Improving Delayed Outpatient First Case Start Times in Interventional Radiology: A UCSF Resident-Led Quality Improvement Project

Tuesday, April 1, 2025

3:36 PM – 3:45 PM CT

Location: Music City Center, 205 A

Presenting Author(s)

Melinda Wang, MD

Resident
University of California San Francisco, United States

Author/Co-author(s)

Alice L. Zhou, MD

Resident Physician
University of California, San Francisco, United States
Parmede Vakil, MD, PhD

Resident
UCSF, United States
Rajesh Shah, MD

Professor of Clinical Radiology
University of California San Francisco, United States
AT

Andrew G. Taylor, MD

Associate Professor of Clinical Radiology
University of California, San Francisco, United States

Purpose: To improve outpatient first case start times in the interventional radiology department using a quality improvement framework.

Materials and Methods: This was a quality improvement project implemented at the primary campus of a large academic medical center with the goal of improving the percentage of cases that were 1) in-room by scheduled case time and b) commencing by a target start time, defined as 30 minutes after scheduled case time. A procedure was defined to have commenced at time-out. A swim-lane analysis was performed following the outpatient experience from check-in to time-out and used to identify areas of inefficiency leading to delayed case start times. Communication between interprofessional team members was identified as a leading source of delay, specifically a possible 30-minute time period of communication delays during which the MD team was occupied with rounds. To address this, the following interventions were implemented: 1) a pre-procedure checklist (PPC) displayed on our status board with commonly discussed case details such as equipment, sedation plan, and antibiotics and 2) a pre-rounds AM huddle between the charge nurse, technologists, and fellows during which case prioritization and status were reviewed. We aimed to improve the percentage of target in-room times from 8.5% pre-intervention to >40% post-intervention and the percentage of target start times from approximately 33% pre-intervention to >50% post-intervention. Patient wait times from check-in to time-out were measured as a secondary endpoint. Time periods were defined as pre-intervention from 5/1/23-9/13/23 and post-intervention from 9/14/23-6/30/24.

Results: After implementing our two-pronged intervention, the percentage of outpatient target in-room times by scheduled case time increased to 31% post-intervention, previously 8.5% pre-intervention. The percentage of outpatient target time-outs increased to an average of 44% post-intervention, previously 33% pre-intervention. Patient wait times from check-in to time-out improved by 12 minutes, from an average of 101 minutes pre-intervention to 89 minutes post-intervention.

Conclusion: Implementation of a pre-procedure checklist and pre-round huddle can modestly improve target start-times for procedures in the interventional suite. Further optimization of the PPC and pre-round huddle or additional interventions may be considered for continued improvement in target start times.