SIMULATION: RADIOLOGY’S NEW

PARTNER

Michael M. Zimmer, PhD

Sr. Business Consultant

Systems & Procedures

VIDANT’S SCOPE

• Serve 1.4 million people

• 29 Counties

• 8 Hospital System

• 80+ Physician Practices

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VIDANT HEALTH

VIDANT MEDICAL CENTER

• 1000 + licensed beds

• Academic Medical Facility w/ ECU Brody School of Medicine

• Level 1 Trauma

MAGNETIC RESONANCE IMAGING

• Validate MRI utilization and performance to maximize MRI capabilities with current resources

• Test new scheduling options and configurations to develop improvement recommendations

• Results and analytics produced will allow leaders to make informed decisions to address MRI backlog, prepare for increasing need of MRI services, ensure MRI availability for all inpatient, outpatient, and emergency department patient population.

VASCULAR INTERVENTIONAL RADIOLOGY

• Assess current state operating utilization and capacity

• Use results and analytics to determine capital equipment need and IR expansion

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SIMIO SAVE US!!

MRI Simulation Model Design VIR Simulation Model Design

Enter Patients MRI Processing Patient Leaves

Pre-processing15 min Delay

Post-processing5 min Delay

MRI Service TimeTotal Time In SuiteArrival Rates and

Interarrival Times accounting for

hospital operations delays

No delays from Patient entrance to

MRI processing

Inpatient

Obspatient

Outpatient

MRI 2Radiology Inpatient

MRI 1Outpatient

MRI 3 Outpatient

Patient Leaves

MRI PROCESS BREAKDOWN

MRI PROCESS

Patient Volumes 10/2015 – 9/2016• Inpatient: 4895• Outpatient: 2922• Obs. Patient: 724• Canceled: 807• Daily Backlog: 4.44 inpts. (1600/yr)

Observed Service Times• Range: 24 minutes to 160 minutes• Average: 58 minutes• Standard Deviation: 11.72

• Radiology supports 3 MRIs: MRI 1, MRI 2, MRI3• MRI 1 & 3 is designated for Outpatients in the Brody School of Medicine

• MRI 2 is designated for Inpatients located within VMC

• Conditions:• Obs-patients may use any of the 3 MRIs when available

• Inpatients may use MRI 1 & 3 when available

• Under special conditions, outpatients may be required to use MRI 2

• Considerations accounted for in the model• Staffing schedules

• Operating hours

• MRI staffing requirements

• Delays: Transportation, Sedations, Ventilator pts., Late patient arrivals, Equipment setup6

DATA & ANALYSIS SUMMARY

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MRI SIMIO BUILD

5388

7950

7008 698974

90

52

75

0

10

20

30

40

50

60

70

80

90

100

4000

4500

5000

5500

6000

6500

7000

7500

8000

8500

Current State Max Schedule New Schedule 1 New Schedule 2

% M

RI U

TILI

ZATI

ON

INPA

TIEN

T V

OLU

ME

/ Y

EAR

MRI OPERATING SCHEDULES

MRI SIMULATION MODEL RESULTS

Inpatient Volume Processed Average MRI Utilization

MRI RESULTS

Mon-Fri: Operationalize 2 MRIs 24 hours and 1 MRI standard hoursSat-Sun: Operationalize 1 MRI 24 hours

Cost Avoidance of $4 million dollars for new MRI and construction + ROI on 1500 patients

INPATIENTPatient scheduled

for procedure

IR Tech transports

patient to IR

Department

Tech and RN setup

IR room for

procedure

Patient brought into

IR room

Tech and RN do

Patient prep-work

----------------------

Emergency only G

room is setup

Anesthesia prep-

work done

RN transports

patient to unit

(inpatient or ARU)

Room is cleaned

END

OUTPATIENTPatients arrives to

ARU

Holding Area

Process

Procedure

Process

ARU Holding

Process

Assessment &

Lab Process

Anesthesia

assessment | IR or

OR

Anesthesia needed

can create time

variance ??

Transport and Room setup

happen congruently. Need

an average transport time

that takes away a Tech from

IR. Need average room

setup time

Consent, NPO recheck,

Physician meet-greet. Time

30-40 min

Patient can wait in Holding

Area from 1min to 2 hours

depending on

circumstances with

Physician, room, etc

15 – 20 min process

Depending on the

procedure time is variable.

This will include patient

clean-up. As long as patient

in the room is considered

Procedure Process

RN taken away from IR.

Need average transport

time to units. ARU transport

short. 10-15 min process

Does this create

more time longer

than 15-20 min?

Will use ARU data to

calculate time range of

patients waiting to begin

procedure.

EMERGENCY

IR

IR or CT

Procedure

Patient brought into

CT roomCT

Patient can wait in Holding

Area from 1min to 2 hours

depending on

circumstances with

Physician, room,

Anesthesia, etc.

Tech and RN do

Patient prep-work

Anesthesia prep-

work done

RN transports

patient to unit

(inpatient or ARU)

Room is cleanedProcedure

Process

15 – 20 min process

30-45 min process, with

patient cleanup another 10-

15 min. Total 40-60 min

RN taken away from IR.

Need average transport

time to units. ARU transport

short.

10-15 min process

VIR WORKFLOW PROCESS MAP

VIR PROCESS

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VIR MODEL – DATA & DESIGN

Epic ProcedureStart Time

Epic ProcedureEnd Time Room Ready

Actual ProcedureStart Time

EVS Clean TimePatient Cleanup

Time

Pt. Leaves RoomPt. Enters Room

Patient Prep Time Procedure Time Length

WORKSTREAM:HOLDING AREAMD GREET

RESOURCES:VIR PAVIR MD

RESOURCES:VIR MD

RESOURCES:VIR RNVIR TECH x2

WORKSTREAM:SINGLEPLANEBIPLANECT

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VIR SIMIO MODEL

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VIR SOURCE

151 Procedures~2500 Procedures over 10 months

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VIR SERVERS

UTILIZATIONCURRENT STATE

VIR

EQ

UIP

MEN

T SINGLEPLANE A 30.67

SINGLEPLANE B 29.53

SINGLEPLANE C 29.32

BIPLANE 21.46

CT 17.48

UTILIZATIONCURRENT STATE

VIR

WO

RK

ERS

NEURO MD 20.36VIR MD 1 (7A-3P) 69.96VIR MD 2 (8A-5P) 65.38VIR MD 3 (12P – 7P) 59.33VIR PA 47.95VIR RN 1 32.76VIR RN 2 30.74VIR RN 3 32.22VIR RN 4 32.74VIR RN 5 31.31VIR TECH 1 (7A-330P) 64.22VIR TECH 2 (7A-330P) 65.23VIR TECH 3 (8A-430P) 62.27VIR TECH 4 (8A-430P) 60.59VIR TECH 5 (9A-530P) 60.06VIR TECH 6 (7A-530P) 63.81VIR TECH 7 (1030A-7P) 55.38VIR TECH 8 (1030A-7P) 55.25

UTILIZATION ∆Worker Productivity ≠

Equipment Productivity

VIR RESULTS

QUESTIONS OR COMMENTS DURING PRESENTATION:• IR feels closed down between 11A – 2P.

• From observations and looking at the data information nothing indicates that this actually occurs. The Epic data report shows a number of procedures occurring between this timeframe where gaps should be visible if true.

• Outpatients are healthier versus Inpatients that affect procedure work• Nothing in our work will dispute that. The information gathered from the logged data for every procedure was accounted for in

the simulation. Therefore the time spent on more complex inpatient cases was also used in the simulation. The model did not bias against out or inpatients but ran the operations as it actually occurred in real life.

• Emergency and Anesthesia cases• The Epic report has every procedure that was done in IR, this data report would account for emergency and anesthesia cases.

The intricacies that happen during emergency and anesthesia cases were not modeled. Reasons being is the frequency in which emergency cases happen were very very low that it would not have impacted results. Emergency cases would only lower the utilization due to the resources pulled to handle them. Anesthesia cases impact the holding area time. Patients do not remain inan IR room waiting for anesthesia, they are either in the holding area or in their ARU room. Utilization is calculated based on wheels in (patient entering the room) to when the room is finished being cleaned by EVS.

• The Epic begin Time – when does that start• It was verified that the Epic Begin Exam Time is when IR assumes responsibility of the patient to reserve an IR room. Patient may

be still in their inpatient bed on the floor or in ARU when this occurs. It is not the true start of when the procedure begins with the MD doing time out and performing the work.

• CT is more in the afternoon – may affect usage• Regardless of when CT procedures are done, it will not alter utilization time since it is purely calculated when the patient enters

the room and when the rooms is cleaned.

• Surprised that Biplane usage is higher than expected• Since the model is ran based on real data of when biplane procedures occurred, this is the result of its utilization.

• Procedure loads are seasonal• This is difficult to corroborate. Looking at the Data Compilation excel file, there is nothing to suggest there are lower or higher

peaks in procedures during certain seasons. The only thing that is cyclical is the swing in weekdays. Mondays being the lowest load and a spike of procedures being done on Fridays. Perhaps on Fridays more is done to offset the weekends so that Mondays are not loaded, hence lower caseloads for Mondays.

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VIR POST DELIVERABLES WORK

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