The Effectiveness of Service Delivery Initiatives at Improving Patients’ Waiting Times in Clinical Radiology Departments: A Systematic Review

Abstract

We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients' waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre-and post-intervention and the postintervention designs were used in 54 (95 %) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore metaanalysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivityenhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis.

Systematic Review of the Application of Lean and Six Sigma Quality Improvement Methodologies in Radiology

“…Clearly, welldesigned studies are needed. Similar conclusions were reached by five other systematic reviews [7][8][9][10][11] that focused on the applications of Lean, Six Sigma, and Lean Six Sigma within various aspects of health care in the clinical setting. A framework for how to improve the quality of the evidence is provided by this review.…”

“…Title and abstract review yielded 38 studies eligible for full-text review, after which 18 met the inclusion criteria and were included. To further identify relevant studies, a secondary search was performed of the reference lists of relevant systematic reviews [7][8][9][10][11] and the included articles. After applying the inclusion criteria, an additional 4 articles were identified.…”

“…Systematic reviews have been conducted to investigate the effectiveness of these methodologies in various health care settings [7][8][9][10][11], but the benefits within the field of radiology remain unknown. Hence, the aim of this study was to conduct a systematic review to investigate the effectiveness of applying Lean, Six Sigma, or Lean Six Sigma within the field of radiology.…”

Factors associated with No-Shows and rescheduling MRI appointments

“…A number of models were concerned with the management of long waiting-time situations rather than solving the long waiting-list issues for all patients [20–24]. Several studies noted that management of inappropriate resource allocation may be one of the important keys to improving the diagnostic imaging waitlist system for MRI and thus improving quality of services [25–27]. …”

Optimizing the Performance of Magnetic Resonance Imaging Department Using Queuing Theory and Simulation

“…Diagnostic services are among the important hospital services, which are very expensive due to employing advanced facilities and technologies in which making and implementing the right managerial decisions is of high importance. The magnetic resonance imaging (MRI) department is a paraclinical and central one, which provides services to the inpatients and outpatients and helps physicians to diagnose the diseases (5,6).…”