BOOKS OF RtfiDIfGS - PAHO/WHO

.oó'io..o. M..:an. V1it. Vol, 0, PP. {5g-lb6. lerogsrlm Pies., 1976. Printed in GfetI Bilnain
PATIENT _LOW ANALYSIS AND THE
l)FlIVFI,¡Y OF RADIOLOGY SERVICEt
BENJAMI N L¿E;, GEORGE REVESZ§, FRANCIS SHEA§
aind ROBERT CALTAGIRONE§
Temíple Universily, Plhiladelphia, PA 19122, U.S.A.
(Received 5 February 1976)
- 108 -
Abstract-in recent years there has been an increased awareness regarding the cost of radiologic health care, and the
patient delays encountered in the delivery to the consumer. The purpose of this paper is to demonstrate that, at least
in one case in the Diagnostic Radiology Departinent al Temple University, the assumplion that better service can be
given to patients provided more technicians and orderlies are available, is not valid. The facts tend to indicate that the
real problem lies in scheduling techniques, and improved utilizalion of available equipment. Therefore, it is safle to
conclude that for improved radiologic services, the emphasis should be directed iowards the design of the management
systems and scheduling techniques, and not the staff andior facilities.
INTRKOU;C'LION
At a time, when there is a continued increase in demand
for health care service,it is assumed that a reason for
inclfrclivc scrvie lo pafients is the shortage of manpower
and facilities. An analysis of Ihe I)i>gnostic Radiology
Department (DRD) at Temple University Hospitai was
organized, searching for reasons associated with the long
waiting times of patients in the DRD and the low
utilization of ecuipment. It has been previously assumed
that betrer service could be presented to the consumers if
more technicians, orderlies and examination rooms were
available at the hospital. However, such a move would
have a tendency to increase the costs of radiologic
services al a time when costs are increasing at an alarming
rate. In many instances, managers suspect reasons for
their inefficient systems performance, but it is only after
an in-depth study is made that the basic causes of the
inefficiency are evident. Moreover, the suspected reasons
appear to be of secondary importance.
In this particular case, the long periods of patient
waiting time cannot be decreased by adding more
technicians or orderlies as some had surmised, but that
patient waiting time can be reduced by improving
scheduling techniques. Better management methods; such
as more sophisticated scheduling algorithms, automated
systems and computer control can be utilized with the
present staff and equipment. The effects will contribute to
decreased patient waiting time, and the total time spent in
the DRD. At the same time, patient service capacity
shouid be increased in the DRD with the present number
of rooms, technicians, orderlies and staff. This increased
cpacity will then enable administrators to accommodate
the expected increase in demand for radiographic services
as predicted in Knowles II, Morgan[2] and National
Advisory Committee on Radiation[3].
Recently, there have been several reports alluding to a
potential shortage of radiologists in thc United States in
the near future. This potenlial shortage is predicted since
the demand for radiologistís' time is increasing al a more
tl'his work w;s supportedl in p;rit hy (¡;tl;' ;M 1454S8-0(.
National Institute of General Medical Scienet,, United States
Public Health Service. All correspondence shoul) be direcled lo
the first author.
tSchool of Business Administration.
§Department of Diagnostic Radiology.
1Table I lists and explains all symbols.
rapid rale than is the supply of radiulogists. Any new
national health insurance program, if enacted, would
presumably cause an even greater inbalance between the
demand for radiological services, and the supply of
radiologisis.
Improvements in DRD can be categorized in three
areas. The first is increased utilization in personnel and
facilities which has been reported by Lindhein[4] and
Revesz et a1.(5,6]. The second area is improvements
attempted by simulation technique. See studies by Covert
et al.[7], Jean et al.[8], Kenny and Murrayl9] and
Lodwick[10]. The third area emphasizing Computer
Scheduling and Control is reported in Donald and
Waxman[Ill, Hansen and Sniderll[2 or Hsish(13].
Computerization of manual methods has demonstrated
that scheduling can also be applied to large departments.
To date, however, no mention has been made of an on-line
scheduling system, which can be dynamically updated as
the patients are processed. In addition, limited research
has been conducted concerning the development of
scheduling rules which have general applicability.
In view of the many possible policies that can be
considered for improving the delivery of radiologic care,
it is necessary to present the data quantitatively for
analytical purposes. Consequently, this paper will investigate
some of the effects of these policies on the DRD. In
most instances DRDs at hospitals are confronted with
similar problems. The methods of providing radiological
services is apparently identical at all departments. The
patient arrives at the department and immediately enters a
sequence of service facilities, which culminates with an
X-ray examination. It should be recognized, however, that
departments may differ in the number of examination
rooms, the procedure used andother non-major facilities. In
most DRDs, however, the patient flow is basically the same.
It appears to be more logical and convincing to analyze the
DRD at Temple University Hospital, using its specific data
and not discuss a hypothetical DRD. Moreover, the
generalized model developed in this study is of sufficient
generality to be associated with the DRDs in most hospitals
with no more than minor modifications.
SYSTEM DESCRIP'lION
The system under study is the Temple University DRD
which has an annual volume of 72,000 X-ray examinations.
The service is provided both for inpatients (IP) and
outpatients (OP), and the ratio of IP/OP is 55145. Figure