Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency’s ambulatory care unit through simulation

Background: Given the increasing necessity to increase efficiency and decrease cost in outpatient cardiology, quality improvement efforts are necessary to enhance delivery of care. Our multidisciplinary clinic tailors care based on individual and family needs to include cardiac and genetic testing along with evaluation by multiple providers involved in the care of every patient. These individualized schedules can greatly impact clinic flow, wait times, and clinic resource utilization if they are not managed and executed appropriately. We see patients of all ages which necessitates dynamic resource utilization. There is a paucity of data evaluating quality improvement (QI) efforts in outpatient cardiology. We hypothesized that we could improve clinic flow via measured, planned interventions. Methods: All outpatients (children and adults) in the Cardiomyopathy/Heart Failure clinic at a single institution were assessed for anticipated and actual duration of clinic visits. Baseline assessments were made prior to QI efforts. A series of measured interventions were made as follows: designation of a flow coordinator for the clinic, implementation of a visual management system (VMS) showing patient status, and use of a clinic wide phone texting system to alert appropriate staff of status and next procedure/appointment. A time for Visit Length Expectation (VLE) was calculated based on the type of visit, complexity of patient, scheduled provider evaluations, and testing. Results: Baseline data revealed 20.6% of patients were meeting VLE. Over a third of patients (38.8%) had wait times > 20 minutes. Following our interventions, 75.6% were meeting their VLE with only 10% having wait times > 20 minutes. We are at 90% reliability in meeting expected VLE. Scheduling capacity has increased allowing for increased timely accessibility to clinic for patients and families. We have sustained these improvements for 6 months. Conclusions: Patient wait times and clinic resource utilization can be greatly improved with simple interventions such as identifying a clinic flow coordinator, utilization of a VMS, and enhanced communication internal and external to the clinic via a texting system. These interventions have increased available appointments and increased scheduling flexibility. Furthermore, we can now reliably predict VLE at the time of registration which better informs families of their anticipated total time in the clinic.

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Wait Times and Diagnostic Pathways among Women with Invasive Breast Cancer in a Population-Based Publicly Funded Cancer Centre, British Columbia, Canada.

10.1158/0008-5472.sabcs-09-3083 ◽

2009 ◽

Author(s):

L. Martin ◽

B. Banno ◽

M. Joffres ◽

F. Wong ◽

C. Sherriff

Keyword(s):

Breast Cancer ◽

British Columbia ◽

Invasive Breast Cancer ◽

Population Based ◽

Wait Times ◽

Publicly Funded ◽

Cancer Centre ◽

Diagnostic Pathways

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Ancient DNA investigation of prehistoric salmon resource utilization at Keatley Creek, British Columbia, Canada

Journal of Archaeological Science ◽

10.1016/j.jas.2005.03.016 ◽

2005 ◽

Vol 32 (9) ◽

pp. 1378-1389 ◽

Cited By ~ 30

Author(s):

Camilla F. Speller ◽

Dongya Y. Yang ◽

Brian Hayden

Keyword(s):

British Columbia ◽

Resource Utilization ◽

Ancient Dna

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E-Consults: an effective way to decrease clinic wait times in Rheumatology

10.21203/rs.3.rs-29630/v2 ◽

2020 ◽

Author(s):

Veena Patel ◽

Diana Stewart ◽

Molly Horstman

Keyword(s):

Rheumatic Disease ◽

Resource Utilization ◽

Control Chart ◽

Antinuclear Antibody ◽

Temporal Association ◽

Wait Times ◽

Imaging Studies ◽

Statistical Process ◽

Monthly Average ◽

Positive Antinuclear Antibody

Abstract Background: To evaluate the effect of E-consults on wait times and resource utilization for positive antinuclear antibody (ANA) referrals in outpatient rheumatology.Methods: We conducted a pre-post study of E-consult implementation for positive ANA referrals. We retrospectively reviewed “positive ANA” referrals from 1/2015-3/2017. A statistical process control chart was created to display monthly average wait times for in-person clinic visits and to identify special cause variation. Final Diagnoses, wait times and resource utilization were recorded and compared between E-consults and in-person referrals.Results: There were 139 referrals for positive ANA with 126 occurring after E-consult implementation in August 2015. Forty-four percent (55/126) of referrals were E-consults; 76% were resolved after initial electronic rheumatology recommendation. A control chart demonstrated special cause variation in the form of a shift from June 2016 – January 2017, suggesting a temporal association between decreased wait times and the implementation of E-consults. Eleven patients were diagnosed with ANA-associated rheumatic disease; the majority of patients (73%, 86/139) did not have a rheumatologic diagnosis. Overall E-consults utilized more labs than in-person visits, but this was not statistically significant. In-person visits utilized more imaging studies, which was statistically significant. Conclusion: E-consults are an effective way to address positive ANA consults without significant resource utilization and were temporally associated with decreased wait times for in-person visits.

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Rehospitalization risk factors for mental health and substance use in Northern British Columbia

10.24124/2020/59106 ◽

2020 ◽

Author(s):

◽

James Campbell

Keyword(s):

Mental Health ◽

Risk Factors ◽

British Columbia ◽

Substance Use ◽

Cultural Identity ◽

Performance Measures ◽

Odds Ratio ◽

Resource Planning ◽

Wait Times

Mental health and substance use (MH&SU) rehospitalization rates are used as indicators of treatment quality, to reduce costs, and measure efficacy. Research on this topic in rural Canadian hospitals and communities is lacking. This study used secondary data on 5159 patients (age 15 and older) hospitalized with International Classification of Disease (ICD) F code MH&SU diagnosis. These patients had 9103 admissions to 18 hospitals in Northern British Columbia during a five-year period, April 1st, 2010 through March 31st, 2015. ANOVA and Tukey Post Hoc tests were used to examine associations of two performance measures with five patient factors; community size, Indigenous culture, relationship status, employment status, and ICD F code diagnoses. The first measure was number of hospital readmissions. Of the 5159 patients with 9103 admissions, 3482 (67.6%) had one hospital admission during the five-year period. The remaining 1677 (32.4%) patients had 3944 (43.3%) of the hospitalizations). Patients whose cultural identity was Indigenous had over-representation and increased readmissions. Patients who were single and never in a relationship had increased hospitalizations. Patients whose ICD F coding for schizophrenia or psychosis had increased hospitalizations. The second measure was wait time for community MH&SU follow-up. Of the 5159 patients, 4512 (87.5%) had contact with community MH&SU during the five-years. Urban communities with specialized MH&SU services had reduced wait times for follow up. Patients whose cultural identity was Indigenous had longer wait times for community MH&SU follow-up. Patients who were divorced or separated had longer wait times. Patients with ICD F coding for schizophrenia or psychosis had shorter wait times for follow-up. The relationship between hospital readmission and community MH&SU follow-up was examined using logistic regression with the five factors. An inverse relationship was found between the two performance measures. Patients who did not have community MH&SU follow-up within 30 days had reduced odds ratio of readmissions, whereas patients who had follow-up within 30 days had increased odds ratio for readmissions. Although the study finds support for patient risk factors, evidence suggests approaches like a Decision Support Tool (DST) might provide reliability for intervention, and resource planning, as well as timely intervention.

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