Reducing MRI access times by tackling the appointment-scheduling strategy

BACKGROUND: High access times for MRI facilities have a negative impact on quality of care and patient service. Since these resources are both scarce and expensive, better utilising the capacity is the most economical way of reducing these access times. As a rule, patient appointments are not scheduled efficiently. Consequently, the most promising way of reducing access times is to optimise the scheduling strategy. The aim of this study was to reduce MRI access times by optimising the scheduling strategy and by implementing this strategy in practice in a university hospital in the Netherlands. ASSESSMENT OF PROBLEMS: The scheduling process was analysed to define the improvement potentials and to simulate the process. Computer simulation was used to copy the process and experiment with scheduling strategies in theory. Promising scenarios were defined and run in the simulation model. Based on the simulation results, a new scheduling strategy was designed and implemented. RESULTS OF ASSESSMENT: The simulation experiments showed that block reduction leads to a maximum decrease in access time of 93%. STRATEGIES FOR CHANGE: Implementing a scheduling strategy with a practically applicable minimum number of blocks resulted in an actual decrease from 36, 22, 28, 9 and 9 to 7, 2, 10, 3 and 1 calendar days, respectively, depending on the patient group. LESSONS AND MESSAGES: This study proved that modelling the scheduling process can contribute to optimising the scheduling strategy, which can lead to a reduction in access times for imaging facilities such as MRI scanner

Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years.

BACKGROUND: The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. METHODS: An individual-patient data meta-analysis of four multicentre randomized trials of EVAR versus open repair was conducted to a prespecified analysis plan, reporting on mortality, aneurysm-related mortality and reintervention. RESULTS: The analysis included 2783 patients, with 14 245 person-years of follow-up (median 5·5 years). Early (0-6 months after randomization) mortality was lower in the EVAR groups (46 of 1393 versus 73 of 1390 deaths; pooled hazard ratio 0·61, 95 per cent c.i. 0·42 to 0·89; P = 0·010), primarily because 30-day operative mortality was lower in the EVAR groups (16 deaths versus 40 for open repair; pooled odds ratio 0·40, 95 per cent c.i. 0·22 to 0·74). Later (within 3 years) the survival curves converged, remaining converged to 8 years. Beyond 3 years, aneurysm-related mortality was significantly higher in the EVAR groups (19 deaths versus 3 for open repair; pooled hazard ratio 5·16, 1·49 to 17·89; P = 0·010). Patients with moderate renal dysfunction or previous coronary artery disease had no early survival advantage under EVAR. Those with peripheral artery disease had lower mortality under open repair (39 deaths versus 62 for EVAR; P = 0·022) in the period from 6 months to 4 years after randomization. CONCLUSION: The early survival advantage in the EVAR group, and its subsequent erosion, were confirmed. Over 5 years, patients of marginal fitness had no early survival advantage from EVAR compared with open repair. Aneurysm-related mortality and patients with low ankle : brachial pressure index contributed to the erosion of the early survival advantage for the EVAR group. Trial registration numbers: EVAR-1, ISRCTN55703451; DREAM (Dutch Randomized Endovascular Aneurysm Management), NCT00421330; ACE (Anévrysme de l'aorte abdominale, Chirurgie versus Endoprothèse), NCT00224718; OVER (Open Versus Endovascular Repair Trial for Abdominal Aortic Aneurysms), NCT00094575