1. System Improvement to Increase Last
Case Efficiency and Decrease Overtime
Bineyam Gebrewold1 Corina Voicu2, Esther Mena2, Natarsha Fields2
May 27, 2015
Nuclear Medicine/PET Center

2. Team members
Bineyam Gebrewold: Project leader (Technologist)
Corina Voicu : member (Supervisor)
Esther Mena : member (Physician)
Natarsha Fields : member (PSC)

3. Objectives
• Describe our efforts to improve last case
efficiency by applying the Lean sigma system
improvement concept.
• To demonstrate the impact of innovative
utilization of existing resources in workflow
improvement.

4. QI Project “Elevator Speech”
• In PET-CT department Residents
and Technologists were required
to stay for unplanned overtime
due to poor last case efficiency.
• This project improved the last
case efficiency by applying the
lean sigma system improvement
concepts.

5. JHH Strategic Priorities
• Integrity: Innovative model of
care delivery …. Enhance
quality and reducing cost.
• Our Department’s mission is
to improve the public health
and well being by …….,
supplying an outstanding
education for our residents,
fellows

6. Six Sigma DMAIC QI Stages
Define
Measure
Analyze
Control
Improve
Lean Sigma, Prescription for Healthcare. Armstrong Institute for Patient Safety
and quality. Johns Hopkins Medicine. Rev Sep-2014. 6

7. Problem Statement
Work flow efficiency in PET-CT is particularly challenging because of
combination of out patient and inpatient being scheduled through out
the day.
Inefficiency results in delays and ultimately, the necessity for
technologists and residents to stay over time.
The Residents overtime violates the residency duty hours standard set
by Accreditation Council for Graduate Medical Education (ACGME).
The Technologists overtime may lower staff satisfaction and incurs
additional avoidable expense to the department.

8. Project Goal and Scope
To improve last
case efficiency in PET-CT
department from base line of
47 %
in September 2014 to
90 %
in February 2015.

9. Project Benefits
– Hard Benefits
• Compliance with residency duty hours set by
ACGME.
• Minimize unplanned over time.
– Soft Benefits
• Increase staff satisfaction.
• Increase patient satisfaction.

10. Project Name: System Improvement to Increase
Last-Case Efficiency and Decrease
Overtime in PET-CT
Champion:
Rathan Subramaniam M.D., Ph.D
Quality Advisor: Jeff Leal
Problem Statement:
Work flow efficiency is highly impacted by the timeliness of the first-
case of the day in a department like PET-CT that require longer
physiological preparation before a scan can be done. Patient
scheduling in PET-CT is carefully designed to avoid camera down time,
as soon as a patient scan is completed the next one will follow with in
a minute. Any delay in a patient scan will have a cascade effect on the
subsequent scans leading to poor last case completion rate and
unplanned overtime.​
Project Goal:
To improve last-case efficiency in PET-CT
department from base line of 47 % in
September 2014 to 90 % in February 2015.
Project Y / Path-Y:
Percentage of last cases completed before 5:00 pm.
Scope:
First and last case of the day in PET-CT
division from September 2014 to April 2015.
Team Members:
Bineyam Gebrewold: Project leader
Corina Voicu : member (Technologist)
Esther Mena : member (Physician)
Natarsha Fields : member (PSC)
Benefits:
Minimize unplanned over time.
Compliance with residency duty hours set by
ACGME.
Increase staff satisfaction.
Increase patient satisfaction.
Project Charter

11. 8/4/2016 11

12. Identification of Process Waste
Waiting
Over
Production

13. Six Sigma DMAIC QI Stages
Define
Measure
Analyze
Control
Improve
Lean Sigma, Prescription for Healthcare. Armstrong Institute fro Patient Safety
and quality. Johns Hopkins Medicine. Rev Sep-2014. 13

14. Baseline Data (September, 2014)
• Data was collected
everyday using a
spread sheet form.
• Data accuracy was
verified by
comparing with time
stamp information
in the PACS system. 0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Before
5:00
5:00-5:30 5:31-6:00 After 6:00
47%
33%
13%
7%
JHU PET/CT Percentage distribution of Last
Patient Of the Day for September, 2014

15. Interventions
• Start the first case 30 minutes earlier (6:30 am)
• Change in patient scheduling.
– No in-patients in late afternoon
– Reduce successive inpatients
– No cardiac viability after 12:00 pm.
• Change in residents work distribution.
• Change in Staff schedule. (Add early techs)
• Eliminated unnecessary delayed scans.
• Staff education and empowerment.

16. Six Sigma DMAIC QI Stages
Define
Measure
Analyze
Control
Improve
Lean Sigma, Prescription for Healthcare. Armstrong Institute fro Patient Safety
and quality. Johns Hopkins Medicine. Rev Sep-2014. 16

17. Results and Outcomes
91% of last cases completed
before 5:00 pm by April, 2015.
Patient volume increased by
from September, 2014.
No Staff overtime reported for the
last three months.
44 %
I
n
c
r
e
a
s
e
I
n
c
r
e
a
s
e
20%

18. Projected in February- Achieved in April
8/4/2016 Bineyam Gebrewold Rad QI 2015 18
0%
10%
20%
30%
40%
50%
60%
70%
80%
Before 5:00 5:00-5:30 5:31-6:00 After 6:00
47%
33%
13%
7%
80%
10% 10%
0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Before 5:00 5:00-5:30 5:31-6:00 After 6:00
47%
33%
13%
7%
91%
9%
Sep vs. Feb Sep vs. April

19. JHU PET-CT Percentage distribution of Last Patient
from Sep, 2014 - April, 2015
8/4/2016 Bineyam Gebrewold Rad QI 2015 19
0%
20%
40%
60%
80%
100%
47%
60%
76%
65%
85%
80%
73%
91%
Before 5:00 5:00-5:30 5:31-6:00 After 6:00

20. Lessons Learned
Lean sigma concepts are instrumental to improve
efficiency in imaging departments.
Data collection is often challenging and needs patience.
Testing accuracy of data should be done at the early
stage of the project.
Seeking continuous feedback and advise from
champions and colleagues is a key for project success.

21. Six Sigma DMAIC QI Stages
Define
Measure
Analyze
Control
Improve
Lean Sigma, Prescription for Healthcare. Armstrong Institute fro Patient Safety
and quality. Johns Hopkins Medicine. Rev Sep-2014. 21

22. What’s the Next Step
• Second phase: (Refine Operation)
– distribution of the work through the day.
– achieve 45% of completion 12 noon.

23. What’s the Next Step
Control
• Maintain and
improvise patient
scheduling template.
• Maintain staff
scheduling.
• Monitor the trend
periodically.

24. The Result of Efficiency
August 4, 2016 Gebrewold 24

25. Thank You