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• W2989062665 abstract "HomeRadioGraphicsVol. 39, No. 7 PreviousNext Practice Policy and Quality InitiativesFree AccessUtilizing Process Improvement Methodology to Improve Inpatient Access to MRIJulia A. Drose , Nancy L. Pritchard, Justin M. Honce, Denise K. Snuttjer, James P. BorgstedeJulia A. Drose , Nancy L. Pritchard, Justin M. Honce, Denise K. Snuttjer, James P. BorgstedeAuthor AffiliationsFrom the Department of Radiology, University of Colorado Health Sciences Center, University of Colorado Hospital, 12401 E 17th Ave, Mail Stop L954, Aurora, CO 80045.Address correspondence to J.A.D. (e-mail: [email protected]).Julia A. Drose Nancy L. PritchardJustin M. HonceDenise K. SnuttjerJames P. BorgstedePublished Online:Nov 7 2019https://doi.org/10.1148/rg.2019190043MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractIntroductionOne of the major challenges in the current health care environment is minimizing the length of stay for hospitalized patients. In particular, lack of timely radiology services has a substantial effect on a patient’s length of stay through delays in timely diagnosis and treatment, with subsequent negative effects on hospital revenue and patient and provider satisfaction (1,2). This is similarly true in the emergency department, where earlier inpatient discharges decrease patient boarding time in the emergency department (2). Imaging delays also adversely affect radiology departments, as equipment utilization and staffing needs are frequently affected.Among the radiology modalities, timely availability of MRI is frequently a source of imaging-related delays in the inpatient hospital setting (3). These delays relate to the relatively extended imaging times required for MRI, the complex nature of the MRI environment, and the related unique safety considerations, all of which must be adequately addressed before image acquisition. In addition, the utilization of MRI for diagnosis is continually increasing.At our institution, an analysis of hospitalization data demonstrated that every 0.1 day that the average length of stay was shortened equated to a gain of seven open hospital beds for additional inpatients. In an effort to improve patient access, a hospital-wide initiative was instituted to focus on the various factors affecting inpatient length of stay. In the radiology department, the length of time from placement of an MRI request until the MRI acquisition began was identified as a significant contributing factor to timely discharge of some inpatients.Given that process analysis and streamlining have proved to be valuable methods for reducing variation, eliminating waste, and increasing employee productivity and satisfaction (4), we undertook a project to apply these methods to our MRI inpatient scheduling and safety screening workflow, in an effort to reduce MRI inpatient access times by 25% from the current state.MethodsSettingOur institution is a 700-bed academic medical center in Aurora, Colorado, that accommodates approximately 52 000 inpatient admissions per year. The process improvement effort was focused on three dedicated inpatient MRI suites with a 1.5-T system (Achieva; Koninklijke Philips, Amsterdam, the Netherlands), a 3.0-T system (MR750w; GE Healthcare, Chicago, IL), and a high-definition 3.0-T system (Hdxt; GE Healthcare).Process of ImprovementA guiding coalition consisting of the radiology department director, the MRI manager, the MRI supervisor, MRI technologists, and the radiology department quality improvement specialist was assembled to discuss the current state of MRI access for inpatients and to brainstorm about potential avenues for improvement (5,6). The consensus of the guiding coalition was to implement a series of “plan, do, study, act” (PDSA) cycles to test recommended interventions, review them for impact, and, if necessary, modify these interventions or test additional ideas as they were proposed. The PDSA cycle method was chosen because it is a useful tool for documenting a test of change, it is relatively simple to undertake the method and interpret the results, and its utility in accelerating quality improvement is well documented (7).Initial baseline data were collected by means of a retrospective review of the electronic medical record system over a 14-day period before the initiation of this quality improvement project. Two variables were collected: (a) the number of inpatient MRI examinations performed, and (b) the average time between placement of an MRI request and initiation of an MRI examination. At our institution, most MRI technologists follow similar processes for entering the start time of the examination in the electronic medical record system immediately before starting the examination. As such, we considered the variation in accuracy of this time stamp to be relatively small but not zero. Manual time stamp studies would have been ideal, but no resources were available to do so in a timely manner.Mapping of the current process for managing MRI requests for inpatients was performed by using a workflow diagram. This showed that before initiation of our project, the default process for inpatient MRI consisted of technologists calling patients for imaging just before there was an available slot on one of the three inpatient MRI systems. Inpatients were not proactively scheduled into available slots at the time of request, and all MRI safety screening procedures were initiated immediately before bringing the patients to the MRI suite. As a result, nursing staff were often not immediately available to prepare patients for transport, MRI screening forms were commonly incomplete, and patient transportation was often not immediately available. Therefore, patients commonly lost these windows of availability for the MRI unit or imaging started late, contributing to substantial examination delays for subsequent patients.Of the barriers identified as being significant factors in delaying MRI access, the absence of proactive scheduling of inpatients into available slots at the time of request was considered to be of the highest impact, given the multiple downstream effects detailed above. As such, this barrier was prioritized for evaluation during the first PDSA cycle. The MRI technologists were instructed to immediately schedule a patient into an available same-day MRI slot as soon as a request was placed. This proactive scheduling was theorized to provide transport staff with earlier notification of when patients would be expected in the radiology department and to ensure that nursing staff would have adequate time to prepare patients before the arrival of transport staff. After implementation of this first intervention, data on the number of MRI examinations and turnaround times (TATs) from examination order to examination start were reassessed.While the results of this initial improvement were encouraging, the MRI technologists tasked with performing proactive scheduling reported difficulty in consistently scheduling patients. When questioned, the technologists relayed that they were too busy with their numerous other required duties, such as imaging and monitoring patients in the radiology department, to have time to monitor the MRI orders list and place each patient into an available time slot. As such, the MRI technologists reported they were able to intermittently schedule inpatients in the proactive manner prescribed in the PDSA cycle. In addition, because the responsibility for proactive scheduling was not specific to any particular technologist, many technologists did not personally prioritize this process in their day-to-day work.The guiding coalition theorized that perhaps the lead technologists, who had fewer clinical imaging responsibilities, might be better able to undertake the proactive scheduling. As such, a second PDSA cycle was undertaken, this time with the lead technologists having the responsibility of proactively scheduling inpatients immediately after entry of the MRI request. Two weeks after this modification was implemented, data were acquired over a 2-week window, again showing similar numbers of MRI examinations performed.The lead technologists who participated in the second PDSA cycle reported that, similar to the original technologist reports during the first PDSA cycle, they were unable to consistently schedule patients as instructed because of the time constraints imposed by their primary clinical and administrative duties.The guiding coalition reassembled to review and discuss the findings. Comments from the frontline staff regarding these processes were collected and reviewed as part of this discussion. A consensus was reached to perform a third PDSA cycle, in which one MRI technologist per shift per day was assigned the responsibility of scheduling inpatients as MRI requests were received. Assigning this task to a specific technologist allowed clear delineation of roles and responsibilities among the technologists and provided incentive for the designated technologist to focus on the task during his or her shift. In addition, the technologists were provided with focused education to better familiarize them with the scheduling process, as some technologists indicated a lack of familiarity with parts of the current process. Scripting was also implemented to allow clearer communication with nursing staff so that patients were more likely to be ready for imaging when the transport staff arrived.At the start of this project, the guiding coalition requested that the MRI staff keep a log documenting each instance when an inpatient was delayed in arriving at the radiology department at the specified appointment time, as well as the reason for the delay. This was done to provide additional information that could be used for further PDSA cycle iterations as the project continued.A large number of log entries had been collected by this point in the project, documenting the reasons patients were delayed in arriving for their specified appointment time. Logs from two separate 1-month time frames (June 2017 and August 2017) were collated and reviewed (Fig 1). A cause-and-effect or fishbone diagram was used to group the entries into several categories (Fig 2). From this diagram, the major underlying reasons for delays were elucidated: transport service–related delays, registered nurse–related delays, patient complications (eg, too unstable to come to the radiology department), and patients who were otherwise ready for imaging but who had been bumped from their scheduled time slot because of an urgent examination request received for another patient. Miscellaneous reasons that did not fit into these groups were categorized as “other.”Figure 1a. Reasons for delays in patient arrival for MRI at the scheduled appointment time at our institution. Logs completed by MRI technologists for two separate 1-month time frames were collated and reviewed. Graphs show the results for June 2017 (a) and August 2017 (b). RN = registered nurse, STAT patient = patient requiring immediate MRI.Figure 1a.Download as PowerPointOpen in Image Viewer Figure 1b. Reasons for delays in patient arrival for MRI at the scheduled appointment time at our institution. Logs completed by MRI technologists for two separate 1-month time frames were collated and reviewed. Graphs show the results for June 2017 (a) and August 2017 (b). RN = registered nurse, STAT patient = patient requiring immediate MRI.Figure 1b.Download as PowerPointOpen in Image Viewer Figure 2. Cause-and-effect or fishbone diagram shows how entries were grouped into several categories of reasons for delay reported by MRI technologists. STAT patient = patient requiring immediate MRI, tele = telemetry monitor.Figure 2.Download as PowerPointOpen in Image Viewer From the review of these logs, transport services and nurse-related delays were identified as the most frequent issues resulting in delays in imaging. The guiding coalition organized a meeting with relevant stakeholders from the radiology, transport services, and inpatient nursing departments. During the meeting, the data collected from the logs were reviewed, and brainstorming was used to look for possible areas for efficiency improvements.From the perspective of the transport services staff, two major issues were identified: (a) the transport services department was understaffed, resulting in a significant backlog of transportation requests, and (b) the transport services team often received unclear communication from MRI staff as to when a patient was or was not available for transportation. From the inpatient nursing staff perspective, many imaging delays seemed unavoidable secondary to frequent changes in the status of the patient (eg, from stable to unstable), which prevented the patient from being transported for imaging. In addition, the numerous imaging tests and procedures ordered for the same patient resulted in scheduling difficulties among the various departments. For patients who required monitoring by the nurse, often the nurse was not readily available to accompany the patient to the MRI department because of other clinical responsibilities on the floor. The nursing staff also expressed notable discomfort with the responsibility of completing the mandatory MRI screening forms. Specifically, they did not believe that they were the subject matter experts for explaining MRI safety information to the patient or for capturing all necessary information to ensure that the screening forms were complete and accurate.From these discussions, two further PDSA cycles were recommended and implemented. The first intervention to be tested, PDSA cycle 4, focused on addressing delays related to transport services. Specifically, a dedicated transporter within the radiology department was assigned the sole task of transporting patients to and from the MRI suite. This involved assigning a current technologist assistant the duty of transporting inpatients to the MRI suite. In this process, the hospital-wide transport services department was no longer relied on for patient transportation.To address issues raised from the inpatient nursing perspective, two additional interventions were tested for PDSA cycle 5. The first of these focused on familiarizing nursing staff with MRI examinations and related safety and procedural considerations. A document was developed for the inpatient nursing staff that provided an overview of different MRI procedures and any needed examination preparation and emphasized the importance of accurate completion of screening forms. A checklist was also provided to help ensure that patients were ready for their examination. This document was distributed to all nursing staff.The second intervention reassigned the responsibility for completing the MRI safety screening form from the registered nurse to the MRI technologist. Screening forms were completed by having the technologist call and speak directly with the patient (when possible) and document the information required to complete the screening form before the patient was transported to the radiology department.ResultsBaseline data collection for our MRI inpatient process revealed that over the 14-day period before initiation of our first PDSA cycle, a total of 227 MRI examinations were performed using the three inpatient MRI systems. The average TAT between placement of the request and initiation of MRI was 751 minutes (Table).Process Improvement Data Collected at Baseline and at PDSA Cycles 1–5The first PDSA cycle, which involved the technologists proactively scheduling all inpatient examinations at order placement, ran for 14 days. Subsequently, data were collected and compared with the baseline data (Table). The data demonstrated that with similar numbers of MRI studies performed, there was a decrease in the average TAT from 751 minutes to 626 minutes, netting a 16.6% improvement from baseline.The second PDSA cycle, which involved the lead technologists being responsible for inpatient MRI examination scheduling, showed that the average TAT decreased an additional 21.2% over the first PDSA cycle to 493 minutes and decreased 34.4% from baseline (Table).For PDSA cycles 1 and 2, current staff were not necessarily allotted additional time to perform the task of scheduling because it was assumed that this task could be absorbed into current operations.For PDSA cycle 3, one MRI technologist per shift per day was assigned the responsibility for proactively scheduling inpatient examinations. After a 3-week implementation of this third PDSA cycle, data collected over a 13-day window showed an average TAT of 399 minutes, which was a 19.1% improvement from the second PDSA cycle and a 46.9% improvement from the baseline data (Table). Again, the staff were polled for their input regarding the process. They believed that assigning a specific technologist to the task of scheduling all inpatients worked well and had no immediate complaints or suggestions for improvements.One week after implementation of PDSA cycle 4, which was implemented secondary to meeting with nursing and transport services leadership, the collected data showed a TAT time of 447 minutes, a 12% decrease in the gain seen at the end of PDSA cycle 3 (Table). A debriefing with stakeholders after this intervention revealed that while having a dedicated staff member for each shift who was focused on transportation was sometimes helpful, this individual was often not readily available.Furthermore, often a single transporter was not able to move the patient without assistance, and frequently nurses were still needed for patient monitoring and were not available when the transporter was ready to move the patient.PDSA 5, involving the MRI technologists taking over the responsibility of completing safety screening forms with inpatients, was then implemented, and data were collected over a 13-day period. This intervention showed a 46.6% decrease in TAT from baseline data, and a 10.3% improvement over the prior PDSA 4 intervention (Table). Although this improvement over baseline was slightly lower than that seen with PDSA cycle 3, frontline MRI and nursing staff believed that this process improved the accuracy and completeness of the MRI screening form and made the nurses better able to prepare patients for transport. All staff involved agreed that efficiency in getting patients to the department at the scheduled examination time was greatly improved.One-tailed two-sample t tests at the 5% significance level were performed for each PDSA cycle to determine whether the mean TAT for each PDSA cycle was less than the mean TAT for the baseline period. The P value for PDSA cycle 1 was 0.019, indicating a statistically significant improvement from baseline when the α level is 0.05. PDSA cycles 2 through 5 yielded P values less than 0.001, which also showed a statistically significant improvement from baseline.A control chart was created that included data from baseline, the five PDSA trials, and after project completion to assess progress during the project and sustainment of the improvement (Fig 3). Four data points were found to lie outside the control limits. This was thought to be secondary to staffing on particular days or times, but a precise explanation was not identified. Postproject data, collected periodically 2 months after project completion through March 2019, showed an acceptable level of sustainment of gains, although gains were slightly decreased from the highest- percentage improvement. Data collected near the 9–11-month postproject time frame did show a shift of 10 data points falling below the average of the postproject phase. This may have reflected a reemphasis with staff that proactive scheduling and screening form completion were expected to be performed consistently.Figure 3. Control chart created using a 1-way analysis of variance (ANOVA) test shows data from the baseline, the five PDSA trials, and the postproject period that were used to assess progress during the project and postproject sustainment of the improvement. IP = inpatient, M-F = Monday to Friday, LCL = lower control limit, UCL = upper control limit.Figure 3.Download as PowerPointOpen in Image Viewer A one-way analysis of variance (ANOVA) test at the 5% significance level was conducted to determine whether the mean TATs from the PDSA period and after project completion were different at a statistically significant level from those at baseline, as well as from one another (Fig 4). The mean TAT from the PDSA period (sample 1) was found to be different from the mean TAT at baseline (sample 0). The postproject mean TAT (sample 2) was also found to be different from the mean TAT during the PDSA period, indicating that some of the gains made during the PDSA period were not sustained. However, the postproject mean TAT was found to be different from the mean TAT at baseline, suggesting a statistically significant improvement from baseline.Figure 4. Summary chart shows the results of a one-way ANOVA test at the 5% significance level that was conducted to determine whether the mean TATs from the PDSA period and after project completion were different at a statistically significant level from the baseline TAT, as well as from one another. Sample 1 is the PDSA period, sample 2 is the postproject period, and sample 0 is the baseline.Figure 4.Download as PowerPointOpen in Image Viewer DiscussionPatient flow throughout a hospital has been shown to be adversely affected when inpatient discharge is delayed (1,2,8–10). When hospitals are operating at peak capacity, discharge delays impact throughput and patient length of stay and affect the emergency department, intensive care units, and incoming patients awaiting inpatient beds (2,9,11). All of these issues affect the cost of care and therefore become a priority when attempting to maintain a financially stable entity (7). It has also been shown that because approximately 80% of patients require some form of imaging during their hospital course, imaging delays have a large impact on prolongation of patient stays (3). These factors were a catalyst for our hospital leadership to focus on improving inpatient access to imaging services.The ever-increasing reliance on MRI for clinical diagnosis and the disease acuity of many inpatients awaiting imaging make MRI an imaging modality particularly susceptible to lengthy waits between the time of request and the time of performance of the MRI examination. Our efforts focused on identifying issues that result in delays in inpatients undergoing timely MRI studies and on efforts to improve patient and staff satisfaction by creating a more uniform and efficient process from the time of study request to initiation of MRI.After numerous PDSA cycle iterations, debriefing of frontline staff, and careful review of time data, it became clear that of the various interventions tested, two resulted in the shortest TATs: (a) Assigning a specific MRI technologist per shift per day with the responsibility for scheduling all inpatient examinations as soon as requests were received resulted in an overall improvement of 46.9% from baseline; and (b) Having MRI technologists rather than nursing staff be responsible for completing the MRI screening forms for all inpatients maintained this improvement to 46.6% from baseline.Several important process improvement takeaways, which reinforce commonly recognized aspects of modern quality improvement methodology, were gleaned from this endeavor. First, the importance of assembling a coalition to represent all staff involved in a current process is key. This coalition should include leadership, frontline staff, and staff from any ancillary services affected. We found that everyone involved with a patient’s care had unique input into the challenges and barriers to change. Different groups also provided different perspectives regarding how a change might affect their current workflow or duties.A second takeaway was that successful and unsuccessful changes to the current state were often readily identified after only a short period. In our PDSA cycle iterations, each intervention was tested for 1–3 weeks, with follow-up outcome data collection lasting 5–14 days, which included querying the electronic medical record as well as detailed debriefing with the involved frontline staff. These relatively rapid turnaround times allowed numerous PDSA cycles to be tested within several months.Discussion with the inpatient nursing staff regarding their unease with completing the MRI screening forms was also enlightening. Radiology staff members often assume that everyone involved in patient care understands the risks and dangers inherent in the MRI environment and the importance of accurately completed MRI screening forms. We also assume that the screening questions being asked and the answers to these questions are relatively straightforward. Our discussions with nursing staff showed that this is not necessarily the case and that, given the nursing staff’s lack of in-depth understanding of the vagaries of the MRI environment and safety considerations, the screening form became a major point of delay in the imaging process. A significant improvement in TATs was realized when MRI technologists completely took over this process. A key lesson here is that shifting the responsibility for a particular process to those with the most understanding should always be considered as a means for improving patient safety as well as efficiency.The original impetus for this project was a hospital-wide initiative to increase efficiencies in processes that may contribute to inpatient length of stay. If the average time saved after our final PDSA project perfectly converted to a corresponding decrease in overall length of stay, by using our internal hospital metrics this would be projected to result in an additional 16.8 available hospital beds per day. However, MRI TAT is clearly not the only entity affecting inpatient length of stay, and therefore the reality is more complicated. However, the impact would still be contributive.As with any quality initiative, sustaining the gain is as important as achieving it. If a process is not sustainable over time, it will not be effective in achieving a goal. Recent review of our data showed that 11 months after the conclusion of our fifth PDSA cycle, the TAT is averaging 599 minutes. In other words, we have maintained a 20.2% improvement over our original request-to-begin time of 751 minutes, which is close to our original goal of 25%. Loss of some of the gains we originally achieved is believed to be the result of recent changes that include balancing inpatient and outpatient scheduling and technologist staffing, the need to perform certain examinations exclusively with specific magnet systems, the length of time of available imaging slots, and requirements for continual education of new MRI and inpatient nursing staff.ConclusionProcess improvement projects require regular periodic reevaluations to assess the need for additional interventions, and our project is no exception. We did not establish a formal plan for sustainment during the course of this project. This likely contributed to the lack of complete sustainment and is considered a lesson learned for future projects. Additional limitations of this project include potential variance in how examination start times are entered in the electronic medical record, and the directive to refine processes further without adding additional full-time equivalent staff members, given the fiscal constraints of most entities. We continue to evaluate opportunities for further improvement for the benefit of our patients.Disclosures of Conflicts of Interest.—J.M.H.Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: institution received research funding from Novartis Pharmaceuticals and Biogen Idec; travel reimbursement from Novartis Pharmaceuticals. Other activities: disclosed no relevant relationships.AcknowledgmentsWe would like to thank Nancy Cheung, MPH, and Christi Janzen for their help in acquiring and analyzing the data collected for this process improvement.Recipient of a Quality Improvements Reports award for an education exhibit at the 2018 RSNA Annual Meeting.The author J.M.H. has provided disclosures; all other authors have disclosed no relevant relationships.References1. Hurlen P, Østbye T, Borthne AS, Gulbrandsen P. Does improved access to diagnostic imaging results reduce hospital length of stay? A retrospective study. BMC Health Serv Res 2010;10:262. Crossref, Medline, Google Scholar2. Wertheimer B, Jacobs REA, Iturrate E, Bailey M, Hochman K. Discharge before noon: Effect on throughput and sustainability. J Hosp Med 2015;10(10):664–669. Crossref, Medline, Google Scholar3. Tokur S, Lederle K, Terris DD, et al. Process analysis to reduce MRI access time at a German University Hospital. Int J Qual Health Care 2012;24(1):95–99. Crossref, Medline, Google Scholar4. Swensen SJ, Dilling JA, Mc Carty PM, Bolton JW, Harper CM Jr. The business case for health-care quality improvement. J Patient Saf 2013;9(1):44–52. Crossref, Medline, Google Scholar5. Bradley EH, Brewster AL, McNatt Z, et al. How guiding coalitions promote positive culture change in hospitals: a longitudinal mixed methods interventional study. BMJ Qual Saf 2018;27(3):218–225. Crossref, Medline, Google Scholar6. Campbell RJ. Change management in health care. Health Care Manag (Frederick) 2008;27(1):23–39. Crossref, Medline, Google Scholar7. Plan-Do-Study-Act (PDSA) Cycle. AHRZ Health Care Innovations Exchange. https://innovations.ahrq.gov/qualitytools/plan-do-study-act-pdsa-cycle. Updated April 10, 2013. Accessed February 12, 2019. Google Scholar8. Destino L, Bennett D, Wood M, et al. Improving Patient Flow: Analysis of an Initiative to Improve Early Discharge. J Hosp Med 2019;14(1):22–27. Crossref, Medline, Google Scholar9. Lees-Deutsch L, Robinson J. A Systematic Review of Criteria-Led Patient Discharge. J Nurs Care Qual 2019;34(2):121–126. Crossref, Medline, Google Scholar10. Rahman AS, Shi S, Meza PK, Jia JL, Svec D, Shieh L. Waiting it out: consultation delays prolong in-patient length of stay. Postgrad Med J 2019;95(1119):1–5. Crossref, Medline, Google Scholar11. van der Veen D, Remeijer C, Fogteloo AJ, Heringhaus C, de Groot B. Independent determinants of prolonged emergency department length of stay in a tertiary care centre: a prospective cohort study. Scand J Trauma Resusc Emerg Med 2018;26(1):81–89. Crossref, Medline, Google ScholarArticle HistoryReceived: Mar 4 2019Revision requested: Apr 17 2019Revision received: May 15 2019Accepted: May 24 2019Published online: Nov 07 2019Published in print: Nov 2019 FiguresReferencesRelatedDetailsCited ByPoint-of-Care Brain MRI: Preliminary Results from a Single-Center Retrospective StudyEdward Kuoy, Justin Glavis-Bloom, Gabrielle Hovis, Brian Yep, Arabdha BiswasLu-Aung MasudathayaLori A. Norrick, Julie Limfueco, Jennifer E. Soun, Peter D. Chang, Eleanor Chu, Yama Akbari, Vahid Yaghmai, John C. Fox, Wengui Yu, Daniel S. Chow, 2 August 2022 | Radiology, Vol. 305, No. 3Quality Improvement Algorithm: A Model for Departmental Quality InfrastructureLindsayRock, JamesBorgstede, JuliaDrose2020 | Journal of the American College of Radiology, Vol. 17, No. 1Recommended Articles No More Waits and Delays: Streamlining Workflow to Decrease Patient Time of Stay for Image-guided Musculoskeletal ProceduresRadioGraphics2016Volume: 36Issue: 3pp. 856-871Increasing the Utilization of Moderate Sedation Services for Pediatric ImagingRadioGraphics2021Volume: 41Issue: 7pp. 2127-2135Increasing Patient Access to MRI Examinations in an Integrated Multispecialty PracticeRadioGraphics2021Volume: 41Issue: 1pp. E1-E8Kaizen Process Improvement in Radiology: Primer for Creating a Culture of Continuous Quality ImprovementRadioGraphics2022Volume: 42Issue: 3pp. 919-928Realizing Improvement through Team Empowerment (RITE): A Team-based, Project-based Multidisciplinary Improvement ProgramRadioGraphics2016Volume: 36Issue: 7pp. 2170-2183See More RSNA Education Exhibits Same Day Prostate MRI and MRI/US Fusion Biopsy Service at Our Institution: How We Do ItDigital Posters2020Managing Time-Sensitive Imaging During a Public Health Crisis: An Institution’s Response to the COVID-19 Pandemic and Lessons LearnedDigital Posters2020Kaizen Process Improvement in Radiology: A Primer for Creating A Culture of Continuous Quality ImprovementDigital Posters2020 RSNA Case Collection Poland SyndromeRSNA Case Collection2020Epiploic AppendagitisRSNA Case Collection2021Piso-Hamate Carpal CoalitionRSNA Case Collection2021 Vol. 39, No. 7 AbbreviationsAbbreviations:PDSAplan, do, study, actTATturnaround time Metrics Altmetric Score PDF download" @default.
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