Use of Patient Flow Analysis to Improve Patient Access and Clinical Efficiency by Decreasing Patient Wait Time in a Tertiary Community Hospital Ob/Gyn Ambulatory Women’s Clinic: A Quality Improvement (QI) Project

Objective.In 2014 the Canadian Rheumatology Association published wait time benchmarks for inflammatory arthritis (IA) and connective tissue disease (CTD) to improve patient outcomes. This study’s aim was to determine whether centralized triage and the introduction of quality improvement initiatives would facilitate achievement of wait time benchmarks.Methods.Referrals from September to November 2012 were retrospectively triaged by an advanced practice physiotherapist (APP) and compared to referrals triaged by an APP from January to March 2014. Each referral was assigned a priority ranking and categorized into one of 2 groups: suspected IA/CTD, or suspected non-IA/CTD. Time to initial consult and time to notification from receipt of referral were assessed.Results.A total of 558 (n = 227 and n = 331 from 2012 and 2014, respectively) referrals were evaluated with 35 exclusions. In 2012, there were 96 (42.5%) suspected IA/CTD and 124 (54.9%) suspected non-IA/CTD patients at the time of the initial consult. Mean wait times in 2012 for patients suspected to have IA was 33.8 days, 95% CI 27.8–39.8, compared to 37.3 days, 95% CI 32.9–41.7 in suspected non-IA patients. In 2014, there were 131 patients (43%) with suspected IA based on information in the referral letter. Mean wait times in 2014 for patients suspected to have IA was 15.5 days, 95% CI 13.85–17.15, compared to 52.2 days, 95% CI 46.3–58.1 for suspected non-IA patients. Time to notification of appointment improved from 17 days to 4.37 days.Conclusion.Centralized triage of rheumatology referrals and quality improvement initiatives are effective in improving wait times for priority patients as determined by paper referral.

Download Full-text

A service evaluation of e-triage in the osteoporosis outpatient clinic—an effective tool to improve patient access?

Archives of Osteoporosis ◽

10.1007/s11657-020-0703-1 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

John R. Lindsay ◽

G. Lawrenson ◽

S. English

Keyword(s):

Patient Flow ◽

Outpatient Service ◽

Service Evaluation ◽

Bisphosphonate Therapy ◽

Patient Access ◽

Specialist Service ◽

Face To Face ◽

Referral Management ◽

Specialist Services ◽

Improve Patient

Abstract Summary We introduced an electronic triage system into our osteoporosis service to actively manage referral demand in a busy outpatient service. Our study demonstrated the effectiveness of e-triage in supporting alternative management pathways, through use of virtual advice and direct to investigation services, to improve patient access. Purpose Osteoporosis referrals are increasing with awareness of the potential for prevention of fragility fracture and with complex decision making around management with long-term bisphosphonate therapy. We examined whether active triage of referrals might improve referral management processes and patient access to osteoporosis services. Methods We implemented electronic triage (e-triage) of referrals to our osteoporosis service using the Northern Ireland electronic health care record. This included the option of ‘advice only’, direct to investigation with DXA or face-to-face appointments at the consultant-led complex osteoporosis service. We anticipated that there was scope to manage patient flow direct to investigation, or to provide referring clinicians with clinical advice without the need for a face-to-face assessment, at the consultant-led specialist service. Results We reviewed e-triage outcomes of 809 referrals (692 F; 117 M) to osteoporosis specialist services (mean age 65 ± 16.5 years) over a 12-month period. There was a high degree of agreement for the triage category between the referring clinician and specialist services (741/809). 73.3% attended a face-to-face appointment at the consultant-led clinic, while active triage enabled direct to investigation (18.4%) or discharge (8.3%) in the remainder. The mean time between receipt of an electronic referral and e-triage was 3 days over the 12-month period as compared with 2.1 days (median 1.1 days) when annual leave periods were excluded. Conclusion E-triage supports effective referral management in a busy osteoporosis service. Efficiency is limited by reliance on a sole clinician and 5 day working at present. There is scope to further improve systems access through multidisciplinary team working, virtual clinics and future information technology developments.

Download Full-text

Optimizing Outpatient Phlebotomy Staffing: Tools to Assess Staffing Needs and Monitor Effectiveness

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2013-0450-oa ◽

2014 ◽

Vol 138 (7) ◽

pp. 929-935 ◽

Cited By ~ 3

Author(s):

Aleksandar S. Mijailovic ◽

Milenko J. Tanasijevic ◽

Ellen M. Goonan ◽

Rachel D. Le ◽

Jonathan M. Baum ◽

...

Keyword(s):

Health Care ◽

Wait Time ◽

Data Driven ◽

Wait Times ◽

Service Capacity ◽

Staffing Levels ◽

Number Of Patients ◽

Patient Wait Time ◽

Staffing Needs ◽

Improve Patient

Context.—Short patient wait times are critical for patient satisfaction with outpatient phlebotomy services. Although increasing phlebotomy staffing is a direct way to improve wait times, it may not be feasible or appropriate in many settings, particularly in the context of current economic pressures in health care. Objective.—To effect sustainable reductions in patient wait times, we created a simple, data-driven tool to systematically optimize staffing across our 14 phlebotomy sites with varying patient populations, scope of service, capacity, and process workflows. Design.—We used staffing levels and patient venipuncture volumes to derive the estimated capacity, a parameter that helps predict the number of patients a location can accommodate per unit of time. We then used this parameter to determine whether a particular phlebotomy site was overstaffed, adequately staffed, or understaffed. Patient wait-time and satisfaction data were collected to assess the efficacy and accuracy of the staffing tool after implementing the staffing changes. Results.—In this article, we present the applications of our approach in 1 overstaffed and 2 understaffed phlebotomy sites. After staffing changes at previously understaffed sites, the percentage of patients waiting less than 10 minutes ranged from 88% to 100%. At our previously overstaffed site, we maintained our goal of 90% of patients waiting less than 10 minutes despite staffing reductions. All staffing changes were made using existing resources. Conclusions.—Used in conjunction with patient wait-time and satisfaction data, our outpatient phlebotomy staffing tool is an accurate and flexible way to assess capacity and to improve patient wait times.

Download Full-text

How does clinical space utilisation impact patient flow?

BMJ Open Quality ◽

10.1136/bmjoq-2018-000542 ◽

2019 ◽

Vol 8 (3) ◽

pp. e000542 ◽

Cited By ~ 1

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.

Download Full-text

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

Hospital Practices and Research ◽

10.15171/hpr.2019.26 ◽

2019 ◽

Vol 4 (4) ◽

pp. 128-133 ◽

Cited By ~ 1

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.

Download Full-text

Driving hospital transformation with SLMTA in a regional hospital in Cameroon

African Journal of Laboratory Medicine ◽

10.4102/ajlm.v3i2.221 ◽

2014 ◽

Vol 3 (2) ◽

Cited By ~ 5

Author(s):

Laura T. Eno ◽

Terence Asong ◽

Elive Ngale ◽

Beatrice Mangwa ◽

Juliana Ndasi ◽

...

Keyword(s):

Quality Improvement ◽

Task Force ◽

Wait Time ◽

Hospital Management ◽

Regional Hospital ◽

Hospital Quality ◽

Infection Rates ◽

Treatment Protocols ◽

Patient Feedback ◽

Patient Wait Time

Background: Inspired by the transformation of the Regional Hospital Buea laboratory through implementation of the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme, hospital management adapted the SLMTA toolkit to drive hospital wide quality improvement.Objective: This paper describes changes in the hospital following the quality improvement activities in hygiene and sanitation, the outpatient waiting area and the surgical and maternity wards.Methods: In March 2011, hospital management established a quality improvement task force and created a hospital-wide quality improvement roadmap, following the SLMTA model. The roadmap comprised improvement projects, accountability plans, patient feedback forms and log books to track quality indicators including patient wait time, satisfaction level, infectionrates, birth outcomes and hospital revenue.Results: There was steady improvement in service delivery during the 11 months after the introduction of the quality improvement initiatives: patient wait time at the reception was reduced from three hours to less than 30 minutes and patient satisfaction increased from 15% to 60%. Treatment protocols were developed and documented for various units, infrastructure and workflow processes were improved and there was increased staff awareness of the importance of providing quality services. Maternal infection rates dropped from 3% to 0.5% and stillbirths from 5% to < 1%. The number of clients increased as a result of improvedservices, leading to a 25% increase in hospital revenue.Conclusion: The SLMTA approach was adapted successfully to meet the needs of the entire hospital. Such a programme has the potential to impact positively on hospital quality systems; consideration should be made for development of a formal SLMTA-like programmefor hospital quality improvement.

Download Full-text

National Comprehensive Cancer Network Infusion Efficiency Workgroup Study: Optimizing Patient Flow in Infusion Centers

Journal of Oncology Practice ◽

10.1200/jop.18.00563 ◽

2019 ◽

Vol 15 (5) ◽

pp. e458-e466 ◽

Cited By ~ 2

Author(s):

Jessica M. Sugalski ◽

Timothy Kubal ◽

Daniel L. Mulkerin ◽

Rebecca L. Caires ◽

Penny J. Moore ◽

...

Keyword(s):

National Comprehensive Cancer Network ◽

Patient Flow ◽

Wait Time ◽

Cancer Centers ◽

Administration Routes ◽

Chemotherapy Drugs ◽

Average Patient ◽

Patient Wait Time ◽

Standard Practices ◽

Cancer Network

PURPOSE: The National Comprehensive Cancer Network (NCCN) formed an Infusion Efficiency Workgroup to determine best practices for operating efficient and effective infusion centers. METHODS: The Workgroup conducted three surveys that were distributed to NCCN member institutions regarding average patient wait time, chemotherapy premixing practices, infusion chair use, and premedication protocols. To assess chair use, the Workgroup identified and defined five components of chair time. RESULTS: The average patient wait time in infusion centers ranged from 25 to 102 minutes (n = 23; mean, 58 minutes). Five of 26 cancer centers (19%) routinely mix chemotherapy drugs before patient arrival for patients meeting specified criteria. Total planned chair time for subsequent doses of the same drug regimens for the same diseases varied greatly among centers, as follows: Administration of doxorubicin and cyclophosphamide ranged from 85 to 240 minutes (n = 22); of FOLFIRINOX (folinic acid, fluorouracil, irinotecan hydrochloride, and oxaliplation) ranged from 270 to 420 minutes (n = 22); of rituximab ranged from 120 to 350 minutes (n = 21); of paclitaxel plus carboplatin ranged from 255 to 380 minutes (n = 21); and of zoledronic acid ranged from 30 to 150 minutes (n = 22) for planned total chair time. Cancer centers were found to use different premedication regimens with varying administration routes that ranged in administration times from zero to 60 minutes. CONCLUSION: There is a high degree of variation among cancer centers in regard to planned chair time for the same chemotherapy regimens, providing opportunities for improved efficiency, increased revenue, and more standardization across centers. The NCCN Workgroup demonstrates potential revenue impact and provides recommendations for cancer centers to move toward more efficient and more standard practices.

Download Full-text

Using quality improvement methodology and tools to reduce patient wait time in a paediatric subspecialty rheumatology clinic

BMJ Open Quality ◽

10.1136/bmjoq-2021-001550 ◽

2021 ◽

Vol 10 (4) ◽

pp. e001550

Author(s):

Bayardo Garay ◽

Denise Erlanson ◽

Bryce A Binstadt ◽

Colleen K Correll ◽

Nora Fitzsimmons ◽

...

Keyword(s):

Process Improvement ◽

Patient Flow ◽

Wait Time ◽

Time Of Day ◽

The Body ◽

Ambulatory Setting ◽

Rheumatology Clinic ◽

Physician Contact ◽

Day Of The Week ◽

Patient Wait Time

Our paediatric rheumatology clinic has experienced inefficient patient flow. Our aim was to reduce mean wait time and minimise variation for patients. Baseline data showed that most waiting occurs after a patient has been roomed, while waiting for the physician. Wait time was not associated with a patient’s age, time of day, day of the week or individual physician. We implemented a checkout sheet and staggered start times. After a series of plan–do–study–act cycles, we observed an initial 26% reduction in the variation of wait time and a final 17% reduction in the mean wait time. There was no impact on patient–physician contact time. Overall, we demonstrate how process improvement methodology and tools were used to reduce patient wait time in our clinic, adding to the body of literature on process improvement in an ambulatory setting.

Download Full-text