisfaction surveys applied in IR to understand how to improve patients’ satisfaction scores. Materials and Methods: In this retrospective study, 1,139 CGCAHPS surveys including 2,000 free-response answers concerning ambulatory IR care were identified between 1/ 2011 and 12/2012 (195 Abdominal, 247 Breast, 454 MSK, 78 Neuro, and 165 Vascular). This survey contains 27 questions aimed at organizational access, provider communications, and staff courtesy/respect, as well as 3 open-ended questions regarding possible improvements, providers, and staff. Qualitative evaluation of free response answers involved categorization by IR specialty, positive or negative nature, and content: general, safety (including pain/sedation and complications), systems (delays, coordination of care, and privacy/environment), and professionalism (competency and attitude of staff). Results: The majority of the free response comments were positive in nature 82.7% (n¼1654). The proportion of positive and negative comments was equal across all specialties. The distribution of comments is shown in the table. The majority of positive comments concerned professionalism related to staff attitude/behavior in 50.0% (827/1654) and staff competency in 25.0% (414/1654) of the responses. The majority of negative comments concerned systems issues (delays in 32.4%, and coordination of care in 12.4%). Conclusion: Overall the patient experience in IR is positive, largely due to provider and staff professionalism. However, patient experience can be improved by focusing on systems issues, including decreasing wait times and improving the coordination of care.
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