• Anna M Varughese, Mohamed A Mahmoud, Bernadette L Koch, and Blaise V Jones.
• Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. mohamed.mahmoud@cchmc.org
• Paediatr Anaesth. 2013 Jul 1;23(7):607-13.

ObjectiveWe applied quality improvement methodology to identify unnecessary, redundant parts of processes that can lead to delayed on-time starts for patients scheduled with general anesthesia (GA) in the radiology department.AimTo address the issue of delayed on-time starts by improving work flow for the first patient scheduled with GA.BackgroundUnplanned imaging in a high-volume MRI suite can result in a significant ripple effect throughout the day. Delayed on-time starts can lead to patient, family, and staff dissatisfaction due to significant wait times.Materials And MethodsThe team conducted a 5 month improvement project. Baseline data were obtained from pilot time studies allowed the team to identify reasons why the first case was not starting on time and to identify several key drivers to improve the process. Using the framework of small tests of change or the Plan-Do-Study-Act model, our key interventions primarily focused on standardizing the processes for completing the preimaging evaluation and for anesthesia induction. The primary objective measure of successful on-time start was defined as obtaining the first MRI image within 10 min of the scheduled start time, for the first patients of the day scheduled with GA. The secondary outcome measure was the extent of the delay quantified in minutes.ResultsPrior to the initiation of the project, only 36% of the first patients scheduled with GA each day met the primary objective measure. At the conclusion of the project 84% started on time. The secondary measure also showed significant improvement.ConclusionsProcess improvement projects in anesthesia can yield positive results, using small incremental standardized changes. We used a quality improvement methods to successfully improve on-time start for patients scheduled with GA in high-volume MRI suite.© 2012 John Wiley & Sons Ltd.

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