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.

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 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.

Reduced isolation room turnover time using Lean methodology

2019 ◽  
Vol 40 (10) ◽  
pp. 1151-1156 ◽  
Author(s):  
Andrea L. Ankrum ◽  
Smriti Neogi ◽  
Molynda A. Morckel ◽  
Adam W. Wilhite ◽  
Zhaoyan Li ◽  
...  
Keyword(s):  
Uv Light ◽  
Patient Flow ◽  
Wait Time ◽  
Turnover Time ◽  
Value Stream Mapping ◽  
Uv Disinfection ◽  
Healthcare Team ◽  
Start Time ◽  
Isolation Room ◽  
Before And After

AbstractObjective:To prevent environmental transmission of pathogens, hospital rooms housing patients on transmission-based precautions are cleaned extensively and disinfected with ultraviolet (UV) light. To do so consistently requires time and coordination, and these procedures must avoid patient flow delays and associated safety risks. We sought to improve room turnover efficiency to allow for UV disinfection.Design:A 60-day quality improvement and implementation project.Setting:A quaternary academic pediatric referral facility.Interventions:A multidisciplinary healthcare team participated in a 60-day before-and-after trial that followed the Toyota Production System Lean methodology. We used value-stream mapping and manual time studies to identify areas for improvement. Areas addressed included room breakdown, room cleaning, and wait time between cleaning and disinfection. Room turnover was measured as the time in minutes from a discharged patient exiting an isolation room to UV disinfection completion. Impact was measured using postintervention manual time studies.Results:Median room turnover decreased from 130 minutes (range, 93–294 minutes) to 65 minutes (range, 48–95 minutes; P < .0001). Other outcomes included decreased median time between room breakdown to cleaning start time (from 10 to 3 minutes; P = .004), room cleaning complete to UV disinfection start (from 36 to 8 minutes; P < .0001), and the duration of room cleaning and curtain changing (from 57 to 37 minutes; P < .0001).Conclusion:We decreased room turnover time by half in 60 days by decreasing times between and during routine tasks. Utilizing Lean methodology and manual time study can help teams understand and improve hospital processes and systems.

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.

scholarly journals Predicting Patient Wait Times in the Phlebotomy Unit

2020 ◽  
pp. 1-5
Author(s):  
Dilek Orbatu ◽  
Oktay Yıldırım ◽  
Eminullah Yaşar ◽  
Ali Rıza Şişman ◽  
Süleyman Sevinç
Keyword(s):  
Waiting Time ◽  
Waiting Times ◽  
Wait Time ◽  
High Accuracy ◽  
Wait Times ◽  
Blood Collection ◽  
Time Prediction ◽  
Number Of Patients ◽  
Patient Will ◽  
Patient Waiting Time

Patients frequently complain of long waiting times in phlebotomy units. Patients try to predict how long they will stay in the phlebotomy unit according to the number of patients in front of them. If it is not known how fast the queue is progressing, it is not possible to predict how long a patient will wait. The number of prior patients who will come to the phlebotomy unit is another important factor that changes the waiting time prediction. We developed an artificial intelligence (AI)-based system that predicts patient waiting time in the phlebotomy unit. The system can predict the waiting time with high accuracy by considering all the variables that may affect the waiting time. In this study, the blood collection performance of phlebotomists, the duration of the phlebotomy in front of the patient, and the number of prior patients who could come to the phlebotomy unit was determined as the main parameters affecting the waiting time. For two months, actual wait times and predicted wait times were compared. The wait time for 95 percent of the patients was predicted with a variance of ± 2 minutes. An AI-based system helps patients make predictions with high accuracy, and patient satisfaction can be increased.

scholarly journals Effect of the PIVO Device on the Procedure of Phlebotomy from Peripheral IV Catheters

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Suzanne Adams ◽  
Bridget Toroni ◽  
Meenal Lele
Keyword(s):  
Clinical Study ◽  
Blood Sample ◽  
Wait Time ◽  
Venous Access ◽  
Wait Times ◽  
Blood Collection ◽  
Sample Collection ◽  
Routine Blood ◽  
Current Guidelines ◽  
Difficult Venous Access

Short peripheral catheters (SPC) are an existing conduit into many patients’ veins and line draws from SPC are a desired method of routine blood collection especially in difficult venous access patients. The PIVO device facilitates blood collection through SPC and is being used clinically in a number of hospitals. This study aimed to determine the appropriate wait time following a flush and the minimum waste volume required to obtain an undiluted blood sample when using the PIVO device and how that differed from current guidelines from SPC line draws. A clinical study was conducted examining the analyte results of samples drawn with PIVO through a SPC at varying wait times following a saline flush. Both an initial waste volume and a postwaste sample were compared to a venipuncture control. The resulting samples showed no saline dilution as measured by sodium and creatinine results at all studied wait times. These findings suggest that blood collections using the PIVO device can produce a clinically valid sample with a 30-second wait following a SPC flush and no waste volume prior to sample collection.

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