A Patient Flow Analysis: Identification of Process Inefficiencies and Workflow Metrics at an Ambulatory Endoscopy Unit

Background. The increasing demand for endoscopic procedures coincides with the paradigm shift in health care delivery that emphasizes efficient use of existing resources. However, there is limited literature on the range of endoscopy unit efficiencies.Methods. A time and motion analysis of patient flow through the Hotel-Dieu Hospital (Kingston, Ontario) endoscopy unit was followed by qualitative interviews. Procedures were directly observed in three segments: individual endoscopy room use, preprocedure/recovery room, and overall endoscopy unit utilization.Results. Data were collected for 137 procedures in the endoscopy room, 139 procedures in the preprocedure room, and 143 procedures for overall room utilization. The mean duration spent in the endoscopy room was 31.47 min for an esophagogastroduodenoscopy, 52.93 min for a colonoscopy, 30.47 min for a flexible sigmoidoscopy, and 66.88 min for a double procedure. The procedure itself accounted for 8.11 min, 34.24 min, 9.02 min, and 39.13 min for the above procedures, respectively. The focused interviews identified the scheduling template as a major area of operational inefficiency.Conclusions. Despite reasonable procedure times for all except colonoscopies, the endoscopy room durations exceed the allocated times, reflecting the impact of non-procedure-related factors and the need for a revised scheduling template. Endoscopy units have unique operational characteristics and identification of process inefficiencies can lead to targeted quality improvement initiatives.

Download Full-text

Improving patient flow and timeliness in the diagnosis and management of breast abnormalities: the impact of a rapid diagnostic unit

Current Oncology ◽

10.3747/co.23.3017 ◽

2016 ◽

Vol 23 (3) ◽

pp. 260 ◽

Cited By ~ 8

Author(s):

J.M. Racz ◽

C.M.B. Holloway ◽

W. Huang ◽

N.J. Look Hong

Keyword(s):

Care Delivery ◽

Patient Flow ◽

Wait Time ◽

Definitive Treatment ◽

Wait Times ◽

Fisher Exact Test ◽

Patient Anxiety ◽

Diagnostic Unit ◽

Clinical Investigations ◽

The Impact

Background Efforts to streamline the diagnosis and treatment of breast abnormalities are necessary to limit patient anxiety and expedite care. In the present study, we examined the effect of a rapid diagnostic unit (RDU) on wait times to clinical investigations and definitive treatment.Methods A retrospective before–after series, each considering a 1-year period, examined consecutive patients with suspicious breast lesions before and after initiation of the RDU. Patient consultations, clinical investigations, and lesion characteristics were captured from time of patient referral to initiation of definitive treatment. Outcomes included time (days) to clinical investigations, to delivery of diagnosis, and to management. Groups were compared using the Fisher exact test or Student t-test.Results The non-RDU group included 287 patients with 164 invasive breast carcinomas. The RDU group included 260 patients with 154 invasive carcinomas. The RDU patients had more single visits for biopsy (92% RDU vs. 78% non-RDU, p < 0.0001). The RDU group also had a significantly shorter wait time from initial consultation to delivery of diagnosis (mean: 2.1 days vs. 16.7 days, p = 0.0001) and a greater chance of receiving neoadjuvant chemotherapy (37% vs. 24%, p = 0.0106). Overall time from referral to management remained statistically unchanged (mean: 53 days with the RDU vs. 50 days without the RDU, p = 0.3806).Conclusions Introduction of a RDU appears to reduce wait times to definitive diagnosis, but not to treatment initiation, suggesting that obstacles to care delivery can occur at several points along the diagnostic trajectory. Multipronged efforts to reduce system-related delays to definitive treatment are needed.

Download Full-text

Factors That Influence the Efficiency of an Endoscopy Unit: A Patient Flow Analysis

The American Journal of Gastroenterology ◽

10.14309/00000434-201410002-01882 ◽

2014 ◽

Vol 109 ◽

pp. S557

Author(s):

Rowena Almeida ◽

Nancy Craig ◽

Lawrence Hookey

Keyword(s):

Patient Flow ◽

Flow Analysis ◽

Endoscopy Unit

Download Full-text

Simulation-based patient flow analysis in an endoscopy unit

2010 IEEE Workshop on Health Care Management (WHCM) ◽

10.1109/whcm.2010.5441266 ◽

2010 ◽

Cited By ~ 4

Author(s):

Pyung-Hoi Koo ◽

Karl Brian Nielsen ◽

Jaejin Jang ◽

Alexander Kolker

Keyword(s):

Patient Flow ◽

Flow Analysis ◽

Endoscopy Unit ◽

Simulation Based

Download Full-text

Telemedicine in the ICU: Innovation in the Critical Care Process

Journal of Intensive Care Medicine ◽

10.1177/0885066620968518 ◽

2020 ◽

pp. 088506662096851

Author(s):

Muhammad Khurrum ◽

Samer Asmar ◽

Bellal Joseph

Keyword(s):

Health Care ◽

Critical Care ◽

Intensive Care ◽

Care Delivery ◽

Care Process ◽

Learning Tools ◽

Care Services ◽

Alarm Systems ◽

Increasing Demand ◽

The Impact

Tele-ICU is a technology-based model designed to deliver effective critical care in the intensive care unit (ICU). The tele-ICU system has been developed to address the increasing demand for intensive care services and the shortage of intensivists. A finite number of intensivists from remote locations provide real-time services to multiple ICUs and assist in the treatment of critically ill patients. Risk prediction algorithms, smart alarm systems, and machine learning tools augment conventional coverage and can potentially improve the quality of care. Tele-ICU is associated with substantial improvements in mortality, reduced hospital and ICU length of stay, and decreased health care costs. Although multiple studies show improved outcomes following the implementation of tele-ICU, results are not consistent. Several factors, including the heterogeneity of tele-ICU infrastructure deployed in different facilities and the reluctance of health care workers to accept tele-ICU, could be associated with these varied results. Considerably high installation and ongoing operational costs might also be limiting the widespread utilization of this innovative service. While we believe that the implementation of tele-ICU offers potential advantages and makes critical care delivery more efficient, further research on the impact of this technology in critical care settings is warranted.

Download Full-text

Treatment Induced Cytotoxic T-Cell Modulation in Multiple Myeloma Patients

Frontiers in Oncology ◽

10.3389/fonc.2021.682658 ◽

2021 ◽

Vol 11 ◽

Author(s):

Gregorio Barilà ◽

Laura Pavan ◽

Susanna Vedovato ◽

Tamara Berno ◽

Mariella Lo Schirico ◽

...

Keyword(s):

Multiple Myeloma ◽

Immune System ◽

T Cell ◽

Flow Analysis ◽

Cytotoxic T Cell ◽

Cd4 Cells ◽

Related Factors ◽

Bortezomib Treatment ◽

Plasma Cell Dyscrasias ◽

The Impact

The biology of plasma cell dyscrasias (PCD) involves both genetic and immune-related factors. Since genetic lesions are necessary but not sufficient for Multiple Myeloma (MM) evolution, several authors hypothesized that immune dysfunction involving both B and T cell counterparts plays a key role in the pathogenesis of the disease. The aim of this study is to evaluate the impact of cornerstone treatments for Multiple Myeloma into immune system shaping. A large series of 976 bone marrow samples from 735 patients affected by PCD was studied by flow analysis to identify discrete immune subsets. Treated MM samples displayed a reduction of CD4+ cells (p<0.0001) and an increase of CD8+ (p<0.0001), CD8+/DR+ (p<0.0001) and CD3+/CD57+ (p<0.0001) cells. Although these findings were to some extent demonstrated also following bortezomib treatment, a more pronounced cytotoxic polarization was shown after exposure to autologous stem cell transplantation (ASCT) and Lenalidomide (Len) treatment. As a matter of fact, samples of patients who received ASCT (n=110) and Len (n=118) were characterized, towards untreated patients (n=138 and n=130, respectively), by higher levels of CD8+ (p<0.0001 and p<0.0001, respectively), CD8+/DR+ (p=0.0252 and p=0.0001, respectively) and CD3+/CD57+ cells (p<0.0001 and p=0.0006, respectively) and lower levels of CD4+ lymphocytes (p<0.0001 and p=0.0005, respectively). We demonstrated that active MM patients are characterized by a relevant T cell modulation and that most of these changes are therapy-related. Current Myeloma treatments, notably ASCT and Len treatments, polarize immune system towards a dominant cytotoxic response, likely contributing to the anti-Myeloma effect of these regimens.

Download Full-text

The societal cost and economic impact of surgical care on patients’ households in rural Uganda; a mixed method study

BMC Health Services Research ◽

10.1186/s12913-021-06579-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Obieze Nwanna–Nzewunwa ◽

Rasheedat Oke ◽

Esther Agwang ◽

Mary-Margaret Ajiko ◽

Christopher Yoon ◽

...

Keyword(s):

Care Delivery ◽

Qualitative Interviews ◽

Surgical Care ◽

Societal Cost ◽

Medical Expenditure ◽

Treatment Modalities ◽

Chi Square ◽

Middle Income ◽

Femur Fractures ◽

The Impact

Abstract Background The epidemiology and cost of surgical care delivery in low-and middle-income countries (LMICs) is poorly understood. This study characterizes the cost of surgical care, rate of catastrophic medical expenditure and medical impoverishment, and impact of surgical hospitalization on patients’ households at Soroti Regional Referral Hospital (SRRH), Uganda. Methods We prospectively collected demographic, clinical, and cost data from all surgical inpatients and caregivers at SRRH between February 2018 and January 2019. We conducted and thematically analyzed qualitative interviews to discern the impact of hospitalization on patients’ households. We employed the chi-square, t-test, ANOVA, and Bonferroni tests and built regression models to identify predictors of societal cost of surgical care. Out of pocket spending (OOPS) and catastrophic expenses were determined. Results We encountered 546 patients, mostly male (62%) peasant farmers (42%), at a median age of 22 years; and 615 caregivers, typically married (87%), female (69%), at a median age of 35 years. Femur fractures (20.4%), soft tissue infections (12.3%), and non-femur fractures (11.9%) were commonest. The total societal cost of surgical care was USD 147,378 with femur fractures (USD 47,879), intestinal obstruction (USD 18,737) and non-femur fractures (USD 10,212) as the leading contributors. Procedures (40%) and supplies (12%) were the largest components of societal cost. About 29% of patients suffered catastrophic expenses and 31% were medically impoverished. Conclusion Despite free care, surgical conditions cause catastrophic expenses and impoverishment in Uganda. Femur fracture is the most expensive surgical condition due to prolonged hospitalization associated with traction immobilization and lack of treatment modalities with shorter hospitalization.

Download Full-text

Contact precautions for colonisation with multidrug-resistant organisms and haemodialysis patient quality of life and mood: a pilot case-control study

Renal Society of Australasia Journal ◽

10.33235/rsaj.15.1.19-25 ◽

2019 ◽

pp. 19-25 ◽

Cited By ~ 1

Author(s):

Rathika Krishnasamy

Keyword(s):

Quality Of Life ◽

Qualitative Interviews ◽

Social Function ◽

Multidrug Resistant ◽

Contact Precautions ◽

Dialysis Vintage ◽

Multidrug Resistant Organisms ◽

And Gender ◽

The Impact

Background: The rate of multidrug-resistant organisms (MDRO) colonisation in dialysis populations has increased over time. This study aimed to assess the effect of contact precautions and isolation on quality of life and mood for haemodialysis (HD) patients colonised with MDRO. Methods: Patients undergoing facility HD completed the Kidney Disease Quality of Life (KDQOL–SFTM), Beck Depression Inventory (BDI) and Personal Wellbeing-Index Adult (PWI-A). Patients colonised with MDRO were case-matched by age and gender with patients not colonised. Results: A total of 16 MDRO-colonised patients were matched with 16 controls. Groups were well matched for demographics and co-morbidities, other than a trend for older dialysis vintage in the MDRO group [7.2 years (interquartile range 4.6–10.0) compared to 3.2 (1.4–7.6) years, p=0.05]. Comparing MDRO-positive with negative patients, physical (30.5±10.7 vs. 34.6±7.3; p=0.2) and mental (46.5±11.2 vs. 48.5±12.5; p = 0.6) composite scores were not different between groups. The MDRO group reported poorer sleep quality (p=0.01) and sleep patterns (p=0.05), and lower social function (p=0.02). BDI scores were similar (MDRO-positive 10(3.5–21.0) vs. MDRO-negative 12(6.5–16.0), p=0.6). PWI-A scores were also similar in both groups; however, MDRO patients reported lower scores for “feeling safe”, p=0.03. Conclusion: While overall scores of quality of life and depression were similar between groups, the MDRO group reported poorer outcomes in sleep and social function. A larger cohort and qualitative interviews may give more detail of the impact of contact precautions and isolation on HD patients. The necessity for contact precautions for different MDRO needs consideration.

Download Full-text

THE IMPACT OF UKRAINE'S EXCISE DUTY POLICY ON THE TRANSFORMATION PROCESSES OF THE TOBACCO MARKET

Economy of Ukraine ◽

10.15407/economyukr.2020.10.019 ◽

2020 ◽

Vol 2020 (10) ◽

pp. 19-33

Author(s):

Nadiia NOVYTSKA ◽

◽

Inna KHLIEBNIKOVA ◽

Keyword(s):

Structural Changes ◽

Tax Avoidance ◽

Transformation Process ◽

State Regulation ◽

Tobacco Products ◽

Excise Duty ◽

Increasing Demand ◽

High Level ◽

The Impact ◽

Transformation Processes

The market of tobacco products in Ukraine is one of the most dynamic and competitive. It develops under the influence of certain factors that cause structural changes, therefore, the aim of the article is to conduct a comprehensive analysis of transformation processes in the market of tobacco and their alternatives in Ukraine and identify the factors that cause them. The high level of tax burden and the proliferation of alternative products with a potentially lower risk to human health, including heating tobacco products and e-cigarettes, are key factors in the market’s transformation process. Their presence leads to an increase in illicit turnover of tobacco products, which accounts for 6.37% of the market, and the gradual replacement of cigarettes with alternative products, which account for 12.95%. The presence on the market of products that are not taxed or taxed at lower rates is one of the reasons for the reduction of excise duty revenues. According to the results of 2019, the planned indicators of revenues were not met by 23.5%. Other reasons for non-fulfillment of excise duty revenues include: declining dynamics of the tobacco products market; reduction in the number of smokers; reorientation of «cheap whites» cigarette flows from Ukraine to neighboring countries; tax avoidance. Prospects for further research are identified, namely the need to develop measures for state regulation and optimization of excise duty taxation of tobacco products and their alternatives, taking into account the risks to public health and increasing demand of illegal products.

Download Full-text

A Study On Impact Of Work Life Related Factors On Employee Engagement In Health Care Sector Workers In Dindigul District.

Restaurant Business ◽

10.26643/rb.v118i7.7242 ◽

2019 ◽

Vol 118 (7) ◽

pp. 20-26

Author(s):

S. JAYARAMAN ◽

R. Sindhya ◽

P. Vijiyalakshmi

Keyword(s):

Health Care ◽

Path Analysis ◽

Employee Engagement ◽

Health Care Workers ◽

Health Care Sector ◽

Work Life ◽

Primary Data ◽

Related Factors ◽

Care Workers ◽

The Impact

this research aims to find out the intensity of Employee Engagement of the health care sector workers and the relationship between the Work life factors and Employee Engagement of Health care sector workers in Dindigul District. Primary data were used in this research, were collected from 298 Health care workers from Dindigul District. Questionnaire was the major tool used to gather the primary data from the selected sample respondents. For this purpose, a well structured questionnaire was constructed with the help of professionals and the practiced employees of various health care units in Dindigul District. The health care employees were chosen by simple random sampling method. The investigative measures of regression Path analysis, and simple percentage analysis were utilized to find the impact of work life related factors with the Employee Engagement. The maximum Health care workers were generally satisfied with their jobs. The analytical procedure of path analysis multiple regressions was utilized to determine the predicting strength among Work life factors and the employee engagement. This study provides an another view about the importance of Work life factors and Employee engagement for organizational effectiveness and performance .

Download Full-text