Operational efficiencies in the infusion center: Improving nursing efficiencies and patient wait times while decreasing costs.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 56-56
Author(s):  
Alyssa Garth ◽  
Susan Schreiner ◽  
Dawn Jourdan
Keyword(s):  
Patient Flow ◽  
Cost Savings ◽  
Wait Time ◽  
Labor Cost ◽  
Nursing Workload ◽  
Wait Times ◽  
Staff Nurse ◽  
Patient Centered ◽  
Patient Assignment ◽  
Role Based

56 Background: Decreased nursing efficiency and patient assignments has increased patient wait times and has significant implications on overall patient flow in the infusion center and labor dollars. Historically, staff nurses signed up for their patients, and took an average of 2 patients at one time. This created disparity in patient/staffing ratios, high number of labor dollars per worked infusion and an overall atmosphere of inequity among the nurses. Methods: Patient flow and labor cost were examined. Analysis of the nursing staffing matrix led to the creation of a patient placement nurse, taken from the daily staff allocation, assigning patients based on current patient assignment and acuity of patients. Nurses were identified to learn the patient placement nurse role based on critical thinking and organizational skills. With the assistance of a patient locator system, the patient placement nurse is able to identify when a patient’s wait begins and which nurse is the best choice to be assigned. A system was implemented in which a staff nurse was assigned a patient every 30-40 minutes with a maximum patient assignment of 4 concurrently. A standard 1:3 nurse to patient ratio was established unless a patient’s acuity prohibited this ratio. Results: Nursing ratios stabilized at 1:3. Staff became more efficient and work was reorganized for less subjectivity in patient assignments, producing more equitable workloads. This resulted in an increase in patients seen within 15 minutes improving from 69.8% to 85.3%. In addition, it allowed for the elimination of one nurse per day shift, resulting in a cost savings of approximately a 1.0 FTE/week or average annual salary of $62,129. Conclusions: Development of a standardized patient placement process can increase infusion center efficiencies and stabilize nursing workload, as well as decrease patient wait time and reduce the cost per infusion. This supports a delivery of patient-centered care while utilizing staff efficiently and appropriately and decreasing cost.

scholarly journals Innovative Strategies for Decreasing Blood Collection Wait Times for Patients in Early-Phase Cancer Clinical Trials

2016 ◽  
Vol 12 (7) ◽  
pp. e784-e791 ◽  
Author(s):  
Bayabel Mengistu ◽  
Dina Ray ◽  
Passion Lockett ◽  
Vivian Dorsey ◽  
Ron A. Phipps ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Early Phase ◽  
Patient Flow ◽  
Care Facility ◽  
Cost Savings ◽  
Primary Source ◽  
Wait Time ◽  
Turnover Time ◽  
Wait Times ◽  
Blood Collection

Purpose: Long wait times are a primary source of dissatisfaction among patients enrolled in early-phase clinical trials. We hypothesized that an automated patient check-in system with readily available display for increasing awareness of waiting intervals would improve patient flow and use of our rooms, with decreased turnover time and increased throughput. Methods: We recorded in-room wait times for patients seen in our clinic and observed the logistics involved in the blood collection process to delineate causes for delays. We then implemented a three-step strategy to alleviate the causes of these delays: (1) changing the collection of materials and the review of faxed orders, (2) improving our LabTracker automated database system that included wait time calculators and real-time information regarding patient status, and (3) streamlining lower complexity appointments. Results: After our intervention, we observed a 19% decrease in mean wait times and a 30% decrease in wait times among patients waiting the longest (95th percentile). We also observed an increase in staff productivity during this process. Modifications in LabTracker provided the biggest reduction in mean wait times (17%). Conclusion: We observed a significant decrease in mean wait times after implementing our intervention. This decrease led to increased staff productivity and cost savings. Once wait times became a measurable metric, we were able to identify causes for delays and improve our operations, which can be performed in any patient care facility.

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

2016 ◽  
Vol 23 (3) ◽  
pp. 260 ◽  
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.

Medical readiness: evaluating the robustness of medical clinic staffing solutions

2016 ◽  
Vol 14 (4) ◽  
pp. 407-419
Author(s):  
Michael Q Corpuz ◽  
Christina F Rusnock ◽  
Vhance V Valencia ◽  
Kyle Oyama
Keyword(s):  
Negative Impact ◽  
Cost Benefit Analysis ◽  
Relative Effectiveness ◽  
Discrete Event ◽  
Cost Savings ◽  
Cost Benefit ◽  
Wait Time ◽  
Cost Effective ◽  
Wait Times ◽  
Staffing Mix

Medical readiness requires Department of Defense medical clinics to be robust to changes in patient demand. Minor fluctuations in patient demand occur on a regular basis, but major increases can also occur. Major demand increases can result from a number of occurrences, including mass military deployments, medical incidents, outbreaks, and overflow from Veterans’ Affairs clinics. This research evaluates a system of clinics at Wright-Patterson Air Force Base in order to determine its ability to handle a 200% surge in patient demand. In addition, this study evaluates the relative effectiveness of six different staffing mix options to minimize patient wait times, also under the surge demand conditions. This evaluation is conducted using discrete-event simulation to estimate patient wait times and includes a sensitivity analysis of the increased patient demand, as well as a cost–benefit analysis to determine the most cost-effective alternative scenario. The study finds that adjustments to staffing mix enable cost savings while meeting current demands. In addition, the study finds that adjusting the staffing mix will not have a negative impact on patient wait time in the surge conditions, relative to the current staffing mix.

scholarly journals Dietitian first gastroenterology clinic: an initiative to reduce wait lists and wait times for gastroenterology outpatients in a tertiary hospital service

2018 ◽  
Vol 10 (3) ◽  
pp. 229-235 ◽  
Author(s):  
Rumbidzai N Mutsekwa ◽  
Russell Canavan ◽  
Anthony Whitfield ◽  
Alan Spencer ◽  
Rebecca L Angus
Keyword(s):  
Patient Flow ◽  
Wait Time ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Wait Times ◽  
Activity Data ◽  
Patient Journey ◽  
Service Activity ◽  
High Level ◽  
The Impact

ObjectiveThe demand for outpatient gastroenterology medical specialist consultations is above what can be met within budgetary and staffing constraints. This study describes the establishment of a dietitian first gastroenterology clinic to address this issue, the patient journey and its impact on wait lists and wait times in a tertiary gastroenterology service.DesignA dietitian first gastroenterology clinic model was developed and a mixed-methods approach used to evaluate the impact of the service over a 21-month period.SettingGold Coast University Hospital, Queensland, Australia (a public tertiary hospital).Patients658 patients were triaged to the clinic between June 2016 and March 2018.InterventionA dietitian first gastroenterology clinic for low-risk gastroenterology patients.Main outcome measuresWe examined demographic, referral, wait list, wait time and service activity data, patient satisfaction and patient journey.ResultsAt the time of audit, 399 new (67.9% female) and 307 review patients had been seen. Wait times for eligible patients reduced from 280 to 66 days and the percentage of those in breach of their recommended wait times reduced from 95% to zero. The average time from referral to discharge was 117.8 days with an average of 2.4 occasions of service. 277 patients (69.4%) had been discharged to the care of their general practitioner and 43 patients (10.7%) had an expedited specialist medical review. Patient surveys indicated a high level of satisfaction.ConclusionA dietitian first gastroenterology model of care helps improve patient flow, reduces wait times and may be useful elsewhere to address outpatient gastroenterology service pressures.

scholarly journals Transforming Access to Specialist Care for Inflammatory Bowel Disease: The PACE Telemedicine Program

2018 ◽  
Vol 2 (4) ◽  
pp. 186-194 ◽  
Author(s):  
Peter Habashi ◽  
Shelley Bouchard ◽  
Geoffrey C Nguyen
Keyword(s):  
Median Time ◽  
Cost Savings ◽  
Wait Time ◽  
Wait Times ◽  
Specialist Care ◽  
Potential Cost ◽  
Health Administrative Data ◽  
Geographic Disparities ◽  
Inflammatory Bowel ◽  
Travel Grant

Abstract Background There are significant geographic disparities in the delivery of IBD healthcare in Ontario which may ultimately impact health outcomes. Telemedicine-based health services may potentially bridge gaps in access to gastroenterologists in remote and underserved areas. Methods We conducted a needs assessment for IBD specialist care in Ontario using health administrative data. As part of a separate initiative to address geographic disparities in access to care, we described the development and implementation of our Promoting Access and Care through Centres of Excellence (PACE) Telemedicine Program. Over the first 18 months, we measured wait times and potential cost savings. Results We found substantial deficiencies in specialist care early in the course of IBD and continuous IBD care in regions where the number of gastroenterologists per capita were low. The PACE Telemedicine Program enabled new IBD consultations within a median time of 17 days (interquartile range [IQR], 7–32 days) and visits for active IBD symptoms with a median time of 8.5 days (IQR, 4–14 days). Forty-five percent of new consultations and 83% of patients with active IBD symptoms were seen within the target wait time of two weeks. Telemedicine services resulted in an estimated cost savings of $47,565 among individuals who qualified for Ontario’s Northern Travel Grant. Conclusions The implementation of telemedicine services for IBD is highly feasible and can reduce wait times to see gastroenterologists that meet nationally recommended targets and can lead to cost savings.

scholarly journals P.017 Results of a Pilot feasibility study to develop reduce wait times strategy in the evaluation of children with new onset epilepsy

2018 ◽  
Vol 45 (s2) ◽  
pp. S20-S20
Author(s):  
JA Mailo ◽  
M Diebold ◽  
E Mazza ◽  
P Guertjens ◽  
H Gangam ◽  
...  
Keyword(s):  
Patient Flow ◽  
Waiting Times ◽  
Wait Time ◽  
Febrile Seizures ◽  
Limiting Factors ◽  
Wait Times ◽  
Timely Access ◽  
Flow Through ◽  
Pilot Feasibility Study ◽  
New Onset

Background: The goal was to understand factors leading to prolonged wait times for neurological assessment of children with new onset seizures. A second objective was to develop an innovative approach to patient flow through and achieve a reduction in waiting times utilizing limited resources.Methods:Audit of the referrals, flow through, wait timesIdentification of bottlenecksDevelopment of triaging strategy:Suspected Febrile seizures and non-epileptic events;Suspected benign and absence epilepsies;Suspected other Focal epilepsies, generalized epilepsies, epilepsy under 2 yearsInitiation of early telephone contact and supportDevelopment of a ketogenic dietResults: Using a triaging strategy and focusing on timely access to investigations, wait times for clinic evaluations were shortened despite larger numbers of referrals (mean wait time reductions from 179 to 91 days). Limiting factors such increase in referral numbers, attrition in support staff, interfered with sustainability of reduced wait times achieved in the initial phase of the program. Conclusions: This pilot study highlights the effectiveness of an innovative triaging strategy and improvements in patient flow through in achieving the goals of reduction in wait times for clinical evaluation and timely investigations to improve care for children with new onset seizures. Insights into limitations of such strategies and factors determining sustainability are discussed.

The Impact of Diagnostic Imaging Wait Times on the Prognosis of Lung Cancer

2015 ◽  
Vol 66 (1) ◽  
pp. 53-57 ◽  
Author(s):  
Suzanne C. Byrne ◽  
Brendan Barrett ◽  
Rick Bhatia
Keyword(s):  
Lung Cancer ◽  
Diagnostic Imaging ◽  
Lung Biopsy ◽  
Patient Flow ◽  
Tumour Size ◽  
Wait Time ◽  
Wait Times ◽  
Eastern Health ◽  
Ct Guided ◽  
Initial Imaging

Objective This study was performed to determine whether gaps in patient flow from initial lung imaging to computed tomography (CT) guided lung biopsy in patients with non–small cell lung cancer (NSCLC) was associated with a change in tumour size, stage, and thus prognosis. Methods All patients who had a CT-guided lung biopsy in 2009 (phase I) and in 2011 (phase II) with a pathologic diagnosis of primary lung cancer (NSCLC) at Eastern Health, Newfoundland, were identified. Dates of initial abnormal imaging, confirmatory CT (if performed), and CT-guided biopsy were recorded, along with tumour size and resulting T stage at each time point. In 2010, wait times for diagnostic imaging at Eastern Health were reduced. The stage and prognosis of NSCLC in 2009 was compared with 2011. Results In phase 1, there was a statistically significant increase in tumour size (mean difference, 0.67 cm; P < .0001) and stage ( P < .0001) from initial image to biopsy. There was a moderate correlation between the time (in days) between the images and change in size ( r = 0.33, P = .008) or stage ( r = 0.26, P = .036). In phase II, the median wait time from initial imaging to confirmatory CT was reduced to 7.5 days (from 19 days). At this reduced wait time, there was no statistically significant increase in tumour size (mean difference, 0.02; P > .05) or stage ( P > .05) from initial imaging to confirmatory CT. Conclusions Delays in patient flow through diagnostic imaging resulted in an increase in tumour size and stage, with a negative impact on prognosis of NSCLC. This information contributed to the hiring of additional CT technologists and extended CT hours to decrease the wait time for diagnostic imaging. With reduced wait times, the prognosis of NSCLC was not adversely impacted as patients navigated through diagnostic imaging.

Wait Times and Bed Capacity for Hematopoietic Cell Transplantation in Ontario: A System Dynamics Model

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2378-2378
Author(s):  
Jonathan Wang ◽  
Saba Vahid ◽  
Hertz Sherrie ◽  
C. Tom Kouroukis
Keyword(s):  
System Dynamics ◽  
Research Funding ◽  
Hematopoietic Cell Transplantation ◽  
Patient Flow ◽  
Wait Time ◽  
Flow Diagram ◽  
Wait Times ◽  
System Dynamics Model ◽  
Dynamics Model ◽  
Bed Capacity

Abstract Objectives: Cancer Care Ontario (CCO) is the provincial governmental organization responsible for planning hematopoietic cell transplantation (HCT) services in Ontario, Canada. The objective of this project is to develop a capacity planning model to investigate the effects on wait times of adding extra bed capacity for allogeneic transplant (ALLOHCT) in HCT centers. Approach: A high-level process flow diagram was generated to understand patient flow at a 6-bed HCT unit within a hospital in Ontario and validated through consultation. This flow diagram was used to construct a system dynamics model to simulate patient flow. The model was parameterized with data from CCO, Discharge Abstract Database, and with hospital and clinical expert input. The effects at six months were projected for five scenarios: 1) current state; 2) increase bed capacity by 1 bed; or 3) increase bed capacity by 2 beds; 4) increasing patient demand by 20 patients per year; 5) combination of scenarios 3 and 4. Provincial clinical consensus established a benchmark wait time of 42 days for ALLOHCT from ready to transplant to the transplant date. In addition, the estimated number of beds required to reduce the wait times to the provincial benchmark within 1 year was calculated. Results:The addition of 1 ALLOHCT bed resulted in a reduction of 22% and 11% to the ALLOHCT wait times and wait lists, respectively. The addition of 2 beds resulted in a reduction of 38% and 22% to the wait times and wait lists, respectively. If the demand increases by 20 patients per year, the addition of 2 beds resulted in a reduction of 16% in the wait times and while the wait list may experience a brief reduction, after 6 months, the wait list size will have increased by 9% as a result of the increased demand. In order to reduce the wait times to the provincial benchmark within 1 year, an additional 8 beds are needed. Considerations: Concurrent planning for additional health human resources (physicians, nurses, etc…) needs to be done to ensure the additional beds are adequately staffed. This model also only considers the effects of adding beds within 1 year. There may be instances where bed space cannot be immediately opened and new capital is required. Additionally, the demand for ALLOHCT continues to increase, which in turn drives up the number of arrivals to the queue. A multi-year model will be built to account for timing of bed openings and increasing demand for ALLOHCT. Conclusion:Using a system dynamics model, we are able to quantify the relationship between ALLOHCT bed capacity and wait times at an HCT center. This model can be used to estimate the ALLOHCT bed requirements for sites in other jurisdictions where ALLOHCT demand and wait time benchmarks are known. Disclosures Kouroukis: Janssen: Research Funding; Karyopharm: Research Funding.

scholarly journals Patient Flow Analysis in General Hospitals: How Clinical Disciplines Affect Outpatient Wait Times

2019 ◽  
Vol 4 (4) ◽  
pp. 128-133 ◽  
Author(s):  
Afsoon Aeenparast ◽  
Faranak Farzadi ◽  
Farzaneh Maftoon ◽  
Hossein Yahyazadeh
Keyword(s):  
Patient Flow ◽  
Flow Analysis ◽  
Wait Time ◽  
Cross Sectional Study ◽  
Outpatient Setting ◽  
Wait Times ◽  
Outpatient Services ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Physical Examinations

Background: Overcrowding is an important problem for outpatient services in healthcare facilities. Patient flow analysis (PFA) is a useful method for identifying inefficiencies in and facilitating patient flow. Objective: PFA was used to estimate patient wait time and determine how different clinical disciplines impact wait times in the studied hospital. Methods: This cross-sectional study investigated a study population comprised of outpatients who referred to clinics at a general hospital in Tehran, Iran. A total of 3836 samples were selected from different stations. Nonrandomized quota sampling was used, and data was gathered using workflow checklists, the content validity of which was proven by experts and hospital authorities. SPSS statistical software was used for data analysis. Results: Total patient stay in the outpatient setting was an estimated 77 minutes (without considering para-clinic units and pharmacy). More than 90% of this time was spent waiting. The wait time of patients at the clinic was greater than that at other stations, and it was less at the cash station than at other stations. Wait times varied at different clinics (P value < 0.001) and were correlated with physician delay (P value < 0.001). Conclusion: The most important result of using PFA in the outpatient setting was managing wait times. This study indicated that a considerable amount of a patient’s total stay in the system was related to waiting for physical examinations. This suggests that the first priority in improving the system should be managing patient wait times for physical examinations.

scholarly journals Improving Patient Experience of Wait Times and Courtesy Through Electronic Sign-in and Notification in the Phlebotomy Clinic

2019 ◽  
Vol 144 (6) ◽  
pp. 769-775
Author(s):  
Vincent Le ◽  
Elizabeth A. Wagar ◽  
Ron A. Phipps ◽  
Robert E. Del Guidice ◽  
Han Le ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Patient Experience ◽  
Patient Flow ◽  
Wait Time ◽  
Satisfaction Score ◽  
Wait Times ◽  
Notification System ◽  
The Mean ◽  
Patients Experience ◽  
And Training

Context.— The phlebotomy clinic, which sees on average 900 patients a day, was faced with issues of congestion and noise due to inefficient workflow and processes. The staff called each patient name for his or her turn, and patients were unsure of wait time and position in line. These factors led to unfavorable patient satisfaction regarding wait times and courtesy of the staff. Objective.— To improve patients' experience of wait times and courtesy in the phlebotomy clinic through an electronic sign-in and notification system, redesign of the area, and training of employees. Design.— An electronic sign-in and notification system was implemented in the phlebotomy clinic. Several sign-in stations and whiteboard wall monitors were installed in the clinic, along with a redesign of the patient flow. A Press Ganey survey was given to patients after their visit which included 3 questions related to wait times, courtesy, and information about delays, respectively. The mean responses for each month between March 2016 and December 2018 were aggregated and compared for each measure. Results.— Overall, wait time saw a 7.7% increase in satisfaction score, and courtesy saw a 1.0% increase in satisfaction score during the course of the several interventions that were introduced. The operational efficiency of the clinic also saw a veritable increase because the percent of patients processed within 20 minutes increased by 27%, from 62% (8212 of 13 245 blood draws) to 89% (11 703 of 13 143 blood draws). Conclusions.— The interventions implemented proved to increase the patient satisfaction in each of the measures. The electronic sign-in and whiteboards provided valuable information to both patients and staff.

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