(P123) Reducing Time From Patient CT Simulation (CT SIM) Appointment Time to Start of Actual CT Scan: Lean Thinking in the VA System

April 30, 2015

By applying Lean thinking, we were able to reduce the time for CT image acquisition for prostate cancer patients requiring radiotherapy planning by 22%. By reducing the time for CT SIM, veterans’ experiences and satisfaction were improved, flow through the radiation oncology department was optimized, and capacity for CT SIMs was increased.

Alice V. Cheuk, MD, George A. Dawson, MD, Jorge H. Restrepo, AS; James J. Peters VA Medical Center

PURPOSE: Computed tomography simulation (CT SIM) is vital to planning a patient’s radiation treatment (RT) and often takes a considerable amount of time to perform. This is particularly true of prostate patients, who have to drink until their bladders are full for the scan. CT SIM appointments are scheduled for 60 minutes, but preliminary observations have found that images are often acquired after the hour mark. The goal of the study was to reduce the time from CT SIM appointment/registration time to actual CT image acquisition for prostate CT SIMs, using Lean methodology.

METHODS: Observation of the process was performed (Gemba walking) to map out the current process and to document time from appointment/registration to actual CT image acquisition. Each step in the process was diagrammed, timed, and recorded. The current map underwent workflow analysis, and areas of delay/redundancy were modified or eliminated. A new process map was generated and put into practice. Five CT SIMs were timed and recorded as before. A sustain plan was implemented, involving measures to maintain use of the new map, and CT SIMs were timed to ensure continuation of the new process.

RESULTS: A total of 10 CT SIMs were timed with the old process, and the average time was 46.6 minutes. On analysis, the old process map had 16 steps with major barriers, which included time needed to consume water before CT SIM, time for consent, and delays caused by patients needing to urinate before the scan, requiring the process to be restarted from the beginning. Several steps were eliminated/consolidated, including waiting for the consent to be completed before starting the drinking process (consolidated), having the front desk call therapists to notify them that the patient is ready (eliminated), and having therapists tell the patient to start drinking (eliminated). After these changes were made, there were 10 steps in the new process map, and the average time for CT acquisition was shortened to 36.2 minutes, a 22% improvement. These changes were maintained with the sustain plan, as revealed by an acquisition time of 32 minutes during the sustain phase.

CONCLUSIONS: By applying Lean thinking, we were able to reduce the time for CT image acquisition for prostate cancer patients requiring radiotherapy planning by 22%. By reducing the time for CT SIM, veterans’ experiences and satisfaction were improved, flow through the radiation oncology department was optimized, and capacity for CT SIMs was increased.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org