scholarly journals How does clinical space utilisation impact patient flow?

2019 ◽  
Vol 8 (3) ◽  
pp. e000542 ◽  
Author(s):  
Alexandra von Guionneau ◽  
Charlotte M Burford
Keyword(s):  
Quality Improvement ◽  
Waiting Time ◽  
Primary Outcome ◽  
Patient Flow ◽  
Waiting Times ◽  
Wait Time ◽  
Limiting Factor ◽  
Electronic Systems ◽  
Improvement Project ◽  
Medical Wards

BackgroundLong waiting times in accident and emergency (A&E) departments remain one of the largest barriers to the timely assessment of critically unwell patients. In order to reduce the burden on A&Es, some trusts have introduced ambulatory care areas (ACAs) which provide acute assessment for general practitioner referrals. However, ACAs are often based on already busy acute medical wards and the availability of clinical space for clerking patients means that these patients often face long waiting times too. A cheap and sustainable method to reducing waiting times is to evaluate current space utilisation with the view to making use of underutilised workspace. The aim of this quality improvement project was to improve accessibility to pre-existing clinical spaces, and in doing so, reduce waiting times in acute admissions.MethodsData were collected retrospectively from electronic systems and used to establish a baseline wait time from arrival to having blood taken (primary outcome). Quality improvement methods were used to identify potential implementations to reduce waiting time, by increasing access to clinical space, with serial measurements of the primary outcome being used to monitor change.ResultsData were collected over 54 consecutive days. The median wait time increased by 55 min during the project period. However, this difference in waiting time was not deemed significant between the three PDSA cycles (p=0.419, p=0.270 and p=0.350, Mann-Whitney U). Run chart analysis confirmed no significant changes occurred.ConclusionIn acute services, one limiting factor to seeing patients quickly is room availability. Quality improvement projects, such as this, should consider facilitating better use of available space and creating new clinical workspaces. This offers the possibility of reducing waiting times for both staff and patients alike. We recommend future projects focus efforts on integration of their interventions to generate significant improvements.

scholarly journals NO WAIT: new organised well-adapted immediate triage: a lean improvement project

2021 ◽  
Vol 10 (1) ◽  
pp. e001179
Author(s):  
Ahmed Elkholi ◽  
Huda Althobiti ◽  
Jamal Al Nofeye ◽  
Mohamed Hasan ◽  
Ahmed Ibrahim
Keyword(s):  
Saudi Arabia ◽  
Patient Flow ◽  
Waiting Times ◽  
Wait Time ◽  
Armed Forces ◽  
Time Of Arrival ◽  
Gulf Region ◽  
Flow Process ◽  
Improvement Project ◽  
No Wait

Long waiting times in the emergency department (ED) are associated with decreased patient satisfaction and increased morbidity and mortality. Triage may be a contributing factor to prolonged wait times in the ED. At Alhada Armed Forces Hospital (Taif, Saudi Arabia), patients other than level 1 and 2 on the Canadian Triage and Acuity Scale are requested to wait until triage. During peak hours (08:00−22:00), the waiting time prior to triage is prolonged, and several patients leave the ED before triage. In this project, a multidisciplinary team was assembled to revise patient flow from the time of arrival at the ED to the time of triage. Lean methodology was used to identify the redundancies and design a seamless flow process for ED patients. Through reorganising the triage area using minimal additional resources, the project team devised a novel floor plan for the triage area which provided a unique patient flow in the ED. The median patient wait time from arrival to triage was reduced from 27 min to 4.09 min and the percentage of patients leaving the ER before triage was reduced to 0%. This project is the first of its kind in Saudi Arabia, as well as in the Gulf region, and provides a radical solution to the problem of patient waiting in the ED during peak hours.

scholarly journals Reducing Waiting Time in the General Pediatric Clinic at Al Wakra Hospital, Qatar

2022 ◽  
Vol 5 (1) ◽  
pp. 01-10
Author(s):  
Sara Kazkaz ◽  
Ghadeer Mustafa ◽  
Almunzer Zakaria ◽  
Muna Atrash ◽  
Ayman Tardi ◽  
...  
Keyword(s):  
Public Health ◽  
Quality Improvement ◽  
Waiting Time ◽  
Pediatric Population ◽  
Waiting Times ◽  
Outpatient Department ◽  
Predictive Tool ◽  
Improvement Project ◽  
Average Waiting Time ◽  
Pediatric Clinic

Background: Waiting times for clinic appointments constitute a key indicator of an outpatient department performance for access to care and patient satisfaction. This is particularly relevant for pediatric population. The Ministry of Public Health in Qatar set a waiting time of 28 days for patients to get new appointment in General Outpatient Department (GOPD). The current average waiting time to get a new appointment in the general pediatric clinic (GPC) at AWH is 57 days. Aim: Decrease the average waiting time to get a new clinic appointment from 57 days to 28 days by the end of December 2018, and to meet the national targets set by the Ministry of Public Health. Methodology: This is a Quality Improvement (QI) project using the Model for Improvement (MFI). The MFI framework is designed to support organizations answering fundamental questions before agreeing on drivers for change. The implementation of change was be facilitated by the Plan-Do-Study-Act (PDSA) cycles methodology. The QI project team performed a root cause analysis using the Ishikawa diagram and identified the key contributing factors to the long waiting times to get a new appointment. Twenty-seven PDSA cycle ramps were designed with support of predictive tool to test innovative changes in current operational processes in an attempt to improve waiting time in the general pediatric clinic at Al Wakra Hospital. Results: The monthly average number of referrals for GPC increased by 200% between the pre and post implementation periods. The average triage waiting time improved from 6 to 2.6 days in 2018 and the average become 1 day in 2019. Post-implementation the average waiting time for patients to get new appointment improved from 57 days to 28 days in 2018 and the average waiting time improved to 16 days in 2019. Conclusion: The quality improvement project for the AWH general pediatric clinic demonstrates significant improvement in waiting times for new appointments, the recommendation for the hospital leadership would be to rollout the improvement methodology to other clinics that suffer from similar challenges.

scholarly journals 365 Arrival to Decision: Improving Waiting Times in Surgical Ambulatory Care

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
F Mahmood ◽  
P Patel ◽  
O Islam
Keyword(s):  
Quality Improvement ◽  
Data Collection ◽  
Ambulatory Care ◽  
Patient Flow ◽  
Waiting Times ◽  
Improvement Project ◽  
Team Members ◽  
Referral Form ◽  
Flow Through ◽  
Clear Communication

Abstract Introduction An audit of the newly established Surgical Emergency Ambulatory Care Unit (SEAC) at Furness General Hospital found perceived patient waiting times were high. This Quality Improvement Project assessed the patient flow through the SEAC unit and aimed to improve the average time from arrival in the department to senior review by 10%. Method The Plan Do Study Act (PDSA) methodology for quality improvement was used, the time from arrival in the unit to senior decision was recorded for each patient seen over one-week data collection periods. Analysis of the data allowed for a patient process map to be created to visualise bottlenecks in patient flow. The findings were discussed with all team members and an agreed intervention was implemented and tested. Results Over three PDSA cycles, a significant improvement in the overall time from arrival to decision was achieved, from an average time of 193 minutes to 150 minutes. This was achieved by introducing a referral form, which altered how and when members of the multidisciplinary team communicated with each other. Conclusions Clear communication at the appropriate time between all members of the SEAC team significantly improved the average time from arrival to decision.

scholarly journals Reducing the waiting time to initiation of infertility treatment at a tertiary care centre in India

2020 ◽  
Vol 9 (4) ◽  
pp. e000975
Author(s):  
K Aparna Sharma ◽  
Anshu Yadav ◽  
Chithira Sridhar ◽  
Neena Malhotra ◽  
Siby Biji ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Waiting Time ◽  
Waiting Times ◽  
Infertility Treatment ◽  
Resident Physician ◽  
Junior Resident ◽  
Improvement Project ◽  
Waiting Period ◽  
Average Waiting Time ◽  
Mean Waiting Time

BackgroundIn a low-resource and high-volume setting, it is often felt that patient care cannot be improved within the limitations of existing infrastructure and resources. However, the use of a systematic problem-solving method can bring about significant improvement even in these settings.AimTo decrease the mean waiting time from first visit to initiation of infertility treatment by 70% within 4 weeks (1–30 June 2019) for patients coming to the gynaecological outpatient department (OPD).MethodsWe constructed a multidisciplinary quality improvement team consisting of an academic consultant, a senior resident physician, a junior resident physician and a nurse to address the problem of long waiting times to initiation of fertility treatment. We collected baseline data from 10 consecutive women presenting to gynaecological OPD with complaints of infertility by calculating the time between their first visit to the facility and the day of performance of hysterosalpingography (HSG). The average waiting time was found to be 6 months and 25 days (mean=6.85 months; 3.5–10 months). The team used process flow diagrams and fishbone analysis to identify various causes of these long waiting times. The main reason for the delay in starting infertility treatment was that the date for HSG was given only after seeing the endometrial aspiration report (ie, after ruling out endometrial tuberculosis as there is a risk of dissemination of tuberculosis during HSG). Also, HSG was done only once a week during a short 2-hour slot in the fluoroscopy room.ResultsAfter the implementation of change ideas, there was significant reduction in the waiting period to starting treatment in patients with infertility. After the first change idea, the average waiting period seen in 10 consecutive patients with infertility reduced to 3.25 months, that is, by 51.8% from baseline within a 2-week interval, and there is shift in the run chart diagram. After the second change idea, the waiting time reduced to 2 months, that is, by 70%, seen in the next 10 consecutive patients with infertility within the next 2 weeks’ time. The results were sustained to the average waiting time of 2 months for 6 months without any additional resources.ConclusionWith a well-organised and conducted quality improvement project and team efforts, the required changes can be brought about in an established conventional healthcare delivery system and improvements can be sustained over a long period of time.

scholarly journals Improving the waiting times within a hospice breathlessness service

2019 ◽  
Vol 8 (2) ◽  
pp. e000582
Author(s):  
Caroline Sime ◽  
Stuart Milligan ◽  
Kevin Donal Rooney
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
Waiting Time ◽  
Current System ◽  
Waiting Times ◽  
Well Being ◽  
Common Symptom ◽  
Specialist Palliative Care ◽  
Published Evidence

BackgroundBreathlessness, a common symptom in advanced disease, is a distressing, complex symptom that can profoundly affect the quality of one’s life. Evidence suggests that specialist palliative care breathlessness intervention services can improve physical well-being, personal coping strategies and quality of life. In the UK, the use of quality improvement methods is well documented in the National Health Service. However, within the independent hospice sector there is a lack of published evidence of using such methods to improve service provision.AimThe aim of this project was to reduce the waiting time from referral to service commencement for a hospice breathlessness service by 40%—from a median of 19.5 to 11.5 working days.MethodsUsing a quality planning and systems thinking approach staff identified barriers and blockages in the current system and undertook plan-do-study-act cycles to test change ideas. The ideas tested included offering home visits to patients on long-term oxygen, using weekly team ‘huddles’, streamlining the internal referral process and reallocating staff resources.ResultsUsing quality improvement methods enabled staff to proactively engage in positive changes to improve the service provided to people living with chronic breathlessness. Offering alternatives to morning appointments; using staff time more efficiently and introducing accurate data collection enabled staff to monitor waiting times in real time. The reduction achieved in the median waiting time from referral to service commencement exceeded the project aim.ConclusionsThis project demonstrates that quality improvement methodologies can be successfully used in a hospice setting to improve waiting times and meet the specific needs of people receiving specialist palliative care.

Enhancing patient flow in emergency department (ED) using lean strategies–an integrated voice of customer and voice of process perspective

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ali Alowad ◽  
Premaratne Samaranayake ◽  
Kazi Ahsan ◽  
Hisham Alidrisi ◽  
Azharul Karim
Keyword(s):  
Waiting Time ◽  
Emergency Services ◽  
Single Case ◽  
Patient Flow ◽  
Waiting Times ◽  
Small Sample ◽  
Content Type ◽  
Lean Tools ◽  
And Performance ◽  
Voice Of Customer

PurposeThe purpose of this paper is to systematically investigate the patient flow and waiting time problems in hospital emergency departments (EDs) from an integrated voice of customer (VOC) and voice of process (VOP) perspective and to propose a new lean framework for ED process.Design/methodology/approachA survey was conducted to better understand patients' perceptions of ED services, lean tools such as process mapping and A3 problem-solving sheets were used to identify hidden process wastes and root-cause analysis was performed to determine the reasons of long waiting time in ED.FindingsThe results indicate that long waiting times in ED are major concerns for patients and affect the quality of ED services. It was revealed that limited bed capacity, unavailability of necessary staff, layout of ED, lack of understanding among patients about the nature of emergency services are main causes of delay. Addressing these issues using lean tools, integrated with the VOC and VOP perspectives can lead to improved patient flow, higher patient satisfaction and improvement in ED capacity. A future value stream map is proposed to streamline the ED activities and minimize waiting times.Research limitations/implicationsThe research involves a relatively small sample from a single case study. The proposed approach will enable the ED administrators to avoid the ED overcrowding and streamline the entire ED process.Originality/valueThis research identified ED quality issues from the integration of VOC and VOP perspective and suggested appropriate lean tools to overcome these problems. This process improvement approach will enable the ED administrators to improve productivity and performance of hospitals.

One-stop breast clinic waiting-time reduction– a Quality improvement project (QIP)

2018 ◽  
Vol 44 (6) ◽  
pp. 917-918
Author(s):  
Raman Vinayagam ◽  
Denise Mason ◽  
Rajaram Burrah ◽  
Shabbir Poonawala ◽  
Maria Callaghan ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Waiting Time ◽  
Quality Improvement Project ◽  
Breast Clinic ◽  
Improvement Project ◽  
One Stop ◽  
Time Reduction

scholarly journals Reducing overcrowding in an emergency department: a pilot study

2019 ◽  
Vol 65 (12) ◽  
pp. 1476-1481
Author(s):  
Fábio Ferreira Amorim ◽  
Karlo Jozefo Quadros de Almeida ◽  
Sanderson Cesar Macedo Barbalho ◽  
Vanessa de Amorim Teixeira Balieiro ◽  
Arnaldo Machado Neto ◽  
...  
Keyword(s):  
Waiting Time ◽  
Waiting Times ◽  
Wait Time ◽  
Federal District ◽  
Arrival Times ◽  
Process Maps ◽  
Manchester Triage System ◽  
Simulation Scenario ◽  
Reduce Wait Time ◽  
Capacity Data

SUMMARY OBJECTIVE Exploring the use of forecasting models and simulation tools to estimate demand and reduce the waiting time of patients in Emergency Departments (EDs). METHODS The analysis was based on data collected in May 2013 in the ED of Recanto das Emas, Federal District, Brasil, which uses a Manchester Triage System. A total of 100 consecutive patients were included: 70 yellow (70%) and 30 green (30%). Flow patterns, observed waiting time, and inter-arrival times of patients were collected. Process maps, demand, and capacity data were used to build a simulation, which was calibrated against the observed flow times. What-if analysis was conducted to reduce waiting times. RESULTS Green and yellow patient arrival-time patterns were similar, but inter-arrival times were 5 and 38 minutes, respectively. Wait-time was 14 minutes for yellow patients, and 4 hours for green patients. The physician staff comprised four doctors per shift. A simulation predicted that allocating one more doctor per shift would reduce wait-time to 2.5 hours for green patients, with a small impact in yellow patients’ wait-time. Maintaining four doctors and allocating one doctor exclusively for green patients would reduce the waiting time to 1.5 hours for green patients and increase it in 15 minutes for yellow patients. The best simulation scenario employed five doctors per shift, with two doctors exclusively for green patients. CONCLUSION Waiting times can be reduced by balancing the allocation of doctors to green and yellow patients and matching the availability of doctors to forecasted demand patterns. Simulations of EDs’ can be used to generate and test solutions to decrease overcrowding.

scholarly journals A telephone assessment and advice service within an ED Physiotherapy clinic: A single-site quality improvement cohort study

2021 ◽  
Author(s):  
Marie Kelly ◽  
Anna Higgins ◽  
Adrian Murphy ◽  
Karen McCreesh
Keyword(s):  
Cohort Study ◽  
Quality Improvement ◽  
Usual Care ◽  
Wait Time ◽  
Single Site ◽  
Site Quality ◽  
Attendance Rates ◽  
Improvement Project ◽  
Face To Face ◽  
Advice Service

Abstract BackgroundIn response to issues with timely access and high non-attendance rates for Emergency Department (ED) physiotherapy, a telephone assessment and advice service was evaluated as part of a quality improvement project. This telehealth option requires minimal resources, with the added benefit of allowing the healthcare professional streamline care. A primary aim was to investigate whether this service model can reduce wait times and non-attendance rates, compared to usual care. A secondary aim was to evaluate service user acceptability.MethodsThis was a single-site quality improvement cohort study that compares data on wait time to first physiotherapy contact, non-attendance rates and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, X, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on wait time and non-attendance rates was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study.ResultsThose that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3 – 8 days) compared to those that opted for usual care (median 35 days; 19 – 39 days) (p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction.ConclusionA telephone assessment and advice service may be useful in minimising delays for advice for those referred to ED Physiotherapy for musculoskeleltal problems. This telehealth option appears to be broadly acceptable and since it can be introduced rapidly, it may be helpful in triaging referrals and minimising face-to-face consultations, in line with COVID-19 recommendations. However, a large scale randomised controlled trial is warranted to confirm these findings.

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