Workflow tweak cuts US-guided FNA wait times by 50 percent

When staff at Emory University Hospital in Atlanta realized patients who were coming in for ultrasound-guided thyroid fine-needle aspiration (FNA) were waiting two or three hours for the procedure after check-in, they took action and redesigned workflows.

The new workflow, detailed in the August issue of the Journal of the American College of Radiology, was able to cut time between patient check-in and needle stick in half for some patients, according to lead author Courtney C. Moreno, MD, of the department of radiology and imaging sciences at Emory University School of Medicine.

The first step toward optimizing workflow for thyroid FNA patients was to gather a team to study the existing workflow. This team included radiologists, a nurse practitioner, nurses and sonographers. Moreno and colleagues also solicited input from departmental administrators, institutional policies and the Joint Commission.

After this initial assessment, it was revealed that the existing workflow included 16 steps from the time a patient checked in at the department front desk till the time the patient was in the ultrasound suite ready for the procedure. This assessment also showed that the space availability in the pre/postprocedure care area (PPCA) was a potential bottleneck. The PPCA features 16 rooms and is staffed by an average of five nurses. These rooms are used for obtaining informed consent from patients, completing nursing evaluations and monitoring patients as they recover from conscious sedation, wrote the authors.

Moreno and colleagues also noted that scheduling of thyroid FNAs, which typically occurred in the early afternoon, was another potential bottleneck as this was a busy period of the workday.

Based on the assessment, the consent process was moved from the PPCA to the ultrasound suite and appointment times were bumped up to begin at 8 a.m. The new workflow was rolled out on Oct. 1, 2012, and Moreno and colleagues obtained a list of all 298 thyroid FNAs performed between April 1, 2012, and April 1, 2013, to study the impact of the workflow redesign.

Results showed these relatively simple changes made an impact. “Anecdotally and subjectively, the new workflow seemed to be an improvement,” wrote the authors. The mean interval between check-in and first pass was 167 minutes under the old workflow, but with the new workflow, the time interval was as short as 80 minutes.

“This 80-minute time interval is not entirely a wait, as the patient is consented during this time and changes into a gown, diagnostic images are obtained, the site is marked, the patient is prepped in sterile fashion, the transducer is prepped, the skin is numbed, and the cytopathology team is paged and then arrives,” wrote Moreno and colleagues.

The new workflow is still in use at Emory University Hospital, according to the authors, and head-and-neck radiologists have also adopted this strategy for ultrasound-guided neck lymph node FNAs.

In offering advice to other sites looking to optimize workflows, Moreno and colleagues underscored the roll of communication. “Despite worrying that we were on the verge of overcommunication with multiple face-to-face and e-mail communications, in the end, we had not communicated enough, in particular with PPCA staff members regarding the rollout date of the new workflow.”