Assessment of CT Coronary Angiogram utilization at the National Hospital of Sri Lanka (NHSL)
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Public healthAbstract
Background: The escalating burden of cardiovascular diseases in Sri Lanka has intensified the demand for Computed Tomography Coronary Angiogram (CTCA) at the National Hospital of Sri Lanka (NHSL). However, operational constraints and disproportionate capacity have generated significant service backlogs for timely cardiac care.
Objectives: This study aimed to assess the utilization and operational efficiency of CTCA services at NHSL, analyse underlying systemic bottlenecks, and propose targeted quality improvement strategies to optimize patient throughput and reduce waiting lists.
Methods: A mixed-methods problem-oriented case study was conducted. Qualitative data were gathered via key informant interviews with cardiologists, radiologists, radiographers and biomedical engineers, alongside focus group discussions and field observations. Quantitative data were obtained by reviewing departmental administrative records, process mapping, waiting lists, and cadre statistics. Issues were structured using SWOT analysis, the Pareto principle, an Eisenhower matrix and root cause analysis.
Results: Annual demand increased sharply from 1,406 patients in 2022 to over 3,000 in 2025. The primary systemic bottleneck was prolonged waiting times of 2–3 months for non-emergency patients, coupled with a 48-hour reporting delay. Root causes included restricted operational hours (8:30 AM–4:00 PM), severe staffing shortages (68 radiographers in position against an approved cadre of 104), absence of comprehensive maintenance agreements leading to equipment downtime, and sole reliance on a single 640-slice scanner.
Conclusion: Service congestion in tertiary cardiac imaging can be addressed by transitioning to extended operating hours (8:00 AM–8:00 PM), implementing integrated teleradiology solutions to cut turnaround times to within 24 hours and securing robust equipment maintenance contracts to ensure continuous high-quality diagnostic delivery.
References
1. Chronic Non-Communicable diseases, the national policy & strategic framework. (2009). CONTROL OF CHRONIC NON-COMMUNICABLE DISEASES Index.
2. Kapoor, D., & Thompson, R. C. (2009). Diagnostic Accuracy of CT Coronary Angiography. Cardiology Clinics, 27(4), 563–571. https://doi.org/10.1016/J.CCL.2009.06.011
3. National Institute for Health and Care Excellence. (2016). Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis,https://www.nice.org.uk/guidance/cg95. March 2010.
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