Middleware to the Rescue: Reclaiming Unused CT Imaging Capacity Automatically

Case Study: Pinnacle Health, Harrisburg, Pa.

Automatic, real-time scheduling software is load-balancing CT exams on a new 320 detector-row scanner. On the busiest day shift, the staff has absorbed a monthly increase of 218 patients and the past three months, with no increase in CT technologists. Outpatient CT exams starting late are down 66 percent.

The typical hospital radiology department is often chaotic as staff struggle to manage patient studies and reschedule appointment changes and emergency cases in the face of constant disruptions. Add in a large healthcare system and an acute-care facility where urgent cases require immediate attention and you end up with unrelenting schedule disruptions. Often-used static scheduling systems do not reflect reality, so the staff is forced to manually manage patient flow and throughput each day. The manual methods include phone, fax, white boards, paper bins and constant rotation through software systems. A new artificial intelligence solution in use at PinnacleHealth brings automatic, real-time scheduling software that reallocates staff and imaging systems and reclaims unused capacity.

The Setting

PinnacleHealth is a large, non-profit healthcare system serving Central Pennsylvania. The healthcare network encompasses four campuses, with the largest located in Harrisburg.

The Harrisburg Hospital rises 11 floors and is surrounded by three busy city streets. Growth is limited to non-existent. The Emergency Room is located on the first floor of the hospital and is equipped with a four-slice CT system. The radiology department is spread across the basement, the first, fourth, fifth and sixth floors. A 320 detector-row CT system and 16-slice CT system are located on the 5th floor. CT studies top 16,000 per year at the hospital.

The CT department consists of three different control rooms separated by five floors. Currently, the hospital only has enough staff to handle two of the three CT systems because 40 percent of their time is spent manually managing schedule changes and patient flow.

To help manage the hospital’s CT volume, PinnacleHealth is taking advantage of a new software solution that enables hospitals to reclaim unused capacity. The On-Cue system from Allocade helps hospital departments handle the dynamic rescheduling changes by allocating resources and managing disruptions that require patient rescheduling in real time.

Utilizing artificial intelligence to obtain constant information from the hospital’s radiology information system (RIS), On-Cue dynamically reacts to each change in the schedule by informing caregivers about what needs to happen next. The system balances all studies on appropriate imaging systems depending on each patient’s condition. Emergent studies are routed to a department’s appropriate resource and existing studies are load-balanced. Hospital staff—whether in radiology, the ER or on the nursing floors—are notified immediately about each schedule change throughout the day. In addition, the software constantly searches for updates on precursor tasks and adjusts the schedule accordingly.

The Challenges

Like so many other facilities today, existing manual processes for coordination of patient logistics between various departments has created undue stress on the staff and patients, as well as poor resource utilization. Unexpected events in healthcare including add-ons, trauma, delays, transport, staffing levels and simultaneous studies can ultimately lead to suboptimal patient care. And, patients who come to the hospital for outpatient services end up waiting significant periods of time for an appointment. Ultimately, a large portion of these patients may leave and go elsewhere, resulting in lost future business.

The decision to purchase the On-Cue system is partially the result of the hospital’s recent investment in a state-of-the-art Aquilion One 320 detector-row CT system from Toshiba America Medical Systems. The new CT system has had a positive effect on patient flow, but also has presented increased demand for CT scans and a host of new options and challenges.

Prior to the On-Cue installation, the lead CT technologist would spend 20 to 25 minutes out of each hour managing patient logistics using phone and paper.

The staff also was spending a lot of time physically transporting paperwork up and down five flights of stairs.

Inpatient studies make up 31 percent of patient volume at the Harrisburg campus, but account for almost 80 percent of their scheduling problems. By acquiring the 320 detector-row CT system, the hospital estimated it would increase its outpatient business significantly. However, the increase in CT exams created challenges for scheduling. Because CT is an area with the highest throughput, it is the department most affected by disruptions. The challenge was to balance the study load among the three CT systems and communicate the schedule throughout the three control rooms.

The On-Cue system takes the real-time updates and unexpected schedule changes from the different areas of the hospital and dynamically reprioritizes everything to ensure that each inpatient stays as close to his or her itinerary as possible. The most urgent and STAT cases are immediately prioritized to the top and the engine load-balances affected patients to the other scanners to minimize the impact.

The team at the Harrisburg Hospital immediately saw the potential for On-Cue to support not only the radiology and emergency departments, but what it could do in the future for the cardiac cath lab, the OR, physical therapy and more.

The Solution

It was the vision of Harrisburg Hospital’s team to present an itinerary to every patient and meet that scheduled itinerary during the patient’s entire hospital stay.

On-Cue allows hospital departments to react, communicate and optimize patient throughput accordingly. With 57 percent of CT volume coming from the ER, there are a lot of emergent cases that need to be assigned a system accordingly.

Since installing dynamic scheduling, Harrisburg Hospital is realizing an increase in overall CT patient volume because we are able to leverage the Aquilion One and load balance the other two CT systems. During the busiest day shift, the staff has been able to absorb a monthly increase of 218 patients over the past three months without having to increase CT technologists.

Prior to real-time scheduling, delayed outpatient start-times were the norm because of the volatility with both the ER and inpatients competing for time on the same resource as the outpatients. Since implementing the technology, PinnacleHealth has experienced a 66 percent reduction in late start times for outpatient CT exams.

In addition, staff stress has gone down. It was estimated that 40 percent of the staff’s productive time was lost in the manual rescheduling process alone, restricting the productivity to 0.6 FTE. After the On-Cue installation, phone calls are down significantly and everyone knows what is happening with each patient down to the minute. Therefore, more time is spent on patient care versus patient logistics.

Summary

The On-Cue dynamic CT scheduling system meets Harrisburg Hospital’s needs in several ways. It provides the radiology and emergency departments with an efficient solution to address delays, trauma, scheduling and emergent add-ons, as well as the surprises that occur regularly every hour. When inpatients, outpatients and emergency patients all need access to the hospital’s three CT systems, often at the same time, the scheduling system eliminates the chaos of making changes by maximizing resource capacity. Now, a patient’s CT itinerary is closely followed and scheduled exams are taking place on time. As a result, the hospital is seeing improvements in individual patient experiences as well as a reduction in overall operating expenses.