University of Michigan Health System Program and Operations Analysis

Transcription

1 University of Michigan Health System Program and Operations Analysis Evaluating the Capacity Expansion of C.S. Mott Hospital s Pediatric Magnetic Resonance Imaging Unit Final Report To: Patricia Warner Chief Administrative Officer, C.S. Mott Hospital Loree Collett Administrative Director, Children s & Women s Services, C.S. Mott Hospital Jacquelynn Lapinski Project Manager, Children s & Women s Projects, C.S. Mott Hospital Richard Coffey Director, Program and Operations Analysis, University of Michigan Health System From: IOE 481 Project Team 12 Program and Operations Analysis, University of Michigan Health System Zhi Wei Cheng Ai Leen Fung Mingcheng Lim Minjie Yu Date: April 13, 2007

2 Table of Contents Executive Summary Introduction Background Goals and Objectives Current Situation Approach and Methodology Data Collection Obtained Historical Demand Data Interviewed Key Personnel Conducted Benchmarking Comparison Surveyed Patients Data Analysis And Findings from Historical Data Background of Demand for MRI Demand Forecast Capacity Forecast Demand and Capacity Comparison Findings from Interviews Findings from Benchmarking Findings from Surveys Conclusions Recommendations Action Plan Appendix A - List of Interview Questions for the Identified Departments Appendix B - List of Benchmarking Questions

3 Appendix C - MRI Patient Survey Appendix D - Background of Demand for MRI Appendix E - Calculation of Demand Forecast Appendix F - Calculation of Capacity Forecast Appendix G - Demand and Capacity Forecast Comparison Appendix H - Summary of Interviews Appendix I - Benchmarking Comparison Appendix J - Survey Results

4 Executive Summary A Magnetic Resonance Imaging (MRI) machine was acquired by the University of Michigan s C.S. Mott Children s Hospital in 2006, and officially operates on Mondays to Fridays, 7.00 am to 6.30 pm. The hospital s Chief Administrative Officer (CAO) has reported that C.S. Mott plans to extend the machine s operating hours to Mondays to Fridays, 7.00 am to pm, and Saturdays and Sundays, 7.00 am to 7.00 pm as current demand exceeds the machine s capacity. In addition, four other expansion options are being considered to meet growing demand until The four options are to: - expand the operating hours to 24 hours, 7 days a week - triage older patients who do not require sedation and send them to East Ann Arbor Health Clinic for MRI scans on: an existing MRI machine a newly set up mobile MRI unit - install an MRI unit on stilts at the Mott Hospital. Background There has been an increasing demand for the use of the C.S. Mott s MRI to help physicians diagnose patient conditions more efficiently and effectively. The Chief Administrative Officer of the Mott Hospital has reported that the MRI unit is being utilized to its limit. The hospital has met the volume requirement for a Certificate of Need (CON) for a second MRI unit but does not have sufficient floor space in the main Mott hospital building to accommodate it. At the same time, the new C.S. Mott Hospital is being constructed and is expected to be completed by This new hospital has the capacity to support up to 4 MRI machines; hence, when the new hospital is completed, the lack of space will not be an issue. To help meet the growing demand while the new hospital is being constructed, the hospital administration is exploring the aforementioned four options. Hence, our team explored the options and provided recommendations based on our findings and analysis. The MRI machine at the Mott Hospital was available for use for 3,120 hours in year Historical data shows that the annual scan duration from years 2000 to 2004 ranged between 2,133 to 2,550 hours. The total duration of scans for year 2006 exceeds the annual available usage time of the MRI machine at the Mott Hospital based on the official operation hours. Hence, this MRI machine is currently utilized to its maximum capacity. However, the demand is observed to be growing annually, and the Mott Hospital foresees unmet demand if the MRI machine is kept at its current capacity. Approach and Methodology First, we collected data, including obtaining historical data of MRI scans of a sample size of 28, 752 scans from year 2000 to 2006 from the Radiology department, interviewed key personnel from relevant departments, benchmarked against other children s hospitals and surveyed patients. Next, we used the data collected from the historical data to forecast the demand for MRI scans at Mott in terms of total duration per year from year 2007 to We forecasted the capacities for the various options based on official operating hours. The data obtained from interviews, benchmarking and surveys were used to provide a qualitative perspective for the various options to assess their feasibility. Findings and Conclusions Based on our demand and capacity forecasts, we have found the implementation of the proposed expansion from now until 2010 will sufficiently meet patient demand. However, the option to send non-sedated patients to an existing MRI machine at the East Ann Arbor Health Center (EAA) should 4

5 be implemented and ready by the end of 2009 to meet the demand in 2010 and Our findings indicate that the alternative options and combinations considered will result in overcapacity. While analyzing quantitative historical demand data, we simultaneously interviewed key personnel from various departments. Through these interviews, we found that most of representatives from the departments were agreeable to the proposed expansion, as well as sending non-sedated patients to the EAA. None of the departments were agreeable to the option of having a 24 hours and 7 days a week due to staffing issues and difficulties. The survey results reflect that 43.5% of patients were uncomfortable or very uncomfortable with coming to the hospital for a scan after pm,. Approximately 35.3% of the patients surveyed were comfortable or very comfortable with coming to the hospital for a scan after pm, while 21.2% of patients surveyed were neutral. As the demand for MRI scans increases beyond 2011, and if the new Mott Hospital is unable to support the demand, extending operating hours to 24 hours and 7 days a week may be a possibility as another established children s hospital, the Children s Hospital of Philadelphia (CHOP) who has been conducting dedicated pediatric MRI scans since 1990, have implemented such operating hours successfully. Recommendations From our findings and conclusions, we propose that the expansion should occur in two phases: 1) Implement the proposed operating hours to Mondays to Fridays, 7.00 am to pm and Saturdays and Sundays, 7.00 am to 7.00 pm immediately. 2) Implement the option of sending non-sedated patients to the existing MRI facility in EAA by the end of 2009, in addition to Phase 1. 5

6 1.0 Introduction The University of Michigan s C.S. Mott Children s Hospital has one Magnetic Resonance Imaging (MRI) machine which was acquired in The current MRI machine operates Mondays to Fridays, 7.00 am to 6.30 pm. The hospital s Chief Administrative Officer (CAO) has reported that current demand exceeds the machine s capacity and has decided to extend the machine s operating hours. The hospital is also considering four other options in addition to the extension of operating hours to Mondays to Fridays, 7.00 am to pm, and 7.00 am to 7.00 pm on Saturdays and Sundays, that may enable C.S. Mott Children s Hospital to meet the demand until The four options are: - expand the operating hours to 24 hours, 7 days a week - triage older patients who do not require sedation and send them to East Ann Arbor Health Clinic for MRI scans on an existing MRI machine a newly set up mobile MRI unit - install an MRI unit on stilts at the Mott Hospital. The purpose of this final report is to present our team s findings, forecasts of patient demand and staffing requirements, as well as recommend the best option that would best meet the forecasted demand. 2.0 Background The C.S. Mott Hospital was ranked by Child Magazine as the best children s hospital in the United States for the state of Michigan in 2005, providing services such as the Congenital Heart Program and the Pediatric Trauma Center, which are scarcely available anywhere else in the state. These special services require the usage of MRI to help diagnose patients conditions and further develop these services. The MRI is extremely popular as a diagnostic tool because it shows both moving form and function, and reduces the patients risk to radiation compared to the alternatives such as Computed Tomography (CT) Scan and X-rays. Therefore, the CAO reported that the hospital purchased an MRI unit in 2005 to help eliminate the risks involving moving patients from Mott Hospital to the main Radiology Department located in the University Hospital. There has been an increasing demand for the use of the C.S. Mott s MRI to help physicians diagnose patient conditions more efficiently and effectively. The Chief Administrative Officer of the Mott Hospital has reported that the MRI unit is being utilized to its limit. The hospital has met the volume requirement for a Certificate of Need (CON) for a second MRI unit but does not have the appropriate floor space in the main Mott hospital building to accommodate it. At the same time, the new C.S. Mott Hospital is being constructed and is expected to be open and available for use by This new hospital has the capacity to support up to 4 MRI machines; hence, when the new hospital is completed, the lack of space will not be an issue. To help meet the growing demand while the new hospital is being constructed, the hospital administration is exploring the four options mentioned earlier. Hence, our team explored the options and provided recommendations based on our findings and analysis. 2.1 Goals and Objectives The primary goal of this project was to examine and evaluate the aforementioned options and recommend the option that will best meet the hospital s MRI demand from now until To help us achieve this primary goal, the team performed the following tasks: 6

7 Evaluated the patient demand, staffing, safety and cost factors of each option Performed benchmarking analysis of C.S. Mott Hospital MRI usage with other children s hospitals With this primary goal in mind, we explored the options listed below in addition to the proposed expansion in terms of staffing and scheduling requirements, as well as patient safety: Proposed: extend current operating hours to Mondays to Fridays, 7.00 am to pm, and 7.00 am to 7.00 pm on Saturdays and Sundays; Option 1: or create a virtual MRI machine by extending the operating hours of the current MRI machine to 24 hours, 7 days a week. The second option also has 2 parts: Option 2A: triage patients aged 13 and above who will not be sedated during an MRI scan to the East Ann Arbor Health Center (one of the University Hospital s satellite clinics), where the patient will undergo an MRI scan on an existing MRI machine or; Option 2B: set up a new mobile MRI unit in the East Ann Arbor Health Center and triage the same type patients for MRI scans on the new machine. Option 3: The last option is to install a modular MRI machine on stilts at Mott Hospital. From these options, we developed recommendations and: Verified and assessed the implications of all the options Determined which sequence or combination of options will best help Mott Hospital meet the demand until Current Situation The MRI machine at the Mott Hospital is currently open for patient use from Mondays through Fridays, 7.00 am to 6.30 pm. Therefore, the machine is available for use for 3,600 minutes a week, which translates to 3,120 hours a year. Historical data shows that the annual scan duration from years 2000 to 2004 ranged between 2,133 to 2,550 hours. With the introduction of the MRI machine at the Mott Hospital in 2005, the duration of scans per year increased from years 2005 to 2006 and ranged between 2,995 minutes to 3,592 hours. The MRI machine operated at 118% of its capacity in 2006 and exceeds the annual available usage time of the MRI machine at the Mott Hospital based on the official operation hours. Hence, this MRI machine is currently utilized to its maximum capacity. However, the demand is observed to be growing annually, and the Mott Hospital foresees unmet demand if the MRI machine is kept at its current capacity. 4.0 Approach and Methodology We performed this project in three main phases: 1. Data collection Collecting historical data 7

8 Interviewing key personnel Benchmarking analysis Surveying patients 2. Data analysis 3. Findings and Conclusions 4.1 Data Collection Our team carried out the data collection in four areas: Obtained Historical Demand Data Interviewed Key Personnel Conducted Benchmarking Comparison Surveyed Patients Obtained Historical Demand Data During the data collection phase, between early February and late March, our team obtained historical data of a sample size of 28, 752 scans from the University of Michigan Hospital s Radiology Department. The data collected pertains to patients aged 18 and younger who came to University Hospital, Mott Hospital, or East Ann Arbor Health Center for an MRI scan from years 2000 through 2006 and includes: Patient medical record number Patient visit number Patient date of birth Patient age Patient gender Patient type, i.e. whether the patient was an inpatient, outpatient, or an emergency patient Patient sedation Commencement date and time of scan Completion date and time of scan Duration of scan Type of scan Performing resource used for the scan 8

9 4.1.2 Interviewed Key Personnel Between February and March, our team conducted interviewed key personnel from: the Pediatric Cardiology & Congenital Heart Program, Radiology Department, Pediatric Anesthesiology and the Neurosurgery Department. These interviews were conducted either through a face-to-face interview or via s. These interviews enabled the team to identify factors affecting future demand and issues affecting a new mobile MRI at the East Ann Arbor Health Center, and also allowed the team to identify potential improvements in the current system. A list of the interview questions can be found in Appendix A Conducted Benchmarking Comparison The team also conducted a benchmarking comparison of the pediatric cardiac MRI management process in three other Children s hospitals: the Children s Hospital of Philadelphia, the Boston Children s Hospital and the Cincinnati Children s Hospital. We benchmarked the pediatric cardiac MRI program of the Mott Hospital against these children s hospitals based on staffing requirements, the number of MRI machines available, the hours of operation of the MRI, and the relationship between sedation and non-sedation during the MRI process. We normalized the data using the number of scans per machine and compared the pediatric cardiac MRI program of the Mott Hospital against a similar congenital heart program or pediatric trauma center at these children s hospitals to ensure a fair and accurate comparison. We obtained a list of the contact information of the key personnel at our benchmarking institutions from Ms. Dawn Whitford, Administrative Manager Associate in Healthcare, Department of Pediatrics. A list of the benchmarking questions can be found in Appendix B. We obtained the responses to the benchmarking questions via with the key contact personnel from these hospitals Surveyed Patients The team enlisted the help of the MRI clerks to conduct a patients survey for three weeks from 12 th March 2007 to 30 th March The MRI clerks conducted a pilot survey run on 8 th March 2007 to 9 th March 2007 to assess the survey s completeness. The aim of the survey was to validate the historical data that we received from the Radiology Department and to gather patients feedback on the options proposed, such as asking how comfortable they are if scans are scheduled after 10pm as well as being referred to EAA for scans. We surveyed 98 patients in total. Please refer to Appendix C for a sample of the survey. 4.2 Data Analysis And Findings from Historical Data During the data analysis phase, we analyzed historical and current demand for MRIs to identify statistical trends, and forecasted the demand for the different types of MRI diagnosis usage from 2007 until We also predicted future demand using a weighted factor system, which accounts for factors such as historical demand, trend, seasonality, and opinions of key personnel Background of Demand for MRI We extracted relevant information from each data category using Excel, and used statistical software, Minitab, to identify data trends, breakdown and observations from the historical data that we obtained from the University of Michigan Hospital s Radiology Department. We obtained the following information and corresponding observations for years 2000 to 2006: 9

10 1) Annual breakdown of scan types The percentages of brain and spine scans range from 72.6% to 75.7% of total scans per year, and have consistently formed the bulk of MRI scans for all years. The total number of scans per year exhibits a positive trend of a 9.5% average growth with a standard deviation of 2.7%. 2) Annual duration of MRI usage Between 2000 and 2004, the total duration of scans per year was relatively stable, ranging from 2,133 to 2,542 hours. Between 2004 and 2006, the total duration of scans per year increased from 2,542 hours to 3,685 hours due to the introduction of the MRI machine in the Mott Hospital. In 2006, 87.9% of the total scan duration for the year was contributed by the MRI machine in Mott Hospital. 3) Annual breakdown of patient type (inpatient, outpatient or emergency patient) The percentage of outpatients increased from 81.5% in 2003 to 90.3% in Emergency patients make up less than 2.5% of patients seen per year. 4) Annual breakdown of patient age group The average age of patients ranged between 8.49 and 8.8 years of age from years 2000 to ) Annual breakdown of number of new and repeat patients The number of repeat patients stabilizes at approximately 38-40% from 2003 to ) Annual breakdown of the number of scans per unique visit The average number of scans per unique visit ranges between 1.53 and The breakdown of the number of scans is fairly consistent, and approximately 67 to 71% of all unique visits involve only 1 scan. 7) Annual breakdown of the number of MRI scans per location of the MRI machine From 2000 to 2006, the total number of scans per year exhibits a positive trend, with a slight growth spurt in 2005 and 2006 due to the introduction of the MRI machine in the Mott Hospital. In 2006, 86.3% of all MRI scans were performed by the MRI machine in the Mott Hospital. 8) Annual breakdown of duration per scan per unique visit The two most common scan durations are 0-30 minutes and minutes. The 0-30 minutes scan duration makes up 25.9% of all scan durations, and the minutes scan duration makes up 53.5% of all scan durations in Approximately 5% of the total scan duration exceeded 90 minutes. 9) Annual breakdown of duration per unique visit For each duration per unique visit, about 45% of each unique visit takes minutes. About 6-7% of total unique visits exceed 120 minutes. 10

11 We also analyzed the demand of the MRI machine at Mott for 2006 by looking at the total number of scans and total duration of scans per month. This analysis and the pie charts of the data breakdown and our observations of the data trends can be found in Appendix D Demand Forecast We forecasted the demand for MRI scans from 2007 to 2011 by calculating the total duration of scans per year Calculation of 2-Year Volume Weighted Average Duration After extracting the average duration per scan per unique visit for each exam description from the historical data, we did the following: Categorized each exam description into 13 categories: Brain, Spine, Low Extremities, Head/Neck, Abdomen, Cardiac, Chest, Outside Read, Pelvis, Research, Spectroscopy, Upper Extremities and Miscellaneous. Calculated the average duration per scan per unique visit for each year for each category. Consolidated the 13 categories into 5 main categories: Brain, Spine, Low Extremities, Head/Neck and Others based on the number of scans per year. Calculated the average duration per year for Others by summing the products of average duration of each type of scan and number of each type of scan, and then dividing the sum by the total number of scans included. Used these 5 categories to calculate the 2-Year Volume Weighted Average Duration (2Yr VWAD). A summary of the 2Yr VWAD is shown in Table 1. Table 1. 2Yr VWAD Exam Description 2 Yr VWAD (minutes) BRAIN 38.5 SPINE 34.4 LOW EXTREM 50.1 HEAD/NECK 33.3 OTHERS 49.4 Source: Calculated from historical data obtained from Radiology Calculation of Total Number of Scans We calculated the annual yearly growth of the 5 main types of scans from 2001 to These types of scans are: Brain, Spine, Low Extremities, Head/Neck and Others. Taking the average of the annual growth from 2001 to 2006, we extrapolated the demand for each type of scan by multiplying the average annual growth from 2001 to 2006 with the previous year s demand. A summary of the total number of scans is shown in Table 2. 11

12 Table 2. Total Number of Scans Per Year Year Brain Spine Low Extrem Head/Neck Others Grand Total 07 2,364 1, , ,570 1, , ,794 2, , ,037 2, ,000 7, ,301 2,545 1, ,124 8,441 Source: Calculated from historical data obtained from Radiology Calculation of Total Duration Per Year Multiplying the average duration of each type of scan with the total number of each type of scans per year, we obtained the total duration of scans per year. A summary of the total duration of each type of scans per year is shown in Table 3. Table 3. Total Duration of Scans Per Year Year Brain Spine Low Extrem Head/Neck Others Grand Total 07 91,062 62,497 29,617 11,140 34, , ,986 68,007 33,902 12,048 39, , ,598 74,004 38,808 13,031 43, , ,961 80,529 44,423 14,093 49, , ,137 87,629 50,851 15,243 55, ,347 Source: Calculated from historical data obtained from Radiology A detailed description of the methodology used to calculate the forecast of the demand for MRI scans at the Mott Hospital from year 2007 to 2011 can be found in Appendix E. Figure 1 shows the historical demand from years 2000 to 2006 and our forecasts of demand from years 2007 to 2011 based on the historical demand. 12

13 Patient Scan Duration (Mins) Year Figure 1. Pediatric MRI Demand Growth Forecast Source: Calculated from historical data obtained from Radiology Capacity Forecast We calculated the available hours of usage of the MRI machine at Mott based on its official hours of operation, and converted this time duration into the total available usage time per year in minutes. Using this method, we assessed the capacities provided by the expansion options according to the available usage time in number of minutes per year, from years 2007 to To find the optimal expansion plan, we performed a scenario analysis to assess new capacities that different combinations of Mott s proposed expansion and the four options would provide and determined the combination that will meet projected patient demand from now until Table 4 shows the proposed and expansion plan and the additional expansion options, and Table 5 shows the results of our scenario analysis, including the forecasted new capacity for each combination of options. 13

14 Table 4. Description of Expansion Plan and Options Type of Expansion Description Current Monday - Friday 7.00 am - 630pm Proposed Option 1 Option 2A Option 2B Option 3 Extension of MRI hours to Monday - Friday 7.00 am pm, Saturday & Sunday 7.00 am 7.00 pm Virtual MRI - 24h, 7 days a week Existing MRI at EAA (assume 50% usage, M-F 7am-7pm, Sat & Sun 730am- 430pm) New mobile MRI at EAA based on extended hours New MRI on stilts based on extended hours Table 5. Forecasted capacity of scenarios Type of Expansion Total Available Time minutes/week minutes/year % increase Current 3, ,200 - Proposed 5, ,880 65% Option 1 (includes Proposed) 10, , % Proposed + Option 2A 8, , % Proposed+ Option 2A + Option 1 14, , % Proposed + Option 2A + Option 2B 14, , % Proposed + Option 2A + Option 3 14, , % Proposed + Option 2B 11, , % Proposed + Option 3 11, , % Source: Calculated from historical data obtained from Radiology A detailed description of the methodology used to calculate the forecast of the capacity created using types of expansion described in Table 5 for MRI scans at the Mott Hospital from year 2007 to 2011 can be found in Appendix F Demand and Capacity Comparison The current MRI machine is utilized at 118% of its maximum capacity based on the demand data in year Assuming that all options work at only 100% capacity, the proposed expansion needs to be implemented immediately to boost capacity to 308, 880 minutes per year, and should be sufficient to meet the demand for scans until year However, by 2009, the second phase of expansion of triaging and sending non-sedated patients to the EAA (Option 2A) should be implemented to further boost capacity to 430, 560 minutes per year. This should be sufficient to meet demand for scans until 2011 based on our demand forecast. By implementing the proposed expansion of extending current operating hours to Monday to Friday, 7.00 am to pm and Saturdays and Sundays, 7.00 am to 7.00 pm and Option 2A, Mott can take advantage of existing physical resources and this also enables for organic growth of capacity. As observed in Figure 2, the proposed expansion will support patient demand for MRI scans until Hence, by 2009, Mott should begin to implement Option 2A to meet the demand in 2010 to

15 750 Patient Scan Duration (Mins '000) Current Proposed Proposed + Option 1 Option 2A (includes Proposed) Proposed + Option 2B Proposed + Option 3 Proposed + Option 2A + Option 2B Proposed + Option 2A + Option 3 Proposed+ Option 2A + Option 1 Figure 2. Forecasted Demand vs. Forecasted Capacity for Options Combinations Source: Calculated from historical data obtained from Radiology Figure 2 shows that implementing Options 1, 2B and 3 will lead to excess capacity. The construction of the new Mott Hospital would have been completed when demand reaches a level that will necessitate further expansion. Option 1 uses the existing MRI machine at Mott but places a larger strain on human resources. Option 2B and 3 however, are capital intensive and involve the procurement of a new MRI. A summary of the demand and capacity forecast comparison can be found in Appendix G Findings from Interviews In general, none of the departments that were interviewed supported the option of the MRI operating 24 hours, 7 days a week. The Department of Anesthesiology has stated its preference for the East Ann Arbor option and is willing to support it with staffing but requires funding for new equipment and requests to be given 6-8 months notice for any increase of MRI hours to hire new staff. In addition, if a new MRI was to be built at the East Ann Arbor Health Center, the Associate Chair of the Department of Anesthesiology requests that his input be considered on where the MRI be placed to optimize the sedation process involved. We have learned from the interviews that though having an MRI on stilts at the Mott Hospital is possible, the lack of space required for expansion of the recovery room to handle the increased patient load will make this option infeasible. Both the neurosurgery and congenital heart program requests that qualified radiologists/ cardiologist be present during scans and ensure that they understand the scans purpose to avoid obtaining irrelevant or unclear image scans. The options comparison from the interviews conducted can be found in Appendix H Findings from Benchmarking In comparing Mott s pediatric MRI operation with that of the Children s Hospital of Philadelphia (CHOP), a few main differences were observed. The main differences are: 15

16 1) CHOP has 5 MRI machines used for Pediatric scans; the first machine has been in place since ) CHOP currently has longer operating hours and available staff to operate the machines around the clock, 24 hours 7 days a week with available technicians, nursing and physician support. 3) With 5 machines, CHOP is focused on improving operational efficiencies before purchasing of a new unit. 4) There were 3,447 scans per machine for 2006 at CHOP, while there were 4,568 scans for the dedicated Mott MRI, as shown in Table 6. Table 6. Number of Scans per Machine CHOP Year Total # of scans 15,359 16,053 18,213 Per machine 3,072 3,211 3,643 Mott (only 1 machine) # of scans 4,568 As the demand for MRI scans increases beyond 2011, and if the new Mott Hospital is unable to support the demand, extending operating hours to 24 hours and 7 days a week may be a possibility as CHOP has been conducting dedicated pediatric MRI scans since 1990, and has implemented such operating hours successfully. A complete benchmarking comparison table can be found in Appendix I Findings from Surveys We concluded that our survey results verify the historical data given to us by the Department of Radiology. Approximately 65% of the patients came in for Cranial scans and that only 3% of the patients were for Cardiac scans. Approximately 95% of the patients surveyed were outpatients and 62% of patients surveyed required sedation. The average age was 10.4 years old. The results showed that 67% of the patients are agreeable being scheduled for scans after 10pm and that 66% are agreeable with being referred to East Ann Arbor Health Center for MRI scans. We recommend that further studies be conducted to investigate patients reason for their willingness to be scheduled for scans after 10pm and how late beyond 10pm are they comfortable with. We also recommend that the Hospital educate the patients about the advantages of being referred to East Ann Arbor Health Center such as free parking and easier highway access. Please refer to Appendix J for the complete summarized survey results. 4.3 Conclusions Based on our demand and capacity forecasts, we have found that the implementation of the proposed expansion of extending current operating hours to Monday to Friday, 7.00 am to pm and Saturdays and Sundays, 7.00 am to 7.00 pm from now until 2010 will sufficiently meet patient demand. However, the option of sending non-sedated patients to an existing MRI machine at the EAA should be implemented and ready by the end of 2009 to meet the demand in 2010 and The alternative options and combinations considered will result in overcapacity. Through the interviews with the key personnel from various departments, we found that most of them were agreeable to the proposed expansion, as well as sending non-sedated patients to the EAA. None of the departments that were interviewed supported the option of having the MRI operate 24 hours, 7 days a week due to staffing issues and difficulties. 16

17 The survey results reflect that a higher percentage of patients that were uncomfortable or very uncomfortable with coming to the hospital for a scan after pm, i.e. 43.5%. Approximately 35.3% of the patients surveyed were comfortable or very comfortable with coming to the hospital for a scan after pm, while 21.2% of patients surveyed were neutral. The benchmarking data remains inconclusive as we have not received a response from the Boston Children s Hospital nor the Cincinnati Children s Hospital. As the demand for MRI scans increases beyond 2011, and if the new Mott Hospital is unable to support the demand, extending operating hours to 24 hours and 7 days a week may be a possible expansion option as another established children s hospital such as the Children s Hospital of Philadelphia has already implemented these hours. 5.0 Recommendations From our findings and conclusions, we propose that the expansion should occur in two phases: 1) Implement the proposed operating hours to Mondays to Fridays, 7.00 am to pm and Saturdays and Sundays, 7.00 am to 7.00 pm immediately 2) Implement the option of sending non-sedated patients to the existing MRI facility in EAA by the end of 2009, in addition to Phase Action Plan To ensure that the demand for MRI scans is met from years 2007 to 2011, Mott should proceed with the two phases that we proposed in our recommendations. Table 7. Action Plan Time Present (2007) Present (2007) Present (2007) By end of 2009 Task Increase operating hours to Mondays to Fridays, 7.00 am to pm, Saturdays and Sundays, 7.00 am to 7.00 pm Affected departments to begin recruitment for additional staff Form a team to do the following: Inform patients about new operating hours Enable building access due to new hours Investigate changes to computer schedules Identify any other potential issues that may arise Start sending non-sedated patients to existing MRI facility in EAA in addition to maintaining the operating hours recommended in Phase 1 Based on the action plan shown in Table 7, capacity will be boosted to 308, 880 minutes/year by 2007, and 430, 560 minutes/year by the end of The capacity increases in both phases will ensure that the growing demand until 2011 will be satisfied. 17

18 Appendix A - List of Interview Questions for the Identified Departments 1. Radiology: What is the age range of the patients seen by radiology? What are the operating hours of radiology? (current vs. proposed) Do you work beyond the operating hours? If so, how often and until what time? How many types of MRI machines does radiology have? What types of machines are they? (64-slice/8-slice) What is the current capacity of these machines? Are there any restrictions on patients who cannot do a MRI scan? (such as age limits, physical conditions, etc.) Do you have a breakdown of the frequency of referrals by departments? What are the types of MRI scans that radiology performs? For each type of these MRI scans, is there a specific machine that can only be used for the scans? (or can a general MRI machine be used) Do you have a breakdown of the frequency of MRI scans and the types of MRI scans? Do you have a breakdown of percentage of patients who need to be anaesthetized based on type of MRI scan? Is there any seasonality or trend affecting the demand of MRI scans? For each type of MRI scan, what are your staffing requirements like? On average, how long does each type of MRI scan take? For each type of MRI scans, what are the staffing requirements? (such as cardiologist, radiologist, anesthesiologist, neurosurgeon, etc.) What is your current staffing? How many shifts do you have? How many staff per shift is there? What types of staff? How much does it cost to hire a new radiologist? How much does it cost to extend the working hours for a radiologist? (if the operating hours for the MRI machine are extended) What percentage of your MRI scans are inpatients? What percentage of your MRI scans are outpatients? Is there sufficient capacity in the recovery room for anaesthetized patients? Is the recovery room shared by other machines, i.e. CT scans? On average, what is the current lead time for patients getting an MRI scan? How satisfied are you with the current scheduling time for patients getting an MRI scan? What is your opinion on extending the operating hours of the current MRI machine to reduce scheduling time? What is your opinion on sending outpatients to East Ann Arbor Health Center to get an MRI scan if it helps reduce scheduling time? What improvements, ideas do you have on helping to reduce scheduling time? Are there any key issues related to taking an MRI scan that apply only to radiology? Does the existing MRI machine at the East Ann Arbor Health Center carry out tests for only adults or for pediatrics as well? 2. Pediatric Cardiology & Congenital Heart Program: How many staff do you have in total now and what kind of staff do you have (i.e. clerks, cardiologists, etc) What is the age range of the patients seen by pediatric cardiology? 18

19 Do you have a breakdown of frequency and patient age? What kind of support do you provide to existing patients who become adults? What percent of all pediatric cardiology patients receive MRI referrals? What are the types of MRI scans that pediatric cardiology refers? Is there any seasonality or trend affecting the demand of MRI scans? For each type of MRI scan, what are your staffing requirements like? How much does it cost to hire a new cardiologist? We understand the department is hiring a new cardiologist. When is the new cardiologist expected to start work? And does the department plan to hire any more from now until 2011? How much does it cost to extend the working hours for a cardiologist? (if the operating hours for the MRI machine are extended ) Current MRI hours: Mondays to Fridays, 8am to 5pm (for sedated patients) Mondays to Fridays, 5pm to 9pm & Saturdays, 7am 7pm (for non-sedated patients) Proposed new hours: Mondays to Fridays, 7am to 10pm (for sedated patients) Saturdays and Sundays, 7am to 7pm on (for non-sedated patients) What is your opinion on extending the operating hours of the current MRI machine to the hours stated in the previous question? Especially in terms of patient safety, equipment cost, staffing requirements and any new physical space required? What is your opinion on sending outpatients to East Ann Arbor Health Center to get an MRI scan if it helps reduce scheduling time? Especially in terms of patient safety, equipment cost, staffing requirements and any new physical space required? What is your opinion in having the Mott MRI operating 24 hours, 7 days a week? Especially in terms of patient safety, equipment cost, staffing requirements and any new physical space required? Are there any key issues relating to taking an MRI scan that apply only to pediatric cardiology? 3. Pediatric Anesthesiology: What is the age range of the patients seen by pediatric anesthesiology? What types of MRI scans does pediatric anesthesiology participate in? For each type of these MRI scans, is there a specific machine that can only be used for the scans? (or can a general MRI machine be used) What is your current staffing like? How many shifts do you have? How many staff per shift is there? What types of staff? How much does it cost to hire a new anesthesiologist? How much does it cost to extend the working hours for an anesthesiologist? (if the operating hours for the MRI machine are extended) How often do you see inpatients doing an MRI? How often do you see outpatients doing an MRI? How satisfied are you with the current scheduling time for patients getting an MRI scan? What is your opinion on extending the operating hours of the current MRI machine to reduce scheduling time? What is your opinion on sending outpatients to East Ann Arbor Health Center to get an MRI scan if it helps reduce scheduling time? What improvements, ideas do you have on helping to reduce scheduling time? 19

20 Are there any key issues relating to taking an MRI scan that apply only to pediatric anesthesiology? 4. Department of Pediatrics: What is the age range of the patients in the department of pediatrics? What types of MRI scans does the department of pediatrics refer? For each type of these MRI scans, is there a specific machine that can only be used for the scans? (or can a general MRI machine be used) Do you have a breakdown of the frequency of MRI scans and the types of MRI scans? How often do you send inpatients for an MRI? How often do you send outpatients for an MRI? On average, what is the current scheduling time for patients getting an MRI scan? How satisfied are you with the current scheduling time for patients getting an MRI scan? What is your opinion on extending the operating hours of the current MRI machine to reduce scheduling time? What is your opinion on sending outpatients to East Ann Arbor Health Center to get an MRI scan if it helps reduce scheduling time? What improvements, ideas do you have on helping to reduce scheduling time? Are there any key issues relating to taking an MRI scan that apply only to the department of pediatrics? 5. Hospital Finance: What is the budget for a new MRI until 2011? Do you have a breakdown of revenue/costs for the different types of MRI scans? (Are the costs related to time or type of procedure?) How much does it cost to hire a new: i. Radiologist ii. Anesthesiologist iii. Cardiologist iv. Clerical assistant v. Technician/Technologist vi. Nurse How much does it cost to extend operating hours of the MRI machine? i. Machine costs ii. Radiologist iii. Anesthesiologist iv. Cardiologist v. Clerical assistant vi. Technician/Technologist vii. Nurse What is your opinion on extending the operating hours of the current MRI machine to reduce scheduling time? What is your opinion on sending outpatients (if any) to East Ann Arbor Health Center to get an MRI scan if it helps reduce scheduling time? What improvements, ideas do you have on helping to reduce scheduling time? 6. Pediatric Intensive Care Unit: What is the age range of the patients in the pediatric intensive care unit? 20

21 What types of MRI scans does the pediatric intensive care unit refer? For each type of these MRI scans, is there a specific machine that can only be used for the scans? (or can a general MRI machine be used) What is your current staffing like? How often do you send inpatients for an MRI? What staffing implications are there for sending a patient to have an MRI scan? (i.e. to prepare patient for MRI, accompany patients, etc.) On average, what is the current scheduling time for patients getting an MRI scan? How satisfied are you with the current scheduling time for patients getting an MRI scan? What is your opinion on extending the operating hours of the current MRI machine to reduce scheduling time? What improvements, ideas do you have on helping to reduce scheduling time? Are there any key issues relating to taking an MRI scan that apply only to the pediatric intensive care unit? 7. Neo-natal Intensive Care Unit: What is the age range of the patients in the neo-natal intensive care unit? What types of MRI scans does the neo-natal intensive care unit refer? For each type of these MRI scans, is there a specific machine that can only be used for the scans? (such as one which can fit a special incubator or can a general MRI machine be used) What is your current staffing like? How often do you send inpatients for an MRI? What staffing implications are there for sending a patient to have an MRI scan? (i.e. to prepare patient for MRI, accompany patients, etc.) On average, what is the current scheduling time for patients getting an MRI scan? How satisfied are you with the current scheduling time for patients getting an MRI scan? What is your opinion on extending the operating hours of the current MRI machine to reduce scheduling time? What improvements, ideas do you have on helping to reduce scheduling time? Are there any key issues relating to taking an MRI scan that apply only to the neo-natal intensive care unit? 8. Neurosurgery: What types of MRI scans does the neurosurgery department refer? Do you have a breakdown of the frequency of MRI scans and the types of MRI scans? How many neurosurgeons are there? How much does it cost to extend the working hours for a neurosurgeon? (if the operating hours for the MRI machine are extended) Current MRI hours: Mondays to Fridays, 8am to 5pm (for sedated patients) Mondays to Fridays, 5pm to 9pm & Saturdays, 7am 7pm (for non-sedated patients) Proposed new hours: Mondays to Fridays, 7am to 10pm (for sedated patients) Saturdays and Sundays, 7am to 7pm on (for non-sedated patients) How often do you send inpatients for an MRI? How often do you send outpatients for an MRI? 21

22 What is your opinion on extending the operating hours of the current MRI machine to the hours stated in the previous question? Especially in terms of patient safety, equipment cost, staffing requirements and any new physical space required? What is your opinion on sending outpatients to East Ann Arbor Health Center to get an MRI scan if it helps reduce scheduling time? Especially in terms of patient safety, equipment cost, staffing requirements and any new physical space required? What is your opinion in having the Mott MRI operating 24 hours, 7 days a week? Especially in terms of patient safety, equipment cost, staffing requirements and any new physical space required? What improvements, ideas do you have on helping to reduce scheduling time? Are there any key issues relating to taking an MRI scan that apply only to the neurosurgery department? 10) Recovery Room Department Currently, what is your staffing like? What is your opinion on extending the operating hours of the current MRI machine to the hours to ones stated below? Especially in terms of patient safety, equipment cost, staffing requirements and any new physical space required? Current MRI hours: Mondays to Fridays, 8am to 5pm (for sedated patients) Mondays to Fridays, 5pm to 9pm & Saturdays, 7am 7pm (for non-sedated patients) Proposed new hours: Mondays to Fridays, 7am to 10pm (for sedated patients) Saturdays and Sundays, 7am to 7pm on (for non-sedated patients) What is your opinion on sending outpatients to East Ann Arbor Health Center to get an MRI scan if it helps reduce scheduling time? Especially in terms of patient safety, equipment cost, staffing requirements and any new physical space required? What is your opinion in having the Mott MRI operating 24 hours, 7 days a week? Especially in terms of patient safety, equipment cost, staffing requirements and any new physical space required? What is your opinion in having the Mott MRI operating 24 hours, 7 days a week? Especially in terms of patient safety, equipment cost, staffing requirements and any new physical space required? 22

23 Appendix B - List of Benchmarking Questions Hospital Background How big is your hospital: o Age range of patients seen o No. of licensed beds/ staffed beds o No. of total annual visits o No. of inpatient/outpatient visits annually o No. of MRI scans annually MRI Background How many MRI machines do you have? Has there been any addition(s) of MRI machines in the past five years? How long have each of your pediatric MRI machines been running? What are the operating days and hours of your pediatric MRI machines? What are the main types of MRI scans that are performed in your hospital? (brain, cardiac, etc.) Do you have any specialty programs in (e.g. for pediatric heart) that utilize MRIs? MRI usage: On average, what is the breakdown of inpatients/outpatients undergoing an MRI scan per week? On average, what is the breakdown of sedated/non-sedated patients undergoing an MRI scan per week? Miscellaneous issues: Does your current MRI demand necessitate acquiring more MRI machines? What is the growth rate for your MRI demand? On average, how many patients per week do you have to reschedule due to capacity issues? Do you perform MRI scans after operating hours or at night? If so, how do you manage safety and staffing issues? 23

24 Appendix C - MRI Patient Survey We are a team of student associates from the University of Michigan Health System Program and Operations Analysis Department. We are helping C.S. Mott Children s Hospital explore options to improve its MRI capacity. As such, we are doing a patients survey to find out your response with regards to changes in operation hours and MRI scan location. Please take a few minutes to fill up this form and pass it back to the registration desk once you are done. Your response is greatly appreciated. Date: 1. What is your (patient) age? years months 2. Are you a repeat MRI patient? Y / N If yes, how many times, including this visit have you visited Mott MRI? 3. Do you require sedation for this scan? Y / N 4. Are you an outpatient? Y / N (If yes, please answer the next question, or else skip to question 6) 5. How comfortable are you with coming for MRI scans after 10pm, Mondays to Sundays? Very uncomfortable Uncomfortable Neutral Comfortable Very comfortable 6. What type of MRI scan will you be taking? (Check all that apply) Cardiac (Heart) Spine Cranial (Brain) Body (e.g. Liver, Kidney) Vascular Others, please state: 7. How far away do you live from the C.S. Mott Hospital? Less than 10 miles miles away miles away miles away miles away Others, please state: 8. How long did you have to wait from your doctor s referral to taking your scan? Less than 1 day 1 2 weeks 1 3 days 3 4 weeks 4 5 days Others, please state: 9. How satisfied are you with your scheduling time? (From doctor s referral to MRI scan date) Very dissatisfied Dissatisfied Neutral Satisfied Very satisfied 10. How comfortable are you with going to East Ann Arbor Health Center instead of Mott Hospital for a MRI scan (Please see attached map for location 4.2 miles NE of Mott Hospital) Very uncomfortable Uncomfortable Neutral Comfortable Very comfortable 24

25 East Ann Arbor Health Center C.S. Mott Hospital Map extracted from 25

26 Appendix D - Background of Demand for MRI 1) Annual Breakdown of Scan Types 26

27 Observations: 1) Percentage of Brain & Spine scans range from 72.6% to 75.7% of total scans per year. 2) Total Scans per Year exhibits positive trend of a 9.5% average growth with a standard deviation of 2.7%. 3) Cardiac scans make up less than 1% of total scans per year (<30 per year) 4) No. of Cardiac scans show a slight growth from 16 to 23 from 2005 to

28 2) Annual Breakdown of Scan Durations 28

29 Observations: 1) From 2000 to 2004, the duration of scans per year was relatively stable, ranging from 128, 000 to 153, 000 minutes. 2) From 2004 to 2006, the duration of scans per year increased due to introduction of the Mott MRI. 3) 2004 to 2005 saw a 24.2% increase while 2005 to 2006 saw a 16.7% increase. 4) From 2005 to 2006, there is a visible shift in MRI demand from other resources to Mott MRI. 5) In 2006, 87.9% of MRI scan times was contributed by the Mott MRI. 29

30 3) Annual Breakdown of Patient Type 30

31 Observations: 1) Outpatients make up the largest proportion of MRI scans, ranging from 81.2% to 87.8%. 2) Emergency patients make up less than 2.5% of patients seen per year. 3) The number of MRI scans is observed to have a general increasing trend per year from 2000 to ) Outpatients make up the largest proportion of MRI scans, ranging from 81.2% to 87.8%. 5) Emergency patients make up less than 2.5% of patients seen per year. 6) The number of MRI scans is observed to have a general increasing trend per year from 2000 to

32 5) Annual Breakdown of Patient Age Group 32

33 Observations: 1) Average age of patients ranged from 8.49 to 8.8 years of age from 2000 to ) Gradual increase of average age observed from 2000 to

34 6) Annual Breakdown of New/Repeat Patients 34

35 Observations: 1) No. of repeat patients stabilizes at approximately 38-40% from 2003 to ) Early percentages of repeat patients not reflective of actual situation (due to assumption that all patients in 2000 are new patients). 35

36 7) Annual Breakdown of No. of Scans Per Unique Visit 36

37 Observations: 1) Average No. of Scans per Unique Visit ranges between and scans per unique visit. 2) The no. of scans is observed to decrease from scans in 2000 to in ) Breakdown of No. of Scans is observed to be fairly consistent, and approximately 45% to 49% of all unique visits involve only 1 scan. 37

38 8) Annual Breakdown of Performing Resource (by No. of Scans) 38

39 Observations: 1) From 2000 to 2006, the total no. of scans per year exhibits a positive trend, with a slight spurt in 2005 and 2006 due to the introduction of Mott MRI. 2) From 2005 to 2006, there is a visible shift in MRI demand from other resources to Mott MRI. 3) In 2006, 86.3% of all MRI scans were performed by the Mott MRI. 39

40 9) Annual Breakdown of Location Code Observations: 1) Demand for MRIs are highly scattered among the various departments. 2) In 2005 and 2006, the MRI department contributed the largest proportion of demand for MRI scans. This could be due to the administrative procedures for the new MRI machine not being able to capture the referring departments, and broadly categorizing the demand as under the MRI department. 40

41 10) Annual Breakdown of Duration Per Scan Per Unique Visit Observations: 1) The 2 most common scan durations are 0-30 minutes and minutes. 2) mins scan duration makes up 53.5% of all scan durations, and 0-30 mins scan duration makes up 25.9% of all scan durations in ) Approximately 5% of total scan duration exceeds 90 minutes. 41

42 11) Annual Breakdown of Duration Per Unique Visit Observations: 1) For duration per unique visit, about 45% of each unique visit takes minutes. 2) About 6-7% of total unique visits exceed 120 minutes. 42

43 12) Mott MRI Performance Analysis for