By K. Richard Douglas
Serving the people of the Texas Hill Country, and sitting on a scenic 35-acre campus, the Peterson Regional Medical Center (PRMC) is an independent, not-for-profit 124-bed health care facility. It is located in Kerrville, Texas, northwest of San Antonio.
Staffed with 900 full-time employees, Peterson Regional serves nine counties.
“The main campus offers over 25 key service lines and departments, including an emergency department, acute rehab unit, a Texas Ten Step designated maternity unit, The Baby Place and women’s services, an intensive care unit, an expanded heart and vascular center, seven surgical suites and an award-winning center for orthopedic health for total joint replacement,” says Tracy C. Moore, RT(R)(M)(CT), CRA, radiology director at PRMC.
“Peterson’s neighboring Ambulatory Care Center offers outpatient surgical services, radiology and imaging, outpatient rehabilitation and an advanced wound healing center offering two hyperbaric oxygen chambers – the only of their kind available in the region,” Moore adds.
Moore manages the imaging department at the hospital and ACC.
“Peterson’s roster of services also includes Peterson Hospice, Peterson Home Care, Peterson Medical Associates, Peterson’s Outreach Lab, Peterson Community Care and Peterson Urgent Care. Proudly, Peterson recently opened a new family practice clinic in Bandera to meet the growing needs of this characteristic community and has recently opened a new physical therapy clinic in Comfort, Texas,” Moore says.
She says that the imaging department consists of a hospital-based department and an ambulatory care center imaging department.
“Both imaging departments offer exams in X-ray, computed tomography, ultrasound, magnetic resonance imaging and nuclear medicine. In addition to these exams, the ambulatory care center also offers mammography and bone density, while the hospital offers interventional radiology. Between both departments we staff 28 full-time registered technologists, two full-time RNs, four full-time clerical and 17 PRN employees including – two nurses, 13 techs, two clerical/RA,” Moore adds.
The team keeps current with the newest advances through several training approaches.
“Continuing education is accomplished in training on new equipment and procedures with the OEM as well as online classes, in-services, inviting reps to come and instruct and travel to vendor sites for new equipment training,” Moore says.
She says that they are also a clinical site that supports student rotations in X-ray and ultrasound for Alamo-St. Philip’s College, College of Health Care Professionals and PIMA Medical Institute.
The department consults with colleagues and stakeholders to make capital purchase decisions.
“We value input from our radiologists, technologists, nurses and performing physicians. Construction planning is accomplished with admin, maintenance, environment of care and infection control (departments),” Moore says.
“Contract negotiations are accomplished by sharing quotes with our materials management director, once received she negotiates to the best pricing before we proceed,” Moore adds.
Finding a Better Way
Employing careful process improvement techniques, the radiology team at PRMC devised a better process for patients to pass through the procedures they have related to mammography and follow-up.
“We had a special project in women’s imaging that gave us an opportunity to meet our community’s needs by improving the process by which a patient is navigated from screening to biopsy in the mammography department. We noticed we were not retaining our patients due to the time it took for them to navigate the system,” Moore says.
“We used Six Sigma and lean processing to define the problem, look at all the steps from scheduling, completion of exam and follow up to create a process map from which we defined all the areas that caused delays and issues. Once this was completed, we were able to come up with a new process we call the Pink Pathway, that allowed a patient to be seen for diagnostic imaging with results, additional imaging and a one-on-one visit with our interpreting physician to navigate that patient to a surgical appointment within that same week, often next day when warranted,” Moore explains.
She says that this change in processes, along with the remodel of the women’s center and purchase of a stereotactic biopsy system, allows them to navigate the patient and biopsy, while meeting patients’ needs throughout the process.
In addition to coming up with a streamlined imaging experience, the group collaborates with other departments to improve workflows and help colleagues understand roles and responsibilities. This has also been an inter-group exercise.
“We utilize unit practice councils in our facility to empower our staff and give them a voice in processes and share frustrations to allow improvement. Oftentimes, we will join another department to solve problems and to ensure all contributing areas have a say and share perspective. This gives us an opportunity to work through issues and build a better understanding of the workflow and approach and how one change affects other departments,” Moore says.
She says that one example concerned issues with double booking exams which caused delays and frustration for techs and patients.
“As a group, we shared concerns and frustrations; mapped out the processes, redefined parameters, adjusted scheduler notes and set up rotations so that the schedulers could spend some time in the imaging department to see how everything plays out in real time,” Moore says.
“This gave a greater understanding of how the scheduling of exams directly affects the performance from details of lab work, screening questions and diagnosis. They could see why everything is so important to collect. Through this process improvement, the techs were able to learn the scheduling process and ins and outs to better appreciate the number of calls taken and worked through and the limitations the schedulers are often dealt when scheduling exams. The scheduling of patients ran much smoother and we work together as a team to improve what we do,” she says.
Beyond their work at Peterson’s facilities, the team members are involved in AHRA (The Association for Medical Imaging Management). “Several in our group have associations with ASRT and TSRT,” Moore adds.
Imaging patients at PRMC are in good hands as they reap the benefits of constant process improvements and a caring team of professionals.