693 - Quality Improvement Project, Part 2: Addressing Delays in Obtaining X-Rays in the Setting of Outpatient Musculoskeletal clinic

Background: The systems process to obtain imaging in the outpatient musculoskeletal (MSK) clinic involves x-ray order placement by provider, x-ray encounter creation by patient services representative (PSR) staff, and x-ray performance by radiology technician (who cannot perform without an imaging encounter). The delay may be between the order placement to encounter creation, encounter creation to x-ray performance, or both.  In part 2, we focused on the delay between encounter creation and X-ray performance since one possibility may be because radiology technicians may be occupied with tasks on different floors, leading to inefficiencies. 

Objectives: The goal was to reduce delays in X-ray imaging in the outpatient MSK clinic by decreasing the time from order placement to when the X-ray is performed. The target was to reduce this time to under 10 minutes within 1.5 months after implementing changes.

Design: We analyzed X-ray data from 9/1/23 to 4/30/24, focusing on the time between when an X-ray order was created and when it was performed. To address delays, we ensured a technician was consistently present on the 15th floor during high-volume clinic days starting 2/1/24.

Results: After implementing the intervention on 2/14/24, the average time from order placement to X-ray performance decreased from 13 minutes to 12 minutes within 1.5 months. However, by 3 months, the average time improved further to 9 minutes, meeting the target.

Conclusions: The intervention successfully reduced X-ray performance time to the target within 3 months. Initial delays were influenced by high clinic volume, multiple X-ray orders for single patients, and patient readiness issues. To sustain improvements, it is recommended to maintain a technician presence during busy times, despite budget constraints.