Appropriate Resource Utilization in Portable Noninvasive Vascular Studies: The Role of Disruptive Technology

Abstract

Purpose Common reasons for avoiding portable noninvasive vascular laboratory (VL) studies include degraded study quality, repetitive stress injuries, the wear and tear of equipment, and inefficiency. We examined the efficiency of portable VL studies in the context of productivity and potential loss of revenue. Methods From January 2005 to March 2005, sonographers in the VL recorded the time required to conduct “in-lab” and portable studies with conventional full-size scanners. A blended average based on frequency of portable studies within different areas of the hospital was used to determine the additional time required to conduct a portable study. The sonographer also made a qualitative assessment on the necessity of the portable study in each case. Results The VL performed an average of 31 portable studies (18% of total studies) per week. On average, portable testing increased overall study time by 17.7 min per test and 1.8 h per day, resulting in 9.1 h of additional study time lost per week. The potential increase in study volume could result in incremental annual gross revenue of $41,204 to $77,258 for the VL. The sonographers estimated that 24% to 45% of portable procedures could have been conducted in the lab. Conclusions In addition to suboptimal imaging and sonographer/equipment wear and tear, the current practice of unrestricted portable tests performed with existing bulky equipment is economically inefficient. New “disruptive” technology, leading to high-quality bedside scanning and limiting portable studies to patients who genuinely need it, will allow for greater productivity, decrease wait time for elective outpatients, and generate incremental revenue for the VL.

Comparison of time utilization in an academic inpatient versus an outpatient vascular laboratory

“…Actual scan time occupied less than 40% of the SG's day across the study sites with the rest spent on patient‐ and non‐patient‐related activities. In our previous report, bedside tests took an average of 17.7 minutes more total test time than examinations done in the VL . As mentioned, we instituted a policy of SG performing several tests before returning to the VL to improve productivity.…”

“…SG at two hospitals at our academic medical center and our OPVL located off‐campus were asked to track and log their daily activities over five consecutive weekdays, including time spent scanning, type of test, delays in patient arrival, preparation for the test, computer entry, lunch breaks, and administrative time (patient‐ and non‐patient‐related). Because our previous study showed that a bedside examination added an average of 17.7 minutes per test compared with one done in the VL, we instructed SG to try and perform several bedside tests per trip to maximize productivity …”

“…All things considered, there are opportunities to improve the efficiency of both the OPVL and the IPVL. Further analysis of patient delays, improving transportation of inpatients, administrative assistance, decreasing bedside tests in the IPVL, optimizing scheduling, and reducing the number of no‐shows should improve resource utilization and maintain financial viability.…”

Contribution of positioning to work-related musculoskeletal discomfort in diagnostic medical sonographers

“…Portable examinations, i.e., taking the sonography equipment to the patient, have been linked with increased incidence of musculoskeletal disorders [14]. However, no significant differences were noted in exam efficiency when portable sonographic examinations were completed with laptop-style ultrasound scanners (compact, lightweight) versus conventional mobile ultrasound scanners (full-size ultrasound machine on wheels) [15].…”

Use, misuse, and underuse of work relative value units in a vascular surgery practice

“…An actual cost study with calculations for supplies, salaries, benefits, equipment, and maintenance costs may be required to arrive at a cost for the procedure. 3 This becomes important in several situations:…”