Lessons learned from COVID-19 about assessing departmental efficiency and uptime
By Martin Wimmer
As COVID-19 spread, hospitals around the world went into emergency mode. With a staggering number of patients infected by a little-understood virus, there was no time to focus on anything other than providing outstanding care. As months passed, healthcare providers and researchers realized that a fast defeat of the virus was not possible, and healthcare procedures shifted to accommodate the sobering and undeniable fact that the virus would be with us for a long while.
Healthcare providers’ and patients’ experiences since the advent of the virus have taught us a lot about its transmission, the course of the disease, and its treatment. COVID-19 taught us other things as well. It lay bare inefficiencies inherent in even the best healthcare systems and made it clear that many healthcare organizations weren’t prepared to confront a major workflow disruption.
In radiology departments worldwide, the pandemic changed day-to-day operations. Many elective procedures were cancelled or postponed, and studies shifted to create priority for COVID-19 patients and others with high-risk conditions or those who had immediate need for imaging. In hindsight, this priority shift was not necessary in all cases: In just one example, researchers at Massachusetts General Hospital and Harvard Medical School found that weekly exam volume during the COVID emergency period at Massachusetts General Hospital and its affiliated imaging centers fell 54% at the main hospital and 64% at the imaging centers. 1
Now, elective procedures are returning and patients are scheduling non-urgent exams. Yet this is just a veneer of normalcy; already, we see signs of a second surge in the pandemic in some places.
As organizations assess what they did well during the first surge and how they can improve, it is important to re-examine radiology department processes and procedures and evaluate how they contribute to the healthcare organization. By taking steps now to assess factors that affect equipment uptime, the lessons learned from COVID-19 can be applied both as workflow returns to normal and if a second surge occurs, resulting in more efficient department operations.
Evaluate Your Equipment Mix
Because imaging equipment is marked by frequent innovation, it is not cost-effective to buy new systems with every advance. Yet to keep systems long past their optimal retirement comes with its own costs, in the form of limited clinical ability, lower productivity, and downtime. So, the first step in department technology assessment is conducting an inventory of your equipment, noting age and use.
Do you have systems that are no longer meeting your clinical needs? Did you decide against several small upgrades that seemed less significant, but that together would make a difference in your operations? For example, CT scanners are sometimes used to assess COVID-19 patients’ lungs. But older systems may be less effective due to workflow inefficiencies caused by slower exam speeds or out-of-date interfaces. If these issues affected imaging for COVID patients with pneumonia, they are likely to continue to be a problem as departments return to a more normal day-to-day imaging mix.
Likewise, other modalities, such as MR and ultrasound, have made significant advances in recent years, and even old standbys like digital x-ray and fluoroscopy may need an update. For each piece of imaging technology in your department, options include retiring older systems that are rarely used to avoid the higher cost of maintenance, investing in more modern equipment, or maintaining your current setup.
A subset of evaluating your equipment mix, but one that deserves special attention, is assessing equipment interoperability and connectivity. Include your IT department in discussions to determine if older equipment is the cause of workflow problems because of interoperability or connectivity challenges. Before retiring systems, investigate solutions designed to integrate legacy systems into your workflow, and analyze the cost and benefits versus replacing systems.
Adjust Protocols to Optimize Throughput
Adjusting exam protocols is a valuable way to optimize equipment use and scheduling without impacting image quality and clinical value. For example, by optimizing CT protocols, departments can minimize stress on the tube and reduce cooling between exams. If you plan to replace a CT scanner soon, consider purchasing scanners that use liquid metal bearing tube technology. Because liquid metal bearing tubes transfer heat away from the anode and dissipate heat faster than standard metal bearings, they do not need to cool down between exams.
Look for Efficiency Drains Throughout the Entire Exam Process
In addition to adjusting protocols, assess the entire exam process, beginning with appointment-making and ending with consulting with referring physicians. Where are the bottlenecks? Are there opportunities to decrease data reentry, improve scheduling (by grouping similar exams together, for example), or enhance communication with referrers?
Consider the patient experience as well. Are patients educated before exams so that they are at ease and know what to expect? After all, a relaxed patient can make a big difference in keeping on schedule. If budget and time allow, consider contracting with a process efficiency consultant.
Investigate Third-Party Options
The increased use of some imaging equipment for COVID-19 patients caused some parts to need more frequent replacement, which increased replacement part costs. Hospitals interested in controlling costs should investigate third-party replacement parts, which provide a cost-effective and quality alternative to parts supplied by imaging system manufacturers. Look for third-party parts manufacturers with a global presence and the resources to mitigate supply chain disruptions.
Maximize Uptime and Safety with Remote Servicing
While remote service has been available for some time in many locations, COVID-19 restricted service personnel access to equipment, and thus demonstrated the value of enabling technicians to address urgent equipment issues in a timely manner while limiting onsite visits.
If remote service was not part of your pre-pandemic strategy, you may want to opt in now. Key benefits of remote system monitoring include identifying issues before they become problems, allowing remote upgrades that keep your imaging equipment on the cutting edge, and using over-the-shoulder remote guidance to troubleshoot—all while protecting the health and safety of patients and employees. Ask your vendors what remote service options they offer, to ensure that you are taking full advantage of this tool to decrease downtime and limit interaction that puts staff and patients at risk of infection.
Consider Keeping Spare Parts Available
The COVID-19 pandemic made it apparent how globally interconnected medical device manufacturing is, as companies struggled to provide needed parts in a timely manner. In addition to a pandemic, other events, such as natural disasters, can also cause disruptions to the supply chain.
If your biomedical engineering department services most of your imaging equipment, consider creating a parts list of items to keep on hand. And if a piece of equipment requires near continuous uptime, it may even make sense to schedule preventative replacement of high-wear parts before they fail. However, the cost of preventative replacement must be weighed against the cost of downtime.
Assess, Train, and Improve
While the pandemic revealed some inefficiencies in system upkeep, the same good advice holds true in both crisis and day-to-day operations: Follow instructions for use. Train the staff on proper usage and maintenance, including investigating remote training programs if face-to-face classes are inadvisable. Revisit the training as needed, for both experienced and new staff.
In addition, follow advice for regularly scheduled maintenance, and assess the environment, because factors such as ventilation, temperature, and dust can affect how equipment functions. These simple factors go a long way to helping you get the most out of your imaging equipment.
In the middle of a crisis, departmental efficiency is the last thing on anyone’s mind, which is why you should assess and address issues now. Careful planning now can prevent future surprises, so that no matter the challenge, your imaging department will contribute to the solution.
Martin Wimmer is the service leader for x-ray tubes and generators at Dunlee. His team helps customers achieve maximum equipment uptime at competitive cost by providing technical training and support, and by ensuring products are developed and maintained to meet current and future service performance needs. Questions and comments can be directed to 24×7 Magazine chief editor Keri Forsythe-Stephens at firstname.lastname@example.org.
- Lang M, Yeung T, Medoza D, Saini S, Little B, Succi M. Imaging Volume Trends and Recovery During the COVID-19 Pandemic: A Comparative Analysis Between a Large Urban Academic Hospital and Its Affiliated Imaging Centers. Academic Radiology. Oct. 1, 2020: Volume 27, Issue 10, p. 1353-1362.