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Optimizing Percutaneous Nephrolithotomy (PCNL) Surgical Scheduling using Lean Methodology and Principles
Mitchell H. Bamberger, MD, MBA.
UMass Medical School, Worcester, MA, USA.

BACKGROUND: Percutaneous Nephrolithotomy (PCNL) scheduling is a labor intensive process requiring coordination amongst Urology (U), Anesthesia, and frequently Interventional Radiology (IR). This process can be cumbersome with frequent delays while each specialty has specific requirements before the scheduling can be completed. As a result, this inefficiency may cause delays and cancellations resulting in poor job satisfaction for both administrative and clinical staff, as well as patient dissatisfaction. By applying lean principles, the scheduling process can be improved with more efficiency, higher job satisfaction for staff, as well as improved patient satisfaction.
METHODS: The process for scheduling PCNL surgery at UMassMemorial Medical Center was evaluated by a team of administrative and clinical staff. This consisted of U and IR schedulers along with IR and U clincians. A survey of U schedulers was peformed to assess the issues regarding coordination between services. Process mapping of the current condition and a root cause analysis (RCA) was undertaken to re-engineer this process.
RESULTS: The current condition revealed there was a minimum of 9 steps to schedule a patient for PCNL surgery. IR requests for further diagnostic radiographic studies were required to be scheduled by U administrative staff. Additionally, U administrative staff were needed to obtain insurance prior authorization. One case required 21 emails betweeen IR and U schedulers to coordinate a preoperative CT scan. Each U secretary had their individual method of scheduling surgery. A RCA was conducted to identify areas to be changed or eliminated. An electronic worksheet was created within the electronic health record that could be accessed by all staff involved with the scheduling process. This allowed for parallel processing to occur instead of a sequential process. IR staff were empowered to order and obtain all necessary preoperative imaging as requested by IR clinicians.
CONCLUSIONS: The RCA allowed for identification of an inconsistent method of booking surgery. In addition, creating parallel processing improved efficiency by allowing both IR and U administrative staff to work simultaneously instead of sequentially. As a result, overall scheduling improved, administrative and clinical job satisfaction rose, and patients were able to be scheduled in a more timely manner without any cancellations. Physicians and staff should be familiar with lean principles and methodology to enhance overall urologic office practice efficiency and job satisfaction.


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