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Case study of patient care in radiography

Implement new standard work. Using a scale where 0 represents no pain or discomfort and 5 indicates severe pain, technologists rated the degree of soreness, pain, stiffness, and loss of motion or loss of strength that they experienced before and after completing their shifts.

Figure 2 summarizes the average ratings of 12 technologists, showing that they were experiencing mild pain at the start of their shifts and that they experienced more pain and discomfort in their shoulders, necks, and backs after completing their shifts. Next, a detailed process map was created showing the steps taken by the technologists to acquire portable x-rays in the ICU in the morning.

The process started when a technologist first arrived in the morning and ended with the last x-ray taken for the ICU patients. Identifying Areas of Opportunity The specific steps at which caregivers sustained injuries were identified. The process map in Figure 3 illustrates that efforts needed to focus on finding better ways to position and reposition the patients and to insert and remove the cassettes.

The fishbone diagram in Figure 4 helped capture the various factors that could contribute to injuries. As the fishbone diagram shows, many different combinations of materials, equipment, and methods were employed every day, and some variations contributed to the poor ergonomic practices that were leading to injuries.

Knowledge Center

The team designed an experiment to test different combinations of materials, equipment, and methods in an attempt to isolate the best combination. Figure 5 shows the variables included in the research. For all variables except max inflate and mattress surface, option 1 represents existing practice. Patient angle refers to the angle at which the patient is sitting. Existing practice was to have the patient sit up as much as possible close to 50 degrees when placing the cassette behind the patient.

An alternative thought was to have the patient only slightly elevated 20 degrees during cassette placement. One of the team members suggested placing the cassette from the side as opposed to the existing practice of reaching over the top. This way, the caregiver could rest the cassette on the bed and slide it instead of reaching up and out with the pound cassette.

A variety of mattress surfaces were in use throughout the hospital. Some surfaces were rubbery and sticky while others were made of slick synthetic fabric. Cassettes tend to slide easier on the slick surface, whereas they get stuck on the sticky material.

One of the team members suggested placing the cassette in a plastic bag prior to placing it behind the patient, thinking that the plastic bag would provide a low friction surface that would be easy to slide. Some mattresses were air filled. This did not work very well because the sheets were made of a jersey material that stretched easily.

The objective of the research was to find the combination of variables that would minimize the amount of effort required to lift the patient, insert the cassette, remove the cassette, and reposition the patient.

Case Study

Simultaneously, the team wanted to find ways to make the portable x-ray experience more comfortable for the patient. Forces required to insert and remove the cassette were measured with a strain gage. The technologist was also asked to rate the amount of perceived effort required to lift the patient, using a scale patterned after the Borg RPE scale for perceived exertion. One of the team members assumed the role of the patient during the experiment.

Eight iterations of the experiment were conducted testing the combinations shown in Figure 6. Figure 7 shows the results for each iteration in terms of the measured forces to insert and remove the cassette, the perceived effort to lift the patient, and the perceived level of discomfort for the patient.

Of the eight combinations studied, iteration four yielded the best combination from the perspective of both the patient and the caregiver. Modify the Existing Process The team concluded that the best practice would be to place the cassette into a plastic bag and insert it from the side while the patient was laying at 30 degrees. The mattress should be fully inflated and the patient should be lifted using the chux.

With the addition of the chux, the fitted jersey sheet remained in place and the plastic bag slid between the chux and the sheet. The underlying mattress surface was no longer a factor.

  • Of an estimated 6,700,000 surgical procedures, 242 were performed at the wrong site, making this a "rare occurrence;
  • How could this logic be used when reviewing radiographs to reduce errors, particularly for chest x-rays?
  • In other words, it should not be used with unstable patients;
  • As the reading of radiographs is increasingly done through telemedicine, and by clinicians thousands of miles from the location of the patient, there is less ability for radiologist to do a face-to-face consult when questions come up.

The team developed a new standard work flow that incorporated the knowledge gained from the experiment. In addition, a stretching regimen was developed for the start of the day. Figure 8 shows the new procedure, detailing how a two-person team tech A and B should work together at each step. Changes designed to reduce injuries are highlighted.

Team members met with nursing unit managers and clinical nursing specialists to gain their support and determine the best way to make this happen. ICU patients need to be turned every two hours to reduce the risk of hospital acquired pressure ulcers. Consequently, the ICU managers agreed to have nurses place a chux behind patients during a routine turning.

The next step in implementing the new practice was to have the frontline nurses and radiology technologists from the lean team attend ICU staff meetings to provide the background regarding why nurses were being asked to change their practices.

In the meantime, the radiology technologists were being trained on the new procedure and stretching exercises. Substantiate and Enumerate Improvements The new procedures were implemented in April At the time of this writing, Aurora St.

Previously, the average had been nearly one injury a month. Radiologic technologists reported starting the day with a lower level of discomfort that was not increasing during the day. Figure 9 shows these results. The impact of the change was remarkable.

Diagnostic radiology productivity over the past three months was 14 percent higher than pre-event levels, in part because there are no longer technologists working on light duty who are unable to work on portable crews.

Case Study

Another factor contributing to improved productivity is that prior to the adoption of the new practice, teams would often work at a slower pace because one or both team members were experiencing shoulder, neck, or back pain or discomfort.

A training video is being created that will be used with new employees and shared with other Aurora facilities. The vice president of operations summarized the success of this project: I saw radiology techs and nursing staff get together in a partnership to find a way that was more ergonomically correct and also safer and more comfortable for the patient.

Read the Mayo Clinic study about the injury risks associated with performing portable chest x-ray procedures. After a year career in manufacturing, Loose joined Aurora in as operations improvement manager, where he is using Lean Six Sigma concepts to find better ways to deliver healthcare.