Radiology Doc

8/8/2019 Radiology Doc

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CHITKARA UNIVERSITY

Fortis, Seshadripuram

Reengenering of the process flow in radiologydept.

Saurabh verma

5/28/2010


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Certificate

This is to certify that Saurabh Verma, a student of MBA Healthcare

Management of Chitkara University has carried out the project onreengenering of process flow in radiology department for Fortis

Hospital, Seshadripuram.

This project work has been prepared as a fulfillment of the requirement for

the degree of MBA Healthcare Management to be awarded by Chitkara

University. This work has not been presented earlier for any other academic

activity.

I wish him all success in life.

Dr. Sonika BakshiProgramme coordinator

MBA Healthcare ManagementChitkara University


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Declaration

I do, hereby, declare that the dissertation entitled Reengenering of process

flow in radiology department is an authentic work developed by me at,

Fortis Hospital, Seshadripuram, under the guidance of Mr. Shubarao and

submitted as a partial fulfillment of the degree of MBA Healthcare

Management to be awarded by Chitkara University.

I also declare that, any or all contents incorporated in this dissertation have not

been submitted in any form for the award of any degree or diploma of any other

institution or university.

Saurabh VermaRoll No. M090710028

MBA Healthcare Management

Chitkara University


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Acknowledgement

I take this opportunity to express my profound sense of gratitude and respect to

all those who helped me throughout the duration of the project. I express my

sincere gratitude and thankfulness towards Mr.Shuba Rao ofFortis Hospital,

Seshadripuram(Banglore) for his valuable time and guidance.

I feel privileged to offer my sincere thanks and deep sense of gratitude to

Dr. Sonika Bakshi, (programme coordinator, MBA Healthcare Management,

Chitkara University), for expressing confidence in me and providing support,

help & encouragement in completing the project.

I am grateful to all my friends for providing critical feedback & support

whenever required.

Last but not the least I thank the Almighty for bestowing his blessings.

I regret any inadvertent omissions.


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Table of content:Abstract

1. About Fortis Healthcare 012. About Fortis Shashadipuram3. Introduction to Radiology 02

4. Research Methodology 044.1.Objectives

4.2.Methodology4.2.1.Nature of study4.2.2.Sample4.2.3.Data collection tools4.2.4.Data analysis

5. Findings: 055.1.For research objective 1 06

5.1.1.Purchase 07

5.1.2.Receiving bay 085.1.3.Storage and redistribution 09

5.2.For research objective 2 12

6. Conclusion: 15

6.1.Summary 156.2.Recommendations 16

7. Limitations & Scope for future research 17

References


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Abstract

The purpose of the report is to understand and improvise the process flow in Radiology

Department in a hospital. In radiology department diagnosis take place using radiation. The

process flow includes fixing of appointment, sending of requisition form, test and giving

report. The process is different for IPD and OPD patients. In research an attempt was also

made to calculate TAT of radiology dept.

The research was carried out at Radiology department in Fortis Seshadripuram. Since, it was

a research to look after the process flow so it was carried out by interviewing the staff of

radiology dept. and taking in primary data available with them for TAT.

The quality and process flow in radiology department. Needs few improvisation, and the

authenticity of data hasto be increased by using the modified process flow and by cooperation

of all the people involved in radiology department services.

The IPD and OPD patients have different process flow and different methods for distribution

of report is used. In this OPD patients are given preference over IPD. Radiology dept, also

catter to people coming for health check-ups and they have the same procedure as OPD

patients with minor differences.

The reporting is done by using normal Microsoft word and is done by radiographer after the

hand written report is given by the Radiologist. This report is also stored as a word file for

future requirement if any.

The process flow in department is efficient but there can be some changes to improve it

further to match the high standards of other Fortis hospitals. Also steps need to be taken to

reduce the TAT along with increasing the authenticity of the data of radiology department,

which is very important to check the functioning of radiology department in future whenever

required.


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Chapter 1

1.1) About Fortis HealthCare:

Globally respected health care organization recognized for clinical excellence and

distinctive patient care

As the mission of Fortis healthcare states Fortis Healthcare Limited, is a leading healthcare

delivery company in India was formed with the vision of "creating a world-class integrated

healthcare delivery system in India, entailing the finest medical skills combined with

compassionate patient care".

From the pursuit of this mission emanates a passion to excel. At Fortis they have assembled

the finest talent in medicine, whether doctors, nurses, technicians or management

professionals across a wide spectrum of functions. They are backed up by state-of-the art

facilities and support infrastructure in each of the hospitals, which enables them to deliver the

highest quality of care.

Fortis Healthcare Limited, while it is one of Indias leading chain of Hospitals is

benchmarked to international standards and achieves quality through the relentless adherence

to protocols observed in some of the world's leading hospitals. Fortis Healthcare is engaged

in providing the latest in internationally recognised medical care to patients with a variety of

ailments and medical conditions.

The Network consists of Super Speciality Hospital Hubs that concentrate on one or more

specialities. These hospitals are interconnected to a larger network of multi-speciality

hospitals that ensures patient access to expert care for any speciality.

Within a little over8 years, Fortis Healthcare has grown as one of the largest and

internationally recognised healthcare chain. Now,Fortis healthcare limited, is a chain of 62

hospitals network of tertiary and quaternary level hospitals with super-specialty focus and

multi-specialty backbone.


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1.2) About Fortis Seshadripuram(Banglore):

Fortis Hospital Seshadripuram is a manifestation of the founders vision of medical care. An

environment where some of the best medical professionals doctors, nurses and technicians

dispense quality medical treatment.

The hospital, located at #65, 1st Main Road, Seshadripuram, Bangalore is a multi-speciality

hospital. It is also a centre of excellence in Advanced Urology with specialized facilities for

Urology, Nephrology and related concerns.

We provide a complete range of the latest diagnostic, medical and surgical facilities for the

quality healthcare of our patients. We are equipped with high end infrastructure and

equipment to provide excellent medical care for the community.

Facilities:

y 60 bedded Multi-Speciality medical centre with Day care facilities

y Diet clinic

y Physiotherapy

y 24 hour Emergency Care

y 24 hour well equipped ambulance service

y Diagonostics

o Comprehensive Lab medicine

o Radiology X-Ray, Ultrasound, Doppler

o NIC ECG, 2 DEcho, TMT, Holter

o EEG

o Urodynamics

y 24 hours pharmacy on the premises


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y 3 well equipped Laminar Flow Operation Theatres with all facilities (dragger lights

and pendants)

y Patient Care Areas to suit all economies

o 9 bedded ICU

o 6 bedded CCU

o 2 General wards - 12

bedded, 8 bedded

o 2 Suites

o 14 Deluxe rooms

o 2 Private rooms

o 7 Semiprivate rooms (14

beds)

o 10 bedded dialysis center

running 24 hours

Specialities

y Renal Sciences

o Urology

o Nephrology

y General Surgery

y General Surgery

y Plastic Surgery

y Oncology

y Gastroenterology

y Dermatology

y Neurology

y Pulmonology

y Neurosurgery

y Internal Medicine

y Gynaecology and Obs

y Orthopedic & Trauma Care

y Dentistry

y Psychiatry

y ENT

y Vascular surgery

y Cardiology

y Preventive Health Checkup


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CENTRE OF EXELLENCE:

y Andrology and infertility

y Endourology

y Lap Urology

y Laser Urology

y Lithotripsy

y Pediatric Urology

y Reconstructive Urology

y Uro Oncology

y Laser Surgery

y Dialysis

y Lithotripsy

y Key Hole Surgery

y Enodoscopy and endoscopic

Surgeries

y Micro Surgery

y Hepatobilliary Surgery

.


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1.3) About Radiology Department:

Radiology is a branch of medicine that deals with the use of radioactive substances in

diagnosis and treatment of disease. It is the process of working and viewing inside the human

body without breaking the skin. By using radiant energy, which may take the form of x rays

or other types of radiation, we are able to diagnose and treat many diseases and injuries. Both

diagnostic and therapeutic radiology involve the use of ionizing radiation (Beta, Alpha,

Gamma, and x rays), with the exception of the MRI, which uses a magnetic field rather then

radiation.

Radiology is classified as being either diagnostic or therapeutic. Diagnostic radiology is an

evaluation of the body, by means of static or dynamic images or anatomy, physiology, and

alterations caused by injury or disease. Other images may be obtained by using ultrasound or

MRI, or by recording the activity of isotopes internally administered and deposited in certain

parts of our body. This practice is called nuclear radiology or nuclear medicine.This include

such techniques as a PET scan, or positron emission tomography, which uses patterns of the

positron decaying to study metabolism reactions in the body.

RADIOLOGY

X-RAY

ULTRA SOUND

SCAN/DOPPLER CT & MRI


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Another form of imaging is ultrasound. Ultrasound, which uses very high frequency

sound, is directed into the body. And because the tissue interference's reflect sound,

doctors are able to produce, by use of a computer, a photograph or moving image on a

television. Ultrasound has many application uses on the body, but is more commonly

used in examinations of the fetus during pregnancy, because use of radiation may affect

the outcome of the baby.

And last of the diagnostic imaging tools is the MRI. MRI, which stands for Magnetic

Resonance Imaging. Was a technique developed in the 1950's by Felix Bloch, and is the

most versatile, powerful, and sensitive tool in use. The process of MRI was originally

called NRI (Nuclear Resonance Imaging), but was found to be to confusing due to the

fact that MRI's don't use radioactivity and ionizing radiation. The MRI generates a very

powerful electromagnetic field, which allows the radiologist to generate thin-sectionimages of any part of the body. Also it can take these images from any direction or angle,

and is done without and surgical invasion. Another plus side to the MRI is The time it

take to perform, where as a CAT scan may take 30-60 min. A MRI may only take 15

minutes max.

The CT scan is an advanced form of x-ray technology, the difference between CT and the

traditional x-ray is that where an x-ray compresses three dimensional objects into The CT

scanner consists of two main parts - an x-ray source and a radiation detector located on

opposite sides of the patient's body. These can be rotated in order to obtain images of any

angle. A two dimensional image the CT scan retains the third dimensionThe patientlies down on a couch which slides into a large circular opening. The x-ray tube rotates

around the patient and a computer collects the results. These results are translated into

images that look like a "slice" of the person.People often have CT scans to further look at

an abnormality seen on another test such as an x-ray or an ultrasound. They may also

have a CT to check for specific symptoms such as pain or dizziness. People with cancer

may a CT to look for the spread of the disease.


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1.4) Radiology department in Seshadripuram:

It is 24 hr department.

Services:

X-ray

Ultrasound

Echo

ECG

TMT

Staff:

1 Radiologist Doctor

1 team head

2 radiographers


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1.5) Title:

Reengenering of process flow in Radiology Department.

1.6) Objective:

y To develop the existing process flow in the radiology department.

y To calculate the Procedure TAT of the services of radiology department.

y To calculate Reporting TAT of radiology department.

y To calculate Overall TAT of radiology department.

y To restructure the process flow.

1.7) Operational Definition:

TAT: Turn around time (tat) it is the time taken to complete a procedure and being ready for

re performing that step. It starts from the 1st step of any process and ends when the last step is

performed and is over.

Process Flow:It the sequence of steps that are required to be taken in an ordered sequence

for a process to be performed effectively and efficiently.


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Chapter 2

Review of literature:

Evaluation of performance by radiology faculty is extremelydifficult. Many of the attributes

that contribute to an excellentradiologist are difficult to define and even more difficult

to

measure. A number of difficulties in evaluating physicianperformance in general have been

identified. "Competency" hasbeen defined as a "complex set of behaviors built on the

componentsof knowledge, skills, and attitudes" [3]. It has been suggested

that ideal

performance measures should be evidence-based andbased on agreed-on standards, be

reproducible, be attributableto the individual physician, be encountered in adequate numbers

so that statistical evaluation is meaningful, and be feasibleto collect [4]. For most radiology

departments, identifyingsuch parameters may be difficult. It is often difficult to identify

reproducible, measurable, and available parameters that reflectthe true nature of what it

means to be a "competent" radiologist.

The purpose of our article is to describe a program for performance-based assessmentof

clinical radiology faculty for the purposes of reappointment. Theintent is to create a program

that fosters process improvement,meets JCAHO standards, and minimizes additional

paperwork anddata collection that are not already in process. This programis definitely a

work in progress and is by no means perfector universally applicable to all departments. We

continuallystrive to improve the program. In addition, with rapidly changing technology,

the

targets or parameters that should be measured are constantly changing.We hope that the

description of our program will serve as atemplate for performance-based review of faculty

that otherscan use as a reference in building programs that work for their

own departments.

The main emphasis in health care has been on quality and availability but increasing cost

pressure has made cost efficiency ever more relevant for nurses, technicians, and physicians.Within a hospital, the radiologist considerably influences the patient's length of stay through

the availability of service and diagnostic information. Therefore, coordinating and timing

radiologic examinations become increasingly more important. Physicians are not taught

organizational management during their medical education and residency training, and the

necessary expertise in economics is generally acquired through the literature or specialized


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courses. Beyond the medical service, the physicians are increasingly required to optimize

their work flow according to economic factors. This review introduces various tools for

process management and its application in radiology. By means of simple paper-based

methods, the work flow of most processes can be analyzed.

Four main areas of quality need to be addressed for a complete quality and safety program in

radiology: safety, process improvement, professional outcome assessment, and satisfaction.

These areas need to be coordinated by individuals who belong to a quality oversight

committee. Management of the data can be facilitated by using a quality scorecard that posts

relevant data for each operational group within a department. The ultimate goal is a cultural

shift in which all departmental workers assume responsibility for quality and safety

improvements and behave consistently with the core values of the organization. A road map

for thinking about quality and safety issues in radiology allows all of these areas to be tiedtogether.

Standards for TAT:

Procedure: 10mins

Reporting: 15mins

Overall: 25-30mins


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Chapter 3

Research Methodology

3.1) Research Methodology followed:

3.1.1) Nature of study:

In this study both descriptive study and explorative research method has been used.

For a part of study where process flow was to be developed descriptive research was

used as I went through the already existing process. Whereas, for calculating TAT and

developing new process flow explorative research was carried out.

3.1.2) Sample:

For the development of process flow the research was to be carried out by interacting

with the staff of radiology department and there are only people in radiology

department so had to interact with all of them so convenient samplingtechnique was

used.

For the purpose of calculating TAT random samplingwas done by taking recent data

of patients who came to radiology department during the week of project and selected

a data of5

0 patients for this purpose from the total patients who came.

3.1.3) Data collection tools:

The data was collected by researcher himself.

Since already existing process flow was to be developed so secondary data was taken

as it was to based on previous procedure. This data was collected by interviewing the

staff. It was an informal open ended question format interview. And also

observational survey was conducted by the researcher to look after modifications that

can be done to develop new process flow and reengineer it.

(Interview questions in annexure 1)

For the purpose of calculating TAT primary data was used and to capture primary

data and excel format was developed by the researcher as the already existing data

maintainence system with the radiology department wasnt upto mark.

(Previous and new format of excel sheets in annexure 2)


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3.1.4) Data analysis:

The data collected was studied and reviewed by the researcher. For the calculation of

TAT analysis was done by using basic mathematical tools. Which are as follows:

Procedure TAT: (Time at completion of procedure of testing) (Time at which

patient got requisition form filled for testing)

Reprting TAT: (Time at which report was printed) (Time at which procedure was

over)

Overall TAT: (Time at which report was printed) (Time at which patient got

requisition form filled for testing)

For the purpose of developing already existing process flow and developing new

process flow analysis on the basis of interview and observation was done.


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Chapter 4

Findings

4.1) Footfall:

Average Footfall (per day) in the given week:

X-ray:15

Ultrasound:8

Echo:2

TMT:3


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4.2) Process flow:

4.2.1) Process flow of IPD:

The process flow of IPD needs some modification as there are chances of lapses and also

work of GDA is increased by 1st

bringing requisition form and then bringing in the patient so

this can be modified.

Requisition sent from wards

Call made by radiology dept. to wards

Patient is shifted with GDAS

Test done

Patient sent back


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4.2.2) Process flow of OPD:

The process flow of OPD is perfect but some modifications are required when a patient

comes after getting a test prescribed from the doctor in the hospital, as at that time they come

to radiology department without requisition form and hence the data cant be maintained

properly by radiology department.

Patient goes to reception area

Comes to radiology dept. with

re uisition form

Test done

Patient is sent back

Reports handed over by reception


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4.2.3) Process flow of reporting:

Since the report is given in hand written from by the radiologist to the radiographer who then

types the report. This, leads to increment in the reporting TAT so this process flow needs

some modification in this area.

Test done by radiologist

Radiologist gives a report to

radio ra her

Radiographer types the report on

word file

Report print out taken

Radiologist checks the report and

si ns it


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4.3) TAT calculated:

Procedure TAT:

X-ray :11mins

Ultrasound:15mins

Reporting TAT:

X-ray :45mins

Ultrasound:42mins

Overall TAT:

y X-ray :56mins

y Ultrasound:57mins

Thus the TAT of radiology dept. is very high in reporting and overall when compared

to standards set that are given above. So there needs to be some change in the

reporting so that TAT can be reduced and brought in control.

4.4) Steps for Data Entry:

Separate register maintained for x-ray, ultrasound, ECG etc.

Radiographer makes the note of patient number, id, test, time taken.

After few days entry of data is made in excel sheet.

No authenticity of timings and load of entry is increased.

No separate column for time of report making.

The used format is in annexure 2.


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4.5) Shortcomings in radiology department:

Process flow doesnt allow proper time keeping.

Lack of staff/ work distribution.

No proper fixed format of reporting.

TAT in reporting.

Authenticity.

No proper format of data entry.

Delay to call IPD patients for test.

4.6) Conclusion:

In the findings chapter it has been observed that there are lot of modification that are required

in the process flow and the TAT has to be taken a special care and needs to be improved. The

flow is well designed and defined but few modifications are required. It is seen that though

radiology department plays a major role in process flow anad procedure but support of other

departments is required to imorove the services.


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Chapter 5

Conclusion

5.1) Summary:

Fortis Hospitals have gained remarkable brand reputation in a short span of time. It

operates through multi-specialty hospitals, providing healthcare in key specialty areas like

cardiac care, renal care, neuro-sciences, orthopedics, etc. To provide quality service, FHL

differentiated itself with its contemporaries in India by adopting unique hospital design,

services, and programmes that comply with international standards. The demographic shift

and higher longevity of Indian population offered tremendous opportunities to many

private corporate hospitals.

Fortis Seshadripuram is among few new acquisitions made by Fortis Healthcare in last few

years. Since, it was acquired from another hospital chain so few old processes are stioll

being followed which need to be changed and modified. All the processes are in the

process of modification and continual upgradation and check.

The research was based on the TAT and process flow in the radiology department. The

various functions performed by the department are:

i) Testing.

ii) Reporting.

iii) PHC

The radiology department works in a defined way in collaboration with other departments

like nursing, front desk etc. the process flow has some flaws and can be improved further.

With average footfall being not too high so some new methods can be used to improve the

services and the quality of services as risk factor involved is not that high.

The services of the radiology department is dependent on the prescription by on board

doctors of hospital and other doctors also. The process starts from the filling of requisition

form by the front desk or by the nursing station.


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The authenticity of data is not that high as there is no proper maintainence of data and the

record of time is kept by radiographer himself and no where else the time is mentioned so

there are chances of manipulation to keep the data within limits.

The record maintainence is also not done in a systematic way since it is also done by the

radiographer who is already overloaded and does the entry in the excel sheet that is

maintained by them once a week depending on the availability of time with the

radiographer.

Also, the data is mainly maintained in a written format which is prone to manipulations.

the data is maintained on the basis of uhid no. and the no. at which the patient comes to the

radiology department.

For testing if there are IPD and OPD patients at the same time then OPD patients are given

preference. Also, there is a portable X-ray machine in ICU which if required the

radiographer goes to ICU and conducts a test there at that time Radiology dept. is left

vacant.


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5.2) Recommendations:

5.2.1) For Radiology Dept.:

One attendant to be present there or proper work division.

OPD patient should get there radiology test billed before coming for test and carry

requisition form.

From wards a call should be made and requisition form should be sent with patient.

IPD patients should be given preference over OPD.

On requisition form there should be an option of entering time at the time of filing of

requisition form.

Reports should be typed directly by doctor.

Wards should make entry of test on HIS as soon as requisition form is sent.

The report should be typed using HIS system and a proper format is used.

Change in process flow.

(New suggested process flow in annexure 3)

5.2.2) For Hospital:.

Change in reception for lab.

Personal touch till patient leaves the hospital.

Cleaning of lift.

Dress coding (different dresses for GDA and Houskeeping staff)

Loose cash on counters.

Magazines in waiting areas.

Water cooler in OPD waiting.


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Chapter 6

6.1) Limitations:

y No authenticity of data.

y Lack of collaboration from other departments for carrying out some test runs

of new process.

y Less footfall so TAT cant be authenticised with large data.

y No authenticity of previous secondary data so secondary data cant be used for

the purpose.

6.2) Scope of future research:

y The study can be conducted on the new process flow suggested to radiology

dept.

y If possible test can be conducted for a longer span of time, with more data so

that it can be seen that how radiology department caters to heavy rush which it

hasnt faced till now.


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Annexure 1

Questions asked to staff:

y How is documentation done?

y What is average footfall?

y What is the process of patient coming to radiology department?

y Who all are linke din the process flow of radiology department?

y Who hands over the reports?

y How is data maintained?

y What is the staff strength and working hours?


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Annexure 2Previous data recording sheet:

For timings:

04-12-2010X-RAY

SL NO PATIENT NAME IP/OP IN TIME OUT TIME

1 MR.S.M. HEGDE OP 10-45AM 11-00AM

2 MR.RAGHU OP 11-05AM 11-15AM

3 MRS. SHAKUNTHALA OP 11-00AM 11-15AM

4 MRS. SULEKHA IP 11-20AM 11-30AM

5 MR.MOHD YOUSUF OP 1-45AM 12-15PM

6 MRS.SUSHMA GUPTHA OP 12-20PM 12-35PM

7 MR. MUNISWAMY NAIDU IP 2-30PM 2-45PM

8 MR.SUBRAMNI IP 3-00PM 3-15PM

9 MR. VISHWANATH IP 4-00PM 4-15PM

10 MRS.JAYAMMA IP 6-15PM 6-25PM

11 MR.MADAIAH IP 7-10PM 7-20PM12 MRS. PINKY CHAN DAWAT IP 8-10PM 8-30PM

13 MRS. LAKSHMAMMA IP 8-40PM 9-00PM

14 MR. KRISHNAPPA IP 10-30PM 10-45PM

U/S SCAN

SL NO PATIENT NAME IP/OP IN TIME OUT TIME

1 MR. NADEEM ANWAR OP 12.55PM 1.05PM

2 MR. SHIVANANDA OP 3.15PM 3.30PM

3 MR. MOIZ OP 3.30PM 3.40PM

4 MR. BORAMMA IP 1.55PM 2.15PM

5 MRS. SAROJA IP 2.20PM 2.40PM

6 MR. REHAMATH NAWAZ OP 4.30PM 4.45PM7 MR. PARAMA SHIVAM IP 2.45PM 2.55PM

8 MR.MANJUNATH KUMAR IP 3.00PM 2.55PM

9 MR. SIDDIQI ALDURAI OP 11.10AM 3.15PM

10 MR. MUNISWAMY NAIDU IP 4.50PM 5.00PM

11 MR. KADIRAPPA IP 1.30PM 1.40PM

12 MRS.SUSHMA GUPTHA OP 3.45PM 4.00PM

13 DR. KIRAN OP 1.10PM 1.20PM

14 MRS. SAVITHA KHANDELAWAL OP 12.45PM 12.55PM


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New format:


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ANNEXURE 3

New process flow for IPD:

Call made from wards to

radiolo y dept.

Call made by radiology dept. to wards

callin the atient

Patient is shifted with GDAS

and requisition form

Test done

Patient sent back


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ANNEXURE 4

New reporting process flow:

Test done by radiologist

Radiologist types the report

Radiographer takes the print out

using HIS

Radiologist checks the report and

si ns it


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References:

y Performance-Based Assessment of Radiology Faculty: A Practical Plan to

Promote Improvement and Meet JCAHO Standards

y Methods of process management in radiology]

[Article in German]Teichgrber UK, Gillessen C, Neumann F. Klinik fr

Strahlenheilkunde, Charit Campus Virchow-Klinikum, Humboldt-

Universitt zu Berlin. [email protected]

y Developing a Radiology Quality and Safety Program: A Primer1

1. C. Daniel Johnson, MD,2. Karl N. Krecke, MD,

3. Rafael Miranda,4. Catherine C. Roberts, MD and

5. Charles Denham, MD

y Lane F. Donnelly1

and Janet L. Strife

Landon BE, Normand SLT, Blumenthal D, Daley J. Physician clinical

performance assessment: prospects and barriers. JAMA2003;290:1183 1189

y Fortis healthcare private limited.y Wikipedia.

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