A solution to radiology wait times over the holidays

An effective, low-cost solution to the long wait times in radiology services around holidays and vacation periods.

Vacation and holiday periods lengthen the wait for service at diagnostic imaging centers, and as a result patients’ perception of service quality declines.

Wait times in radiology services

Wait times in radiology services directly affect how well early prevention processes work and, to an even greater degree, patients’ overall experience and satisfaction. A large share of patient complaints about radiology services centers on delays and long waits for care [1]. It is also well established that long waits for imaging are directly associated with worse outcomes for the patient’s condition [2]. Wait times from the moment the treating physician orders the radiology exam to the moment the image is acquired are therefore key metrics of how well a radiology center operates, and a key factor in improving the overall patient experience.

The most natural way for clinical facilities to respond to long wait times is to increase capacity in terms of staff for the operational side of their diagnostic center. That strategy, however, has a direct impact on the facility’s operating costs, and it does not necessarily correlate with service improvement. Recent evidence shows that a 20% increase in a radiology center’s operating capacity reduces wait times by only 6.2%; worse still, a 100% increase in operating capacity reduced patient wait times by only 13% [3]. That reveals a growing need for new approaches to reducing how long patients wait for service at diagnostic imaging centers.

Holidays, vacations and wait times

One of the triggers that sharpens wait times at diagnostic centers is the arrival of collective vacation and holiday periods in each country. In many countries it is common to have collective vacation periods around the last week of December and in the summer months in seasonal countries. In countries such as Colombia there are additional collective breaks, during Holy Week and the October break week. Around those dates, patients prefer to avoid scheduling long-term follow-up appointments, which are usually set for 3, 6 or even 9 months out. As a result, appointment slots at radiology centers become saturated in the periods before and after holidays or vacations, making it harder to serve patients with short-term or immediate needs during those windows.

Appointment scheduling and wait times

Appointment scheduling is known to be a fundamental pillar of how diagnostic imaging centers operate, and how it is managed has a direct impact on wait times for service. Experimenting with scheduling schemes in real time is very expensive, disruptive and impractical in a realistic setting; for that reason, a recent study used computer simulation to evaluate three experimental scenarios in the appointment scheduling process and their impact on patient wait times for diagnostic imaging. A reference scenario was established in which scheduling and staffing remained unchanged around vacation dates. A second scenario evaluated an increase in operating capacity in the weeks following the vacation period (more staff and more available hours). A third scenario evaluated a novel scheduling scheme in which a quota of appointment slots is reserved exclusively for services needed within 30 days, such as priority requests, short-term care and emergencies. Under that scheme, follow-up appointments only get a portion of the total scheduling quota in the weeks around vacation dates, which ensures that orders requiring short-term attention have a higher probability of getting a slot.

An effective, low-cost solution

The results of the study show that the spikes in wait times around a public holiday or collective vacation period can be managed effectively through an appointment scheduling system in which a portion of exam slots is reserved for exams that are not long-term follow-ups (more than 30 days out). That simulated scheme produced reductions in maximum wait times around a holiday or collective vacation that were significant both statistically and operationally. Specifically, reserving 45% of slots for short-term exams is equivalent to doubling operating capacity in the 4 weeks following the break. Reductions in maximum wait times also occurred even when the new scheduling method was applied only in the 3 weeks before and 1 week after the holiday or vacation period.

In conclusion, improving how radiology services operate and how users experience them requires new ways of thinking, at odds with what has usually been imposed as standard in the field. The account described here shows that the traditional route to optimizing services — increasing staff availability and extending working hours, for instance — does not necessarily produce service improvements proportional to the resources spent. On the contrary, understanding the problem and proposing something new can produce significantly better results simply by letting the imagination run.

References

[1] Salazar G, Quencer K, Aran S, Abujudeh H. Patient Satisfaction in Radiology: Qualitative Analysis of Written Complaints Generated Over a 10-Year Period in an Academic Medical Center. Journal of the American College of Radiology. 2013;10:513–517. doi: 10.1016/j.jacr.2013.03.013.

[2] Lo DS, Zeldin RA, Skrastins R, et al. Time to Treat: A System Redesign Focusing on Decreasing the Time from Suspicion of Lung Cancer to Diagnosis. Journal of Thoracic Oncology. 2007;2:1001–1006. doi: 10.1097/JTO.0b013e318158d4b6.

[3] Pisharody VA, Yarmohammadi H, Ziv E, Sotirchos VS, Alexander E, Sofocleous C, Erinjeri JP. Reducing Wait Times for Radiology Exams Around Holiday Periods: A Monte Carlo Simulation. J Digit Imaging. 2023 Feb;36(1):29-37. doi: 10.1007/s10278-022-00728-2