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Departments Collaborate to Improve Turnaround Time

For too long a time, the task of improving efficiencies between the Emergency Department and the Department of Imaging seemed to make little progress.

Then, in 2017, Claude Stang joined Cedars-Sinai as executive director of Emergency Services and started working with Lynne Roy, executive director of the Department of Imaging. It was a turning point.

As soon as Stang and Roy began collaborating, they quickly realized efficiencies could only happen if their respective teams took greater ownership of their own workflows. The two leaders embarked on a nearly two-year project to improve CT (computed tomography) turnaround-time metrics for patients in the Emergency Department waiting for imaging studies.

The results have been significant. In July 2017, when the project first kicked off, roughly 68% of emergency room patients received CT imaging within 120 minutes of admission, including those who required contrast. As of July 2019, 90% of CT patients not requiring contrast were scanned within 85 minutes and almost 91% of CT patients requiring contrast were scanned within 120 minutes.

"The key ingredient to these successes was our teams coming together in the spirit of collaboration," said Stang. "We challenged our teams to work differently than they had and openly discuss value-added activities, versus those of low value—all without pointing fingers or blame."

Discussions like these were led by Erica Spivack, MHA, a consultant in Performance Improvement, who facilitated many meetings between the two departments.

"The first step was getting the right people in the room, many of whom had never met each other or even been in the same room together," said Spivack. "We worked on building trust with one another, understanding we all have a common goal—to get a patient diagnosed as quickly as possible."

Once trust was built and goals were set, Spivack examined old processes and root causes with the group and discussed how to improve. Then, the teams formalized plans on how to monitor and sustain these new processes. One of the root causes affecting flow and turnaround times was an existing push culture instead of an ideal pull culture.

"A pull culture gives accountability to the resources needed to provide the service, in this case, CT," said Roy. "If successfully using a pull method, imaging will be done as soon as possible, rather than waiting for the push (from ED) to occur."

This concept, Roy said, helped change her employees' mindsets and encouraged them to take a leadership role over imaging needs within the Emergency Department.

"Imaging took ownership and they began pulling their own patients," said Spivack. "They started doing everything in their power to get patients in scanners the moment one was available, instead of waiting for someone in the Emergency Department to give the green light."

And although a pull culture was pivotal to the team's success, Spivack said the ultimate gains occurred because leadership set the tone from the start of the project.

"Lynne and Claude came together to address the real issues affecting both departments, instead of merely placing a bandage on the situation," said Spivack. "That's when turnaround times started lessening and efficiencies steadily began to improve."