Emory orchestrated 14 different “tests of change” to address these issues, including equipping all nurses with access to the point-of-care INR testing device. Three received the most positive feedback:

1. Instituting daily morning huddles at 8:10 a.m., with representatives from each procedural staff role.
2. Eliminating phone calls between nurses and CT techs used to assess readiness for accepting the patient.

3. Setting arrival time to 90 minutes prior to that first 8:30 a.m. appointment instead of an hour beforehand.

With the changes, mean turnaround time dropped from 71.5 minutes to 15.9, a gain of close to 78%. Exams starting on time — defined as within 15 minutes of an appointment — went from 11% to 82%, excluding outliers such as late arrivals.

“Despite initial success with this project, it is imperative that future directions include the development of a permanent system to monitor mean TATs beyond the post-implementation phase,” said the authors. “This will help mitigate the possibility of the "Hawthorne effect" or observer effect that may have taken place during our current project. Furthermore, a dedicated assessment and optimization of inpatient procedural workflow is also necessary as there may be overlap in shared resources which could result in potentially avoidable waits and delays of both inpatient and outpatient procedural service lines.”

The findings were published in Current Problems in Diagnostic Radiology.

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