1436 - Quality Improvement Project, Part 1: Improving Timed Efficiency of X-ray Performance Flow in an Outpatient Musculoskeletal Clinic

Objectives: Lags in obtaining x-rays in outpatient musculoskeletal (MSK) clinics cause subsequent delays in diagnosis, patient and provider dissatisfaction from lost time, and decreased efficiency of healthcare delivery. In our outpatient MSK clinic, an encounter must be created before the x-ray is performed. We implemented the Plan-Do-Check-Act method, identifying a potential contribution to such a delay: patient-service-representative (PSR) staff assigned to create encounters had other higher-priority responsibilities including checking patients into clinic or physical therapy. We aimed to decrease average time between x-ray order placement and x-ray encounter creation to less than five minutes within three months.

Design: We worked with the PSR manager to designate one PSR staff member, who prepares next-day patient charts, to undertake x-ray encounter creation beginning 10/17/23. Due to limited improvement, the PSR manager identified yet a different PSR staff member, who schedules outpatient MRIs, to create and prioritize x-ray encounters beginning 2/1/24.

Results: Times from x-ray ordered to x-ray encounter created were reviewed for 275 patients from 9/1/23-4/30/24. There was no significant change in the average time to encounter creation (ATEC) between one month prior and 1.5 months after the first intervention, which decreased from nine to eight minutes. There was no significant change in ATEC one month prior and 1.5 months after the second intervention, which decreased from 10 to nine minutes. However, three months after the second intervention, ATEC decreased to seven minutes.

Conclusions: Improving timeliness of x-rays in outpatient MSK clinics optimizes quality and efficiency of care. Although the goal to decrease ATEC to five minutes in three months was unmet, our data demonstrate that a single staff member who prioritizes encounter creation enhances clinic flow. Additionally, efficiency improves with increased experience. Based on this data, we will continue designating this prioritized role to one individual and collect data over five and seven months.