Body Scans and Bottlenecks: Optimizing Hospital CT Process Flows Custom Case Solution & Analysis

Evidence Brief: Case Researcher

1. Financial and Operational Metrics

• Scanner Capacity: The facility operates two CT scanners (CT1 and CT2). CT1 is a 64-slice scanner; CT2 is a 16-slice scanner.
• Patient Demand Profiles:
  • Emergency Department (ED) Patients: High variability, immediate priority, average 1.2 patients per hour.
  • Inpatients (IP): Moderate urgency, scheduled within a daily window, average 0.8 patients per hour.
  • Outpatients (OP): Low urgency, pre-scheduled, average 1.5 patients per hour.
• Process Times:
  • Setup and Patient Prep: 15 minutes average.
  • Actual Scan Time: 10 minutes for standard scans; 20 minutes for contrast-enhanced scans.
  • Post-Scan Cleanup: 5 minutes.
• Utilization: Peak hours (08:00 to 16:00) show utilization exceeding 90 percent, leading to exponential growth in wait times.

2. Operational Facts

• Geography: The CT suite is located between the ED and the main Radiology department.
• Staffing: Two technicians are assigned per shift. One tech manages the patient while the other operates the console.
• Priority Protocol: ED patients preempt scheduled outpatients, causing a ripple effect of delays for the remainder of the day.
• Facility Constraints: CT2 is frequently used for simpler scans due to its lower slice count, creating an imbalance in workload distribution.

3. Stakeholder Positions

• Dr. Robert Hecht (Section Chief): Focuses on clinical accuracy and reducing the backlog of ED patients to clear hospital beds.
• Radiology Technicians: Report high stress and fatigue due to constant schedule shifts and lack of predictable breaks.
• Hospital Administration: Concerned with outpatient satisfaction scores and the potential loss of revenue to specialized imaging centers.
• ED Physicians: View CT wait times as the primary driver of ED overcrowding.

4. Information Gaps

• Detailed breakdown of revenue per patient type (ED vs. IP vs. OP).
• Maintenance downtime logs for CT1 vs. CT2.
• Exact arrival patterns (Poisson distribution data) for ED patients during night shifts.
• Cost-benefit data for hiring a third technician or a dedicated prep nurse.

Strategic Analysis: Market Strategy Consultant

1. Core Strategic Question

• How can the hospital optimize CT process flows to satisfy high-priority ED demand while protecting the high-margin outpatient revenue stream without investing in a third scanner?

2. Structural Analysis

• Queueing Theory Application: The current system suffers from high utilization and high variability. According to Kingman Formula, as utilization approaches 100 percent, wait time increases exponentially. The priority preemptive discipline for ED patients effectively reduces the available capacity for OP and IP by 40 percent during peak hours.
• Bottleneck Identification: The bottleneck is not the scan time itself but the setup and prep phase. The scanner remains idle for 15 minutes while the patient is positioned and prepped. This represents a 37.5 percent loss of potential machine capacity.
• Value Chain Analysis: The hospital is losing value in the service delivery phase. Outpatients represent the most mobile and price-sensitive segment; long wait times drive them to competitors, eroding the hospital's long-term market share in elective procedures.

3. Strategic Options

• Option A: Dedicated Scanner Assignment. Assign CT1 exclusively to ED and IP, and CT2 to OP.
  • Rationale: Segregates variability. OP schedules become predictable.
  • Trade-offs: Total system capacity decreases because pooling benefits are lost. If CT1 is idle, it cannot help with the OP backlog.
• Option B: Parallel Process Redesign (Prep-Bays). Create a dedicated prep area outside the CT room.
  • Rationale: Moves the 15-minute prep time out of the bottleneck. Increases throughput by approximately 30 percent.
  • Resource Requirements: Minor facility renovation and one additional nurse or tech assistant.
• Option C: Dynamic Scheduling with Buffer Slots. Implement a scheduling model that leaves 20 percent of slots open for ED arrivals.
  • Rationale: Reduces the frequency of bumping outpatients.
  • Trade-offs: Lower theoretical utilization but higher actual reliability.

4. Preliminary Recommendation

Pursue Option B (Parallel Process Redesign). The primary constraint is machine uptime. By decoupling patient preparation from the scanning process, the hospital can treat the CT scanner as a high-speed engine that only stops for the duration of the scan. This maximizes the utilization of the most expensive asset while improving throughput for all patient types.

Implementation Roadmap: Operations Specialist

1. Critical Path

• Week 1-2: Time and Motion Study. Validate prep-time variance across different scan types to establish a baseline for the new workflow.
• Week 3-4: Facility Modification. Designate and equip two adjacent bays as CT-Prep zones. Ensure oxygen and monitoring equipment are mirrored in these bays.
• Week 5-6: Staff Realignment. Hire or reassign one Licensed Practical Nurse (LPN) to handle all prep (consents, IV starts, gowning). This frees the Radiology Techs to focus solely on console operation and machine positioning.
• Week 7-8: Pilot Run. Execute the parallel flow for four hours daily during peak demand to iron out communication friction between prep-nurse and techs.

2. Key Constraints

• Physical Proximity: If the prep bays are too far from the scanners, the transit time negates the efficiency gains.
• Staffing Rigidity: Resistance from technicians regarding changes in their traditional roles.
• Information Flow: The current Electronic Health Record (EHR) must be updated to show patient status as Prepped and Ready to avoid machine idle time.

3. Risk-Adjusted Implementation Strategy

The strategy assumes a 15 percent friction loss during the first month. To mitigate this, a shadow scheduling system will be used for outpatients, adding a 10-minute buffer between appointments. This buffer will be phased out once the prep-bay transition time hits the 5-minute target. Contingency: If prep-time remains high, the hospital will shift to a staggered shift model for techs to ensure 100 percent machine coverage during lunch hours.

Executive Review: Senior Partner

1. BLUF

The hospital must transition from a serial to a parallel processing model in the CT suite. The current bottleneck is not machine speed but patient preparation. By implementing dedicated prep-bays and adding one mid-level staff member, the hospital can increase throughput by 30 percent. This eliminates the need for a multi-million dollar capital expenditure for a third scanner while simultaneously reducing ED wait times and protecting outpatient revenue. Failure to act will lead to continued outpatient leakage and worsening ED physician dissatisfaction.

2. Dangerous Assumption

The analysis assumes that the ED patient arrival rate (1.2 per hour) is the ceiling. However, improved efficiency often creates induced demand. If the ED becomes known for fast CT turnaround, physicians may increase scan orders, potentially neutralizing the newly created capacity within six months.

3. Unaddressed Risks

• Technical Failure: With utilization pushed higher through parallel processing, the mechanical strain on CT1 (the 64-slice unit) increases. A single day of downtime would create a catastrophic backlog that the new process cannot absorb. (Probability: Medium; Consequence: High).
• Credentialing Lag: The plan relies on a prep-nurse. If the hiring process or credentialing for IV contrast administration takes longer than 4 weeks, the implementation stalls while costs increase. (Probability: High; Consequence: Medium).

4. Unconsidered Alternative

The team did not evaluate a price-based demand management strategy. Implementing a peak-hour premium or off-peak discount for non-urgent outpatients could shift demand to early morning or late evening slots, naturally smoothing the utilization curve without facility changes.

5. Verdict

APPROVED FOR LEADERSHIP REVIEW. The recommendation is MECE and addresses the fundamental operational mismatch between fixed capacity and variable demand.