Multiple variables were identified in causing delays and inefficiencies within the ultrasound procedure room. The largest delay on a patients journey was found between the checkpoints 'patient entering department/patient called for from the ward' to 'patient arrived in room'. Causes for these delays were attributed to patients not being sent for in a timely manner, delays in acquiring patients from the ward, and delays waiting between each procedure.

The largest gap between procedures or 'deadtime' within the patient room was found between the last case in the morning and the first case in the afternoon. The mid-day deadtime was attributed to the morning staff predicting delays in patients arriving to the room, and thus not calling for an additional patient in case the procedure ran into the afternoon shift, thus extending the gap between both.

These delays highlighted the need for streamlined pathways and adequate preparation of patients prior to arriving to the procedure room. 

Data analysis did demonstrate, however, that the time taken to complete procedures was satisfactory, with minimal efficiencies identified once the patient entered the room. 

Based on these findings, several targeted interventions were introduced. Solutions for reducing delays in a patient's journey include provisional schedules created the day prior to aid in efficient daily planning, ensuring patients are consented/fasting prior to adding them on the list, and considering separating inpatient and outpatient procedures to aid daily planning.

To reduce deadtime bewteen cases, solutions introduced were standardized online triage lists, optimized scheduling protocols, and enhanced communication pathways between radiology trainees, with dedicated time to handover day-to-day information. Requisition forms were created, to allow teams communicate their procedure requests without delay. 

Following these interventions, there was an increase in volume of cases performed within the ultrasound procedure room, providing early optimistic data on postivie changes to the room. More complex interventions were proposed, such as separating inpatients and outpatients into separate rooms to reduce delays and inconsistenices in providing service for both groups, however there were limitations in staffing, funding and space to implement this change.

Overall, a comprehensive data-set was gathered, highlighting inconsistancies within the ultrasound procedure room. Causes for these delays were addressed, and interventions were applied to imrpove time delays for patient care.

This snapshot into a month's work within the ultrasound procedural department highlights the need for basic guidelines on procedural management to reduce the potential inefficiences casued by unregulated room structuring. It also highlights, however, the impact quality improvement projects have on improving work efficiencies within the radiology department.