Process mapping of PTA and stent placement in a university hospital interventional radiology department

Abstract

ObjectiveTo apply the process mapping technique in an interdisciplinary approach in order to visualize, better understand, and efficiently organize percutaneous transluminal angioplasty (PTA) and stent placement procedures in a university hospital’s interventional radiology department.MethodsAfter providing an overview of seven established mapping techniques for medical professionals, the process mapping technique was chosen and applied in an interdisciplinary approach including referrers (physicians, nurses, and other staff in referring departments, e.g., vascular surgery), providers (interventional radiologists, nurses, technicians, and staff of the angiography suite), and specialists of the hospital’s controlling department.ResultsA generally binding and standardized process map was created, describing the entire procedure for a patient in whom the radiological intervention of PTA or stent treatment is contemplated from admission to the department of vascular surgery until discharge after successful treatment. This visualization tool assists in better understanding (especially given natural staff fluctuation over time) and efficiently organizing PTA and stent procedures.ConclusionProcess mapping can be applied for streamlining workflow in healthcare, especially in interdisciplinary settings. By defining exactly what a business entity does, who is responsible, to what standard a process should be completed, and how the success can be assessed, this technique can be used to eliminate waste and inefficiencies from the workplace while providing high-quality goods and services easily, quickly, and inexpensively.Main Messages• Process mapping can be used in a university hospital’s interventional radiology department.• Process mapping can describe the patient’s entire process from admission to PTA/stent placement until discharge.• Process mapping can be used in interdisciplinary teams (e.g., referrers, providers, and controlling specialists).• Process mapping can be used in order to more efficiently organize PTA and stent placement procedures.• Process mapping can assist in better understanding and efficiently organizing procedures in standardized fashion.

Process Mapping in Healthcare: A Systematic Review

“…Four projects [75][76][77][78] reported both "as-is" and "to-be" maps, while 5 describe the "to-be" process. [79][80][81][82][83] For example, in TDABC projects the analysis is focused on process costs and is mainly completed after the "as-is" process map is created. [84][85][86][87][88][89] In projects implementing evidence-based recommendations, a process analysis was completed before the creation of the ideal or "to-be" process map.…”

“…[64,94,[96][97][98][98][99][100][101][102][103][104] (ii) Inform scope, design, development and evaluation of interventions The identi cation of actual constraints and opportunities within local systems helped assessment of problem areas and development of improvement solutions grounded in research evidence and local knowledge. [68,72,74,80,86,90,[105][106][107] The use of PM before the implementation of information systems (IS) to help project members with diverse backgrounds achieve a shared understanding of the system has been reported as crucial for solving design challenges. [82,[108][109][110][111][112] Some studies describe how PM has also been used to assess actual care processes against recognized evidence-based standards.…”

“…[108][109][110][111][112]115] Studies also describe how greater understanding of different perspectives provided by PM encouraged a culture of ownership and responsibility for improvement work. [35,74,80,86,98,116,117] For example, within ICP projects, PM allowed the clari cation and reassessment of the roles and responsibilities within the team. [79,81,95] Other studies highlight how participation in PM helped to establish sense of urgency in clinicians regarding patient safety issues, thus enhancing their engagement.…”

Lean management in a liaison psychiatry department: implementation, benefits and pitfalls

“…Its usefulness has been demonstrated in medical settings, where it generates enhanced staff understanding and improved, coordinated delivery of care. [1][2][3] Research indicates similar benefits in behavioural crisis units 4 but its use in an emergency department liaison psychiatry setting has not been demonstrated. Although psychiatric patients comprise a minority of emergency department presentations, they require a disproportionate amount of time and resources, which can frustrate emergency department staff and cause negative attitudes towards such patients.…”

Evaluation of a children's hospital's direct admission process to improve outcomes and efficiency of care.

“…This tool allows all the steps that make up a patient's visit visible to everyone (de Bucourt, et al, 2012;Johnson, et al, 2012;Ben-Tovin et al, 2008). To aid the investigation of above topic 5 concerning the process flow of the AEU, a magnetic whiteboard was used with the different process steps labeled on magnets to map out the process, Figure 4.…”