In by 9 out by 6 - Load Leveling

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Lean / Six Sigma

Kate Bombach
Lean Coach
University of Michigan Health System

Susan Fisher
Special Projects Coordinator
University of Michigan Health System

It is often assumed that in the inpatient setting, nothing much can be done to affect the timing of the demand for diagnostic tests. In the case of the CT (computerated tomography),ordering physicians had no predictable way of knowing when they would receive results. The CT department had no way to predict necessary resources to devote to inpatients needing CT's. We will be presenting the approach that was used to level the demand for CT tests. In addition, we will demonstrate the daily visual management system to monitor and adjust for inpatient CT test demand.

A lean workshop brought together 25 individuals from all areas touching this flow of patients, information and documentation. The current process showed a first time quality of 0.004 %. In addition, only 39% of the CT scans ordered between 8 am and 5 pm were read the same day. We prioritized the areas of waste. The workshop participants were divided into workgroups to create an improved process. We created an incentive to the ordering clinicians, In by 9 out by 6, to get CT requests earlier. In order to meet our goal, three areas needed to be addressed: 1) Batching 2) Scanner access 3) Protocoling. Batching occurred in multiple areas. Ordering physicians batched CT requests after rounding, the unit clerks sent patient paperwork in batches, and the radiologists interpreted, dictated and signed cases in batches. These groups were educated on the negative impact of batching. To address scanner access, one CT scanner was dedicated to inpatients and a second CT scanner was added during peak hours. Assigning protocols in the various sub-specialty areas was time consuming. To address this, an NP was trained to protocol cases. Prior to the project, monthly administrative reports reported CT volumes and turn around times. Daily operations did not have any way of monitoring performance to goals.